GLP-1 BMI Eligibility Chart (2026): Do You Qualify for Wegovy, Zepbound, or Foundayo?
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The Short Answer
In 2026, U.S. adults qualify for an FDA-approved GLP-1 or related incretin weight-loss medication — Wegovy, Wegovy HD, Zepbound, Saxenda, or the new oral pill Foundayo — at a BMI of 30 or higher, or a BMI of 27 to 29.9 with at least one weight-related condition (high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, or heart disease).
Teens 12 and up have separate pediatric rules: Wegovy injection requires a BMI at or above the 95th percentile for age and sex. Saxenda requires body weight greater than 60 kg (132 lb) plus obesity for that age and sex.
Editorial. Not medical advice. See your licensed clinician for individual eligibility.
GLP-1 BMI eligibility chart (quick reference)
| Your BMI | What it usually means in 2026 |
|---|---|
| Under 25 | GLP-1s are not approved for weight loss at this BMI. |
| 25 to 26.9 | Below the adult FDA threshold. Coverage for weight loss is very unlikely. |
| 27 to 29.9 | You meet the FDA label only if you have a documented weight-related condition. |
| 30 to 34.9 | You meet the adult FDA obesity threshold. Most commercial plans still require prior authorization. |
| 35 and up | You meet the BMI bar for Pathway 1 of the Medicare GLP-1 Bridge with no extra condition required — though you still need an eligible Part D plan and prior authorization. |
| Started above threshold, now below it | You don’t automatically lose coverage. Aetna, CVS Caremark, Cigna, and CMS policies look at your starting BMI, not today’s. |
Weight-by-Height Chart: What You Have to Weigh to Hit Each BMI
Below is the minimum whole-pound weight at every common adult height that reaches BMI 27, 30, 35, and 40. Built using the standard CDC formula: BMI = weight in pounds × 703 ÷ height in inches². We rounded up rather than to the nearest pound, because an eligibility threshold is a line you have to meet.
| Height | BMI 27 (overweight floor) | BMI 30 (obesity floor) | BMI 35 (Medicare Bridge P1) | BMI 40 (Class III) |
|---|---|---|---|---|
| 4’10” (58”) | 130 lb | 144 lb | 168 lb | 192 lb |
| 4’11” (59”) | 134 lb | 149 lb | 174 lb | 199 lb |
| 5’0” (60”) | 139 lb | 154 lb | 180 lb | 205 lb |
| 5’1” (61”) | 143 lb | 159 lb | 186 lb | 212 lb |
| 5’2” (62”) | 148 lb | 165 lb | 192 lb | 219 lb |
| 5’3” (63”) | 153 lb | 170 lb | 198 lb | 226 lb |
| 5’4” (64”) | 158 lb | 175 lb | 204 lb | 234 lb |
| 5’5” (65”) | 163 lb | 181 lb | 211 lb | 241 lb |
| 5’6” (66”) | 168 lb | 186 lb | 217 lb | 248 lb |
| 5’7” (67”) | 173 lb | 192 lb | 224 lb | 256 lb |
| 5’8” (68”) | 178 lb | 198 lb | 231 lb | 264 lb |
| 5’9” (69”) | 183 lb | 204 lb | 238 lb | 271 lb |
| 5’10” (70”) | 189 lb | 210 lb | 244 lb | 279 lb |
| 5’11” (71”) | 194 lb | 216 lb | 251 lb | 287 lb |
| 6’0” (72”) | 200 lb | 222 lb | 259 lb | 295 lb |
| 6’1” (73”) | 205 lb | 228 lb | 266 lb | 304 lb |
| 6’2” (74”) | 211 lb | 234 lb | 273 lb | 312 lb |
| 6’3” (75”) | 217 lb | 241 lb | 281 lb | 321 lb |
What BMI Do You Need to Qualify for a GLP-1?
To qualify for an FDA-approved GLP-1 or related incretin weight-loss medication in 2026, U.S. adults need a BMI of 30 or higher, or 27 or higher with at least one weight-related health condition such as high blood pressure, type 2 diabetes, high cholesterol, obstructive sleep apnea, or cardiovascular disease. Teens 12 to 17 have separate pediatric rules.
That's the FDA-label rule, and it's the same starting line across Wegovy, Wegovy HD, Zepbound, Saxenda, and Foundayo. None of them invented their own threshold.
