You qualify for a GLP-1 weight-loss medication such as Wegovy or Zepbound if you are an adult with a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher plus at least one weight-related health condition, and a clinician finds no safety reason to rule you out. BMI is the starting point, not the whole decision. Your health history, current medications and a plan for nutrition and activity all count. Insurance eligibility is a separate question, with its own rules.
The FDA label for Wegovy (semaglutide) and the matching label for Zepbound (tirzepatide) use the same two-tier logic for adults who want weight management:
| Your situation | Typically eligible? |
|---|---|
| BMI 30 or higher | Yes, no other condition needed |
| BMI 27 to 29.9 plus at least one weight-related condition | Yes |
| BMI 27 to 29.9 with no related condition | Not under the weight-management indication |
| BMI under 27 | No |
These thresholds come from FDA prescribing information as summarized in our research. Wegovy is also approved for certain patients aged 12 and older with obesity, which is a pediatric decision made with a child’s own doctor.
To check your BMI, divide your weight in pounds by your height in inches squared, then multiply by 703. Someone who is 5 feet 6 inches (66 inches) and 190 pounds has a BMI of about 30.7. The same person at 170 pounds is at about 27.4. A clinician will use a measured height and weight, so treat your own calculation as a rough guide.
The NIDDK frames it the same way: weight management medications are meant for people who have health problems related to overweight or obesity, and health care professionals use BMI to help decide whether you might be a candidate. The word “help” matters. BMI is a screening number, not a diagnosis.
If your BMI is between 27 and 29.9, you need at least one weight-related condition. The label’s examples include high blood pressure, high cholesterol and sleep apnea. Type 2 diabetes is another common one, and the Lancet study of eligibility across 99 countries used a BMI of 27 or more with hypertension or diabetes as its working definition.
The condition has to be real and documented. A prior blood pressure reading, a lab result showing elevated cholesterol, or a sleep study all help. If you suspect you have one of these but have never been tested, that is a reason for a primary care visit first, not a reason to skip the step.
Meeting the BMI number does not clear you. As of 2026, all FDA-approved GLP-1 receptor agonists are contraindicated for people with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). They are also generally not recommended during pregnancy. If you are pregnant, planning to become pregnant or breastfeeding, tell your provider before any prescription.
Be ready to discuss:
This list is a starting conversation with a licensed clinician, who will decide what applies to you.
Eligibility on paper and eligibility in a visit are close but not identical. A thorough evaluation usually covers:
The NIDDK is clear that these drugs support, rather than replace, changes to eating and activity. Patients who go in expecting a shortcut tend to struggle. Those who treat the medication as one tool among several do better.
The same active ingredient can be sold under different brand names for different approvals, and this confuses insurance coverage as much as it confuses patients.
If you have type 2 diabetes, your eligibility runs through a diabetes indication and usually standard drug coverage. If your goal is weight management without diabetes, the weight-management labels and the BMI tiers above apply. If you are weighing a change between the two active ingredients, our guide on switching from semaglutide to tirzepatide explains the practical steps.
The FDA decides who a drug is approved for. Your insurer decides whether it pays. A plan may exclude weight-loss drugs entirely, or cover them only with prior authorization, a higher BMI, a failed attempt at lifestyle change, or a specific diagnosis. Employer plans differ from each other, even within the same insurance company.
What to do before you assume the answer:
Our breakdown of Wegovy insurance coverage goes further into how plans handle this, and the note on telehealth copay rules explains why a virtual visit may be billed differently from an in-person one.
Medicare has historically not covered drugs prescribed only for weight loss. That changed temporarily. The Medicare GLP-1 Bridge is a CMS demonstration running from July 1, 2026 to December 31, 2027. It gives eligible Part D beneficiaries access to select GLP-1s for weight management (Wegovy, Zepbound and Foundayo) for a $50 monthly copay, according to CMS. Medicare’s own weight loss drugs page describes the same coverage start date.
The Bridge uses stricter BMI tiers than the FDA label:
| BMI | Additional requirement |
|---|---|
| 35 or higher | None beyond program rules |
| 30 or higher | Specific heart, kidney or blood pressure conditions |
| 27 or higher | Pre-diabetes, or a history of stroke, heart attack or peripheral artery disease |
Two details trip people up. The Bridge operates outside the usual Part D payment flow, with a single central processor handling prior authorizations and claims. And if your standard Part D plan already covers a GLP-1 for another indication such as diabetes, you are not eligible for the Bridge, even if you meet the weight-loss criteria. Because this is a temporary demonstration, check the CMS pages for current details before you plan around it.
Most people who search for eligibility want a yes or no from a number. We understand why. But the number is the least interesting part of the answer.
We think of GLP-1 eligibility as three separate questions that people blur together. First, are you clinically appropriate? That is BMI, conditions and safety screening. Second, will your plan pay? That is prior authorization and formulary rules. Third, can you sustain it? That is the plan for food, movement, side effects and follow-up. A patient can pass the first and fail the second, and the right response is to adjust the plan, not to look for a workaround.
That is also why we built AM Rx as one integrated platform: video visits with providers, prescription evaluation, delivery of medication when a provider prescribes it, insurance coordination and messaging for questions between visits. Side effects are the most common reason people want to message a provider, so we wrote practical guides on nausea and constipation for exactly those weeks.
We also hold a firm line on safety. Medication should come through a licensed prescriber and a pharmacy, in the form the FDA has approved. The label is explicit that pens must never be shared between people, and the FDA-approved products are pre-filled pens or tablets, so vials or powders sold outside formal clinical channels are unauthorized and risky. If a price looks too good, that is usually why.
— Bryan
If you think you meet the criteria, the quickest way to find out is a provider visit. At AM Rx you can start online, talk to a provider by video, and have your history and medication list reviewed. If a GLP-1 is appropriate, we can handle prescription evaluation and coordinate with insurance where it applies. Start on our weight loss page. If you also want help with blood pressure or cholesterol, our primary care service can document the conditions that matter for eligibility.
A short prep list saves time:
Not under the weight-management labels for Wegovy and Zepbound, which start at a BMI of 27 with a related condition. If you have type 2 diabetes, a GLP-1 may be prescribed for blood sugar control regardless of BMI, and that is a decision for your doctor. Talk to a clinician rather than trying to reach a number.
Only if your BMI is between 27 and 29.9. At a BMI of 30 or higher, obesity alone meets the FDA criteria. Your insurer may still ask for documentation of other health issues or lifestyle efforts before it pays.
Temporarily, for some people. The Medicare GLP-1 Bridge runs from July 1, 2026 to December 31, 2027 with a $50 monthly copay for eligible Part D beneficiaries who meet its BMI and condition tiers. Standard Part D coverage for diabetes is separate.
GLP-1 medications are generally not recommended in pregnancy. A personal or family history of medullary thyroid carcinoma or MEN 2 is a contraindication, so these drugs are not an option. Your provider can discuss other approaches.
