How to Qualify for Semaglutide: Requirements to Meet

To qualify for semaglutide — available as a compounded medication and under the brand names Ozempic®, Wegovy®, and Rybelsus® — you’ll need to meet a few eligibility requirements. If you don’t have type 2 diabetes, you’ll need to have an elevated body mass index (BMI).

To qualify for semaglutide for weight loss, you need to have a BMI of 30 or higher. Or a BMI of 27 or higher with at least one weight-related health condition, like high blood pressure or heart disease.

But a healthcare provider can determine whether semaglutide is right for you.

Below, we’ll dive into what those weight-related health conditions are and who should and shouldn’t use semaglutide for weight loss.

Qualifying for semaglutide isn’t totally straightforward. You may qualify for some versions of semaglutide, but not others. This is because the U.S. Food and Drug Administration (FDA) has approved brand-name semaglutide drugs for different uses.

Healthcare providers might refer to these uses to see if you qualify, but they may also take other factors into account.

One thing to keep in mind…just because you qualify for semaglutide doesn’t mean your insurance will cover it. Most insurance providers don’t cover weight loss drugs.

Here are the details.

Who Qualifies for Ozempic?

Ozempic is FDA-approved to help people with type 2 diabetes manage their blood sugar levels.

It’s sometimes prescribed off-label for weight loss and chronic weight management. This is when a licensed medical provider prescribes a drug for a condition it isn’t FDA-approved to treat.

To qualify for Ozempic, you’ll typically need to have type 2 diabetes. But your healthcare provider might deem it a suitable weight loss treatment for you, even if you don’t have type 2 diabetes.

In that case, there are no hard-and-fast rules.

Your provider may see if you have a BMI above a specific number. (Based on the BMI categories used by the World Health Organization and National Institutes of Health, 25 or higher is overweight and 30 or more is considered obesity.)

Your provider might also look for a weight-related health condition to determine whether they think Ozempic is right for you.

The qualifying requirements may be similar to Wegovy. Wegovy’s FDA prescribing information indicates that it’s intended for people at a BMI of 27 or higher.

Who Qualifies for Wegovy?

Wegovy is FDA-approved for weight loss.

To qualify for Wegovy, you’ll typically need to have a:

• BMI of 30 or more (obesity)

• BMI of 27 or more (overweight) and at least one weight-related condition

These weight-related conditions include:

• Hypertension (high blood pressure)

• Dyslipidemia (high cholesterol)

• Type 2 diabetes

• Heart disease

• Sleep apnea

In March 2024, the FDA approved Wegovy to reduce the risk of heart attack, stroke, and cardiovascular death. To qualify for this use, you’ll have to have heart disease and overweight or obesity.

Check out our guide to Wegovy versus Ozempic to learn more about how these drugs compare.

Who Qualifies for Rybelsus?

Ozempic and Wegovy are injectable forms of semaglutide, whereas Rybelsus comes in tablet form.

Rybelsus is FDA-approved for type 2 diabetes, but — just like Ozempic — it can be prescribed off-label for weight loss.

If a healthcare provider thinks Rybelsus would work well for you as a weight loss treatment, they can prescribe it off-label.

You may need to meet requirements similar to Wegovy by having a BMI above a certain level or having a weight-related health condition.

Long-term data for GLP-1 medications for weight loss isn’t very robust at this point. But since semaglutide was originally designed to manage blood sugar levels in people with diabetes, it is meant for long-term use.

A 2022 review of the Wegovy STEP trials (Semaglutide Treatment Effect in People with Obesity) examined how weekly semaglutide injections (at 2.4 milligrams) affected those with excess body weight and obesity.

One trial lasted two years and showed that the medication was safe and effective, with mild to moderate side effects that improved with time.

How Long Can You Stay On Ozempic For Weight Loss?

Insurance companies don’t usually cover semaglutide drugs for medical weight loss. So, if you qualify for a semaglutide treatment, you might have to pay out-of-pocket for the drug.

The costs of brand name drugs like Ozempic and Wegovy aren’t pretty. They range from about $1,000 to $2,000 a month. Yes, you read that correctly — per month.

And you may need to take semaglutide for a long time for weight management or blood sugar control.

You might be eligible for savings programs from Novo Nordisk, the manufacturer of Wegovy, Ozempic, and Rybelsus. And you can look out for coupons and discounts to help reduce your costs.

Another option is compounded semaglutide.

Compounded semaglutide contains the same active ingredient as Ozempic and Wegovy. While it’s not an FDA-approved medication, compounded semaglutide is an option for people who don’t have access to brand-name drugs (due to costs or supply shortages).

You might qualify for compounded semaglutide if you have a:

• BMI of 30 or more (obesity)

• BMI of 27 or more (overweight) and at least one weight-related condition like hypertension, dyslipidemia, or type 2 diabetes

As well as being more available, compounded drugs are often more affordable than their non-compounded, brand-name cousins.

For example, Hers offers compounded semaglutide starting at $199 a month.

When looking into compounded semaglutide for weight loss, it’s important to get it from a trusted source that requires a doctor’s prescription.

Compounded semaglutide available through the Hers platform is produced in FDA-regulated, state-licensed compounding pharmacies in the United States. Each batch is tested for safety and efficacy.

Let’s say you meet the above requirements and are now wondering, Can I take semaglutide? It’s not a done deal yet.

Semaglutide is safe for most people, but some people should avoid it.

You shouldn’t use semaglutide if:

• You or someone in your family has had medullary thyroid carcinoma (a rare thyroid cancer)

• You have multiple endocrine neoplasia syndrome type 2 (an inherited condition that causes tumors)

• You’re allergic to any ingredients in semaglutide drugs

• You’re pregnant or want to try to conceive within the next two months

• You’re taking another semaglutide medication or another glucagon-like peptide-1 (GLP-1) receptor agonist

You should also let your healthcare provider know about any medical conditions you currently have or previously had and health-related situations, such as:

• Problems with your kidneys or pancreas

• Type 2 diabetes and a history of diabetic retinopathy

• Depression, suicidal thoughts, or other mental health issues

• Pregnancy, trying trying to conceive, or breastfeeding

And tell your provider about any medication you’re on, including prescription and over-the-counter medications, vitamins, and supplements.

With this information, your medical provider can let you know if semaglutide is suitable for you.

Semaglutide can be a positive part of your weight loss journey — but not everyone qualifies for it.

Here are the details on how to qualify for semaglutide:

• You probably need a specific BMI for semaglutide. Semaglutide BMI requirements are usually 30 or more or 27 or more with at least one weight-related health condition like high blood pressure, high cholesterol, or type 2 diabetes.

• Compounded semaglutide will likely have the same requirements. Compounded semaglutide is more affordable and more available, but a healthcare professional will likely follow the same guidelines as the brand-name drugs to determine if it’s right for you.

• Semaglutide is prescribed at your healthcare provider’s discretion. Your provider will make the final call on whether you qualify for semaglutide injections or tablets. They’ll take into account your BMI, health history, and weight loss goals, among other factors.

• Semaglutide is usually prescribed with lifestyle changes. To get the most out of your medication and achieve lasting weight loss, your provider will likely recommend a nutritional eating plan and regular exercise.

Take our free online assessment to find out if you qualify for semaglutide and, if you do, start your treatment journey.

If you don’t qualify for semaglutide, don’t panic. Plenty of other weight loss medications are out there to help you achieve your goals and improve overall wellness.