What changes is who else gets to say yes after the FDA does:
Your clinician
They make the medical call: is this drug right for you, given your history?
Your insurance plan
They make the coverage call: will we pay for it?
Medicare or Medicaid (if applicable)
They have their own rules, separate from commercial plans.
If you don't know your BMI
BMI = (weight in pounds × 703) ÷ (height in inches)²
Example: A 5′6″ adult who weighs 186 lb: (186 × 703) ÷ (66 × 66) = 30.0. Use the weight-by-height chart above to find your threshold. Any reputable BMI calculator works — the math is the math.
The four BMI categories that matter for GLP-1 eligibility
Overweight: BMI 25 to 29.9. Includes the FDA’s BMI ≥27 starting point if you have a qualifying condition.
Class I obesity: BMI 30 to 34.9. Meets the FDA threshold without needing a comorbidity.
Class II obesity: BMI 35 to 39.9. Strong eligibility across nearly every pathway, including Medicare.
Class III obesity: BMI 40+. Sometimes called “severe obesity.” Also a bariatric-surgery threshold.
GLP-1 BMI Eligibility by Drug: Wegovy, Wegovy HD, Zepbound, Saxenda, Foundayo
| Drug (brand / generic) | Adult BMI threshold | Adolescent threshold | Special prerequisite | FDA status |
|---|---|---|---|---|
| Wegovy injection (semaglutide 2.4 mg) | ≥30, or ≥27 with ≥1 weight-related condition | Ages 12–17: BMI ≥95th percentile (CDC growth charts) | None | Approved 2021 (weight loss); 2024 cardiovascular indication; 2025 MASH indication |
| Wegovy oral tablets (semaglutide 25 mg) | ≥30, or 27–29.9 with ≥1 weight-related condition | Not approved for teens | Take in the morning on an empty stomach; wait at least 30 minutes before food, drink, or other oral meds | Approved December 2025 |
| Wegovy HD (semaglutide 7.2 mg) | ≥30, or overweight with ≥1 weight-related condition | Not approved for teens | Must have tolerated 2.4 mg for ≥4 weeks, with additional weight loss clinically indicated | Approved March 19, 2026 |
| Zepbound injection (tirzepatide, GIP/GLP-1 agonist) | ≥30, or ≥27 with ≥1 weight-related condition | Not approved for teens | None | Approved November 2023 (weight loss); 2024 OSA indication |
| Saxenda (liraglutide 3 mg, daily) | ≥30, or ≥27 with ≥1 weight-related condition | Ages 12–17: body weight >60 kg (132 lb) AND obesity | Daily injection (not weekly) | Approved 2014 (adults); 2020 (adolescents) |
| Foundayo (orforglipron, oral pill) | ≥30, or ≥27 with ≥1 weight-related condition | Not approved for teens | Daily oral pill; can be taken any time of day with or without food or water | Approved April 1, 2026 |
Wegovy injection
The GLP-1 with the most FDA-approved indications. Beyond weight loss, it’s approved to reduce major cardiovascular events in adults with established heart disease (BMI ≥27), and as of 2025, to treat noncirrhotic MASH (a serious form of fatty liver disease) with moderate-to-advanced fibrosis. Each is a separate FDA-approved use with its own coverage rules.
Wegovy HD
Not a starter dose. The FDA approval is for people who’ve been on 2.4 mg for at least 4 weeks and still need more weight loss. In the STEP UP trial, 7.2 mg produced about 21% average weight loss at 72 weeks. The tradeoff: about 22% of patients reported altered skin sensations (dysesthesia), compared to 6% on the 2.4 mg dose. A real signal to discuss with your prescriber.
Zepbound
Same weight-loss threshold as Wegovy. Also separately FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity — a pathway some insurers cover even when they exclude GLP-1s for weight loss. If you have a recent sleep study showing moderate-to-severe OSA, that’s worth flagging.
Saxenda
The daily-injection option (most others are weekly). The GLP-1 with the longest track record for adolescent weight loss, approved for ages 12+ since December 2020. The pediatric criteria require both body weight greater than 60 kg (about 132 pounds) and obesity as defined for that age and sex.
Foundayo
The newest weight-loss pill, FDA-approved April 1, 2026. Unlike oral Wegovy, you can take Foundayo any time of day with or without food. In the Phase 3 ATTAIN-1 trial, patients on the highest dose (17.2 mg) lost an average of 12.4% of their body weight at 72 weeks. Lowest dose lists at $149/month via LillyDirect.
Off-label: Ozempic, Mounjaro, and Rybelsus
Ozempic, Mounjaro, and Rybelsus are not FDA-approved for weight loss. They're approved for type 2 diabetes. Many prescribers use the Wegovy/Zepbound BMI rules when prescribing them off-label for weight management, but commercial insurance will almost never cover Ozempic or Mounjaro for weight loss alone. That's not a workaround — it's a separate path with its own rules.
What Conditions Count as a “Weight-Related Comorbidity” at BMI 27?
Conditions on the FDA label
Hypertension (high blood pressure)
Documented readings above 130/80 mmHg, especially if you’re on at least one BP medication. A single high office reading isn’t enough — you usually need a chart history.
Dyslipidemia (abnormal cholesterol/triglycerides)
A recent lipid panel showing high LDL, low HDL, or elevated triglycerides. If you’re on a statin, that’s strong documentation.
Type 2 diabetes
Documented HbA1c ≥6.5%, fasting glucose ≥126 mg/dL, or an existing T2D diagnosis in your chart.
Obstructive sleep apnea
A sleep study (in-lab polysomnogram or home sleep test) with a documented Apnea-Hypopnea Index (AHI). Severity matters: moderate-to-severe OSA opens up the Zepbound OSA pathway separately.
Cardiovascular disease
A history of myocardial infarction, stroke, coronary artery disease, peripheral artery disease, or heart failure. Imaging studies, cardiology notes, and event records all count.
Conditions sometimes accepted but not explicitly listed on FDA labels
Clinical practice and insurer policies vary. Some accept these; some don't:
- Prediabetes (HbA1c 5.7%–6.4%, or fasting glucose 100–125 mg/dL). Explicitly accepted under the Medicare GLP-1 Bridge BMI ≥27 pathway, and by many commercial plans.
- Polycystic ovary syndrome (PCOS). Listed by some payer policies as a qualifying comorbidity; check your specific plan.
- MASLD/MASH (metabolic dysfunction-associated steatotic liver disease). For Wegovy, MASH with moderate-to-advanced fibrosis (F2–F3) is its own FDA-approved indication as of 2025.
- Osteoarthritis of weight-bearing joints. Some plans accept, some don’t.
What “documented” really means
Saying you have a condition is not the same as having it documented. Your clinician's chart needs to show at least one of:
- An active diagnosis code in your medical record (an ICD-10 code your clinician has entered)
- A current medication for the condition (an ongoing prescription)
- Or recent lab/measurement evidence (within the last 6–12 months)
If you're in the BMI 27–29.9 range and suspect you have a qualifying condition that isn't formally diagnosed, the practical path is: schedule a primary-care visit, ask whether the relevant labs make sense for you (fasting glucose and HbA1c, lipid panel, liver enzymes, blood-pressure history), and — if results support a diagnosis — ask your clinician to add it to your active problem list.
BMI Eligibility by Payer: FDA vs. Commercial Insurance vs. Medicare vs. Medicaid
Commercial insurance and PBM policies we checked
| Source | Drug(s) | Adult BMI threshold | Extra requirements | Continuation language |
|---|---|---|---|---|
| Aetna Wegovy policy | Wegovy weight management | BMI ≥30, or ≥27 with ≥1 weight-related comorbidity | 6-month comprehensive weight-management program before drug therapy | Baseline BMI; continuation may require ≥5% loss or maintenance |
| Aetna Zepbound policy | Zepbound weight management | BMI ≥30, or ≥27 with ≥1 weight-related comorbidity | 6-month comprehensive weight-management program | References baseline BMI when transitioning between drugs |
| CVS Caremark Wegovy policy | Wegovy (adult and pediatric) | Adult BMI ≥30, or ≥27 with comorbidity; pediatric ≥95th percentile | 6-month comprehensive weight-management program | Baseline BMI at start of weight-loss drug therapy referenced explicitly |
| CVS Caremark Zepbound policy | Zepbound (weight + OSA) | Weight: BMI ≥30 or ≥27 with comorbidity. OSA: current BMI ≥30 plus moderate-to-severe OSA | 6-month weight-management program for weight pathway; sleep-study documentation for OSA | Continuation may require stable maintenance dose and ≥5% loss or maintenance |
| UnitedHealthcare Commercial | Weight-loss meds, Wegovy/Zepbound special indications | BMI ≥30, or ≥27 with comorbidity; pediatric BMI >95th percentile | Lifestyle modification required | Authorization durations vary by drug |
| UHC Zepbound OSA-only | Zepbound for OSA | BMI ≥30 plus moderate-to-severe OSA documentation | Sleep study, prior dietary effort, PAP-related criteria, specialist requirements | Reauthorization may require AHI improvement and weight-loss response |
| Cigna national formulary GLP-1 PA | Wegovy / Zepbound / Saxenda | BMI ≥30, or ≥27 with ≥1 comorbidity | Behavioral modification and reduced-calorie diet | Baseline BMI and ≥5% loss referenced in policies reviewed |
| Cigna EncircleRx (benefit-exclusion override) | GLP-1 weight loss under benefit-exclusion override | BMI ≥32, or ≥27 plus TWO comorbidities | At least 3 months behavioral modification | Stricter than FDA threshold — a specific Cigna plan design |
Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027)
Medicare has historically been barred by law from covering weight-loss drugs. The Medicare GLP-1 Bridge is a CMS demonstration program creating a temporary path for Medicare Part D beneficiaries to access GLP-1s for weight loss at a $50/month copay. It runs from July 1, 2026, through December 31, 2027.
The Bridge has its own BMI rules. There are three pathways — you only need to meet one.
| Pathway | BMI at time of starting therapy | Required additional diagnosis | Drugs covered |
|---|---|---|---|
| Pathway 1 | ≥35 | None | Wegovy (injection + tablets), Zepbound KwikPen, Foundayo |
| Pathway 2 | ≥30 | One of: heart failure with preserved ejection fraction (HFpEF); uncontrolled hypertension (SBP >140 or DBP >90 despite 2+ antihypertensives); chronic kidney disease stage 3a+ | Same as above |
| Pathway 3 | ≥27 | One of: prediabetes (per ADA guidelines); previous heart attack; previous stroke; symptomatic peripheral artery disease | Same as above |
Other important Medicare Bridge details (from CMS FAQ)
- You must be at least 18 and enrolled in a qualifying Part D plan: standalone PDP, MA-PD, SNP, EGWP, or LI NET.
- The prescriber must submit prior authorization and attest the medication is for weight reduction and maintenance.
- BMI is measured at the time you started GLP-1 therapy, not today. If you started at BMI 37 in 2024 and are now at 33, your prescriber can attest you met Pathway 1 at initiation.
- Copay is $50/month flat, regardless of dose. CMS pays a net price of $245 per monthly supply to manufacturers.
- The $50 copay does not count toward your Part D deductible or out-of-pocket maximum.
- Not covered through the Bridge: Zepbound single-dose vials and pens (only the KwikPen formulation qualifies). Ozempic is not on the Bridge — it is a diabetes drug, not a weight-loss drug.
Medicaid
Medicaid coverage for GLP-1 weight loss varies by state. Some states cover Wegovy and Zepbound for chronic weight management; others do not, and several have announced restrictions. Massachusetts, Connecticut, Rhode Island, and Wisconsin have signaled restrictions or proposed ending coverage.
- State Medicaid programs are generally required to cover GLP-1s for their FDA-approved non-weight-loss indications (Ozempic and Mounjaro for type 2 diabetes; Wegovy for cardiovascular risk reduction; Zepbound for moderate-to-severe OSA), often with prior authorization and utilization controls.
- Where Medicaid covers GLP-1s for weight loss, criteria typically follow the FDA-label threshold (BMI ≥30 or ≥27 with comorbidity) plus prior-authorization requirements.
- The picture is changing fast. For current state-by-state coverage, see our Medicaid GLP-1 tracker (updated monthly).
If Your BMI Drops Below 27 or 30 After GLP-1 Treatment, Do You Lose Coverage?
Aetna and CVS Caremark
Both reference baseline BMI — your weight at the time you started GLP-1 therapy — rather than your current BMI for continuation review. They typically require evidence of treatment response: either ≥5% weight loss from baseline, or maintenance of an initial 5% loss. A patient who started at BMI 35 and is now at BMI 27 with documented sustained loss generally meets continuation criteria in the policies we reviewed.
Cigna
Cigna’s national formulary policy and EncircleRx policy both reference baseline BMI and require ongoing evidence of response. The continuation language typically reads as “≥5% loss from baseline” or maintenance.
Medicare GLP-1 Bridge
The CMS Bridge FAQ is explicit: BMI is assessed at the time of GLP-1 therapy initiation. The Bridge specifically accommodates beneficiaries who started GLP-1 therapy before July 1, 2026, and have since lost weight. CMS’s example: a beneficiary who started at BMI 37 in September 2024 and now has a BMI of 34 can still be eligible under Pathway 1 (BMI ≥35) because the prescriber attests they met that threshold at initiation.
What to do before you switch drugs or change plans
The risk isn't your BMI dropping. The risk is your records not showing where you started. If you're already on a GLP-1, save copies of:
- Your starting weight and starting BMI (the visit note from the day you started therapy is best)
- The date your first prescription was written
- Every prior-authorization approval letter you’ve received
- Documentation of your qualifying weight-related conditions at baseline
- Records showing your weight trajectory since starting (especially the first 6 months)
GLP-1 BMI Eligibility for Kids and Teens (Ages 12–17)
How adolescent BMI is measured
A teen's BMI is plotted on age- and sex-specific CDC growth charts. The 95th percentile is the standard cutoff for childhood/adolescent obesity. A 15-year-old boy with a BMI of 30 is well above the 95th percentile. A 16-year-old girl with a BMI of 27 might be just below or just above, depending on her exact age. That's why the percentile matters more than the raw number.
Wegovy injection for adolescents
- Age: 12 to 17 years
- BMI threshold: At or above the 95th percentile (CDC growth charts)
- Trial: STEP TEENS, 68-week placebo-controlled trial in 201 adolescents (avg. starting BMI 37.7)
- Lifestyle requirement: reduced-calorie diet and ≥60 minutes/day activity
- 12-week response rule: discontinue if BMI hasn’t dropped by ≥5% after 12 weeks at maintenance dose
Saxenda for adolescents
- Age: 12 to 17 years
- Weight requirement: Body weight greater than 60 kg (about 132 lb)
- BMI requirement: Obesity as defined for that age and sex
- Daily, not weekly (unlike Wegovy injection, which is weekly)
What about Zepbound, Foundayo, and Wegovy HD?
None of them are FDA-approved for adolescent weight loss as of May 2026. Zepbound, Foundayo, Wegovy HD, and oral Wegovy tablets are all adult-only. For insurance, when plans cover adolescent GLP-1 prescriptions, expect stricter documentation: often 6+ months of documented comprehensive weight-management program participation before approval, a pediatric or family-medicine prescriber, and sometimes a referral to a pediatric obesity medicine specialist.
Verified Corrections: Three Commonly Mistaken GLP-1 BMI Facts
“Adolescent Wegovy requires BMI ≥35”
The verified rule: The FDA prescribing information for Wegovy injection states the adolescent threshold as BMI at or above the 95th percentile standardized for age and sex (CDC growth charts). The STEP TEENS trial enrolled patients meeting that threshold, with an average starting BMI of 37.7 — but the 37.7 was the trial average, not the eligibility cutoff. Some payer policies add a pediatric severity requirement on top of the FDA threshold, but those are insurance-side restrictions, not the label.
“All Cigna plans cover Zepbound at the FDA BMI threshold”
The verified rule: Cigna’s national formulary policy does use the FDA threshold for most plans. But Cigna’s EncircleRx benefit-exclusion override (used by some employer plans that otherwise exclude weight-loss drugs) requires BMI ≥32, or ≥27 plus two comorbidities, with at least 3 months of documented behavioral modification. This is publicly available on Cigna’s coverage policy PDFs. If your employer uses EncircleRx, the FDA threshold is not your threshold.
“Medicare now covers Ozempic for weight loss”
The verified rule: The CMS Medicare GLP-1 Bridge covers only Wegovy (injection and tablets), Zepbound KwikPen, and Foundayo — the products FDA-approved specifically for weight loss. Ozempic is FDA-approved for type 2 diabetes only. Medicare Part D continues to cover Ozempic under the standard benefit when prescribed for diabetes, but not through the Bridge for weight loss. CMS’s official Bridge FAQ lists the exact NDC codes for what’s covered.
What If Your BMI Is Under 27 or in the Borderline Zone?
BMI under 25
GLP-1 weight-loss medications are not indicated for adults at a normal-range BMI. Using these drugs outside their indication carries real risks (gastrointestinal side effects, gallbladder disease, pancreatitis, and others), and the benefit at this BMI is not established.
BMI 25 to 26.9
This is the CDC overweight range, but it’s below the FDA’s 27-with-comorbidity threshold. Coverage for weight loss is very unlikely. If you’re carrying recent weight gain or have a family history of obesity, lifestyle interventions and primary-care follow-up are the appropriate first steps.
BMI 27 to 29.9 — the gray zone
The honest path: (1) Get checked for the labeled conditions — schedule a primary-care visit and ask about fasting glucose and HbA1c, a lipid panel, liver enzymes, and documented blood-pressure history. (2) If you have OSA symptoms (loud snoring, witnessed apneas, daytime sleepiness), ask about a sleep study. (3) If you’ve already been diagnosed but the diagnosis isn’t in your active problem list, ask your clinician to add it. The practical issue in this band is documentation.
BMI 30+ but denied by insurance
You meet the FDA label, but your plan is saying no. Most common denial reasons: no documented prior weight-loss attempts (many plans require 6 months of documented diet/exercise effort); step therapy (the plan wants you to fail a cheaper medication first); no documented qualifying condition (yes, even at BMI 30+, some plans require it); or plan exclusion (some employer-funded plans exclude GLP-1s for weight loss entirely). A formal appeal with a letter of medical necessity from your prescriber gives you a direct way to address each denial reason.
A safety note we don't bury
The FDA has repeatedly warned about unapproved “research-use only” GLP-1 products marketed online, often labeled “for research purposes” or “not for human consumption”. The agency has documented cases of products containing the wrong active ingredient, the wrong dose, contaminants, or no active ingredient at all. If your BMI doesn't meet the threshold, the answer is not an off-the-shelf workaround.
What Proof to Gather Before Talking to Your Prescriber or Insurer
Body measurements
- Current height (in inches, measured at office if possible)
- Current weight (lb)
- Current calculated BMI
- Starting weight (if already on a GLP-1)
- Starting BMI (same)
Qualifying conditions
- Blood pressure history >130/80 mmHg, plus any antihypertensive meds
- Recent lipid panel (LDL, HDL, triglyceride values)
- Recent HbA1c result
- Sleep study showing AHI/RDI/REI, severity grade
- Cardiology records (MI, stroke, CAD, PAD, heart failure)
- ICD-10 diagnosis codes in your active problem list
Lifestyle program documentation
- 6+ months of structured diet/exercise effort (Weight Watchers, Noom, clinician-supervised)
- Visit notes documenting prior weight-management discussions
- Records of any prior weight-loss medications tried
If continuing therapy on a GLP-1
- First prescription date
- Original prior authorization approval letter
- Weight trajectory documentation (visit notes at intervals)
- Documented response (typically ≥5% loss from baseline)
Plan-specific paperwork
- Your insurer’s prior authorization form (from plan website)
- Plan formulary page showing which GLP-1s are listed
- Any prior denial letters (matter for appeals)
The single most useful thing you can do before your appointment: print or save your plan's prior-authorization criteria PDF and bring it. Most are 2–4 pages. Your prescriber's office can prepare exactly what's needed if they can see the requirements.
How to Get Started: A 5-Step Path from “Do I Qualify” to a Prescription
Calculate and document your BMI
Use the weight-by-height chart above, or get an office measurement. The office measurement is more valuable than a home scale because it goes into your chart.
Jump to weight-by-height chart ↑Gather your medical records
Use the documentation checklist above. The goal is to walk into the appointment with everything your prescriber needs to make the case.
Jump to documentation checklist ↑Choose where to start
Primary care: best if you have an established relationship and your PCP is comfortable with obesity medicine. Weight-management clinic: best if your case is complex (multiple comorbidities, prior denials, high BMI). Telehealth GLP-1 platforms: faster onboarding, often lower friction.
Compare insurance-accepting GLP-1 providers →Submit prior authorization
Most commercial plans require PA before covering a GLP-1. The PA submission includes your BMI, qualifying conditions, prior weight-loss attempts, and clinical justification. Ask the prescriber’s office what timeline they typically see for your plan.
If denied, appeal
GLP-1 prior authorizations are often denied on first submission, typically because of documentation gaps. Most denials cite specific criteria you didn’t meet. A formal appeal with a letter of medical necessity from your prescriber gives you a direct way to address each one.
Frequently Asked Questions About GLP-1 BMI Eligibility
- What BMI do you need to qualify for Wegovy in 2026?
- Adults need a BMI of 30 or higher, or 27–29.9 with at least one weight-related condition such as hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, or cardiovascular disease. Teens 12–17 qualify at a BMI at or above the 95th percentile for age and sex. These criteria apply to both Wegovy injection and Wegovy oral tablets.
- What BMI do you need to qualify for Zepbound?
- Adults qualify at a BMI of 30 or higher, or 27 or higher with at least one weight-related comorbidity — the same threshold as Wegovy. Zepbound is not FDA-approved for adolescent weight loss. Cigna’s EncircleRx benefit-exclusion override uses a stricter BMI of 32 or higher (or 27 with two comorbidities).
- What BMI do you need to qualify for Foundayo?
- Adults qualify at a BMI of 30 or higher, or 27 or higher with at least one weight-related condition. Foundayo (orforglipron) was FDA-approved April 1, 2026. It is not approved for adolescents.
- Can I qualify for a GLP-1 if my BMI is 27?
- Yes — for the FDA-approved weight-loss use — if you have at least one documented weight-related condition such as hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, or cardiovascular disease. Without a qualifying condition, BMI 27 alone does not meet the FDA threshold for any approved weight-loss GLP-1.
- Can I qualify for a GLP-1 weight-loss medication if my BMI is under 27?
- No. The FDA-approved BMI threshold for GLP-1 weight-loss medications starts at 27 with a qualifying comorbidity. We recommend against pursuing unapproved or “research-use only” GLP-1 products marketed online — the FDA has warned about counterfeit and mislabeled products in this space.
- How much do I have to weigh to qualify for a GLP-1?
- It depends on your height. At 5’6”, you reach BMI 27 at 168 lb, BMI 30 at 186 lb, and BMI 35 at 217 lb. At 5’10”, you reach BMI 27 at 189 lb, BMI 30 at 210 lb, and BMI 35 at 244 lb. See the weight-by-height chart on this page for all common heights from 4’10” to 6’3”.
- Will Medicare cover GLP-1 for weight loss in 2026?
- Yes, for eligible Part D beneficiaries through the Medicare GLP-1 Bridge demonstration starting July 1, 2026. Three BMI pathways apply: BMI ≥35 alone; BMI ≥30 with HFpEF, uncontrolled hypertension, or CKD stage 3a+; or BMI ≥27 with prediabetes, prior MI, prior stroke, or symptomatic PAD. Covered drugs: Wegovy (injection and tablets), Zepbound KwikPen, and Foundayo. Copay: $50/month flat. Program runs through December 31, 2027.
- Does Medicaid cover GLP-1 for weight loss?
- It varies by state. Some states cover GLP-1s for weight management; others do not, and several have announced restrictions. State Medicaid programs are generally required to cover GLP-1s for their FDA-approved non-weight-loss indications (type 2 diabetes, cardiovascular risk reduction, OSA), often with prior authorization.
- Can my teenager get a GLP-1?
- Only two GLP-1s are FDA-approved for weight loss in adolescents ages 12–17: Wegovy injection (at BMI at or above the 95th percentile for age and sex) and Saxenda (body weight greater than 60 kg plus obesity for that age and sex). Zepbound, Foundayo, Wegovy HD, and oral Wegovy tablets are not approved for teens. No GLP-1 is currently FDA-approved for weight loss in children under 12.
- What conditions count as a weight-related comorbidity?
- The FDA labels list these five as examples: hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, and cardiovascular disease. Many prescribers and some insurers also accept prediabetes, PCOS, MASH/fatty liver disease, and osteoarthritis of weight-bearing joints. Check your specific plan’s policy for its exact list.
- If I lose weight on a GLP-1, will I lose coverage when my BMI drops?
- Not automatically. The Aetna, CVS Caremark, Cigna, and CMS policies we reviewed evaluate eligibility based on your BMI at the time you started therapy, not today’s. Continuation typically requires evidence of response — usually at least 5% weight loss from baseline or maintenance. Keep records of your starting weight, starting BMI, and first prescription date.
- What if my insurance has a higher BMI threshold than the FDA?
- That is allowed and not uncommon. Cigna’s EncircleRx override requires BMI ≥32 or ≥27 with two comorbidities. Some employer-funded plans require BMI ≥35 or even ≥40. Your options: verify the plan’s criteria from the published PA policy, submit with full documentation, appeal if denied, or consider switching to a plan with better GLP-1 coverage during open enrollment.
- What’s the difference between FDA approval and insurance coverage?
- FDA approval means a medication has met federal standards to be sold and prescribed for a specific use. Insurance coverage means a specific plan will pay for it. They are separate. A drug can be FDA-approved for your situation and still not be covered by your plan. The FDA threshold is the floor; your plan can set a higher one or exclude the drug entirely.
What We Actually Verified
This page was built by reviewing primary-source documents directly, not by paraphrasing other articles. Here is exactly what we checked on :
- FDA prescribing information on accessdata.fda.gov for Wegovy injection (label revision March 2026 including Wegovy HD 7.2 mg), Wegovy oral tablets (December 2025 approval), Zepbound, Saxenda, and Foundayo.
- FDA press announcements for the Wegovy HD approval (March 19, 2026), Foundayo approval (April 1, 2026), and Wegovy MASH indication (August 2025).
- CMS Medicare GLP-1 Bridge FAQ page at cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge, page last modified May 6, 2026. The April 6, 2026 update added Foundayo to the eligible drug list and clarified that only Zepbound KwikPen is included.
- Public prior-authorization policy documents for: Aetna (Wegovy and Zepbound), CVS Caremark (Wegovy and Zepbound), UnitedHealthcare Commercial (weight-loss medications and Zepbound OSA), Cigna (national formulary GLP-1 PA and EncircleRx BMI 32 override).
- CDC BMI definitions for adult and pediatric obesity at cdc.gov.
- FDA Drug Safety Communications on unapproved “research-use only” GLP-1 products.
- Peer-reviewed clinical trial publications for STEP UP (Wegovy HD), STEP TEENS (Wegovy adolescent), and ATTAIN-1 (Foundayo).
What we did not independently verify and would treat as evolving:
- Any individual employer’s specific plan formulary — those vary at the employer level.
- State-specific Medicaid policies — tracked separately, updated at different cadences.
- Cash prices through LillyDirect, NovoCare, and manufacturer channels beyond what’s stated in manufacturer announcements — these change quarterly.
How We Keep This Page Current
GLP-1 facts move fast. Two new products (Wegovy HD and Foundayo) were approved in March and April 2026 alone. Medicare's program launches July 1, 2026.
- Monthly: FDA approvals and label changes; CMS Bridge updates; major insurer PA policy changes.
- Quarterly: Full re-verification of every source linked on this page; weight-by-height chart spot-check.
- As-needed: New FDA safety communications, new clinical guideline releases, new state Medicaid changes.
If you're reading this more than 60 days after the date at the top of this page, check the most recent FDA label or CMS FAQ before making a decision based on what's written here.
Authorship and Disclosures
Written by: The RX Index editorial team
Source-verified by: The RX Index editorial team
Medical review: Not medically reviewed. This page is editorial reporting on FDA labels, CMS policy, and public insurer prior-authorization documents. It is not a substitute for medical advice from a licensed clinician.
What this page is and isn't: It is a source-verified eligibility reference built from primary documents. It is not a prescription service, a diagnostic tool, or a guarantee of insurance coverage. It is not a recommendation for any specific medication or provider for your individual case.
Affiliate disclosure: The RX Index earns commissions from telehealth providers we feature on our provider comparison guides. No provider paid for inclusion on this BMI eligibility page, and no affiliate links appear on this page. Provider links here point only to our own comparison guides, where our full editorial methodology and any affiliate relationships are disclosed.