Who Qualifies for Ozempic, Wegovy or Zepbound? BMI Rules and Prescriptions

For Zepbound and Wegovy, adults qualify under the label with obesity, defined in the trials as a BMI of 30 or more, or with overweight (BMI 27 to 29.9) and at least one weight-related condition.1,2,5 The FDA's Zepbound approval announcement names high blood pressure, type 2 diabetes and high cholesterol as examples of weight-related conditions.5 The Zepbound trials also enrolled people with obstructive sleep apnea or cardiovascular disease as qualifying conditions.1

The Wegovy label also covers reducing the risk of heart attack, stroke and cardiovascular death in adults with established cardiovascular disease and either obesity or overweight.2 Zepbound is approved for moderate to severe obstructive sleep apnea in adults with obesity; our Zepbound and sleep apnea guide covers that use.1

Under its label, Ozempic is for adults with type 2 diabetes, to improve blood sugar control and to lower the risk of major cardiovascular events and kidney decline in those with diabetes and related disease.3 It is not FDA approved for weight loss. Wegovy contains the same ingredient, semaglutide, and is the version approved for weight reduction.2,3 Our Ozempic vs Wegovy comparison shows how the doses and approvals differ.

No. Ozempic is a prescription drug, and a prescriber decides whether it is appropriate for you.3,7 The FDA says that once a drug is approved, healthcare providers generally may prescribe it for an unapproved use when they judge it medically appropriate for their patient.6 If you would be paying cash, the Ozempic cost guide lists current prices.

Yes. Wegovy injection is approved for weight reduction in children aged 12 and older with obesity.2 The pediatric trial behind that approval enrolled 201 patients aged 12 and older with a BMI at or above the 95th percentile for age and sex.2 Zepbound's safety and effectiveness have not been established in pediatric patients.1 Wegovy tablets are approved for adults only.2

The labels list the same main contraindications: a personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, or a known hypersensitivity to the drug or its ingredients.1,2 Both carry a boxed warning about thyroid C-cell tumors seen in rodents.1,2

Other label points a prescriber screens for:1,2

• Pregnancy. The weight-loss labels say to stop when pregnancy is recognized. See GLP-1s, pregnancy and breastfeeding.
• Severe gastroparesis. Zepbound is not recommended in this group.
• Another GLP-1. The labels advise against combining these drugs with other GLP-1 or tirzepatide products.
• Insulin or a sulfonylurea. The risk of low blood sugar rises with these.

Yes. Every FDA-approved GLP-1, including Ozempic, Wegovy, Zepbound and Mounjaro, is prescription-only.1,2,3,4 The FDA advises patients to "obtain a prescription from their doctor and fill the prescription at a state-licensed pharmacy."7

Yes. Ozempic cannot be bought over the counter in the US.3,7 Our guide on how to get Ozempic walks through the routes to a prescription.

Not legally from a legitimate US pharmacy. The FDA lists "Do not require a doctor's prescription" as a warning sign of an unsafe online pharmacy.8 It has issued warning letters over illegally marketed semaglutide and tirzepatide, and warns that counterfeits can contain the wrong ingredient, the wrong amount or none at all.7 Products labeled "for research purposes" or "not for human consumption" and sold with dosing instructions are another FDA warning sign.7

Compounded semaglutide and tirzepatide also need a prescription, and the FDA notes compounded drugs are not FDA approved or reviewed for safety, effectiveness or quality.7 See compounded semaglutide for the current rules.

A legitimate online program works like any prescription: a licensed prescriber reviews your history against the label, and a state-licensed pharmacy fills it.7,8 The label criteria above, BMI, weight-related conditions, contraindications and current medicines, are what that review is built around.1,2 The FDA's signs of a safe online pharmacy are that it always requires a prescription, has a US address and phone number, has a licensed pharmacist available and is licensed by a state board of pharmacy.8

Insurers add their own rules on top of the label. UnitedHealthcare's weight-loss prior authorization program, effective October 1, 2026, approves drugs such as Wegovy and Zepbound for a BMI of 30 or more, or 27 or more with a weight-related condition, used alongside lifestyle changes.9 It applies only to employer plans that chose to cover weight-loss drugs.9 Our guide does insurance cover Zepbound covers other plans.

Medicare has different thresholds. The Medicare GLP-1 Bridge requires age 18 or older and a BMI of 35 or more, or 30 or more with certain heart or kidney conditions, or 27 or more with conditions such as prediabetes or a prior heart attack or stroke.10 People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease are excluded from the Bridge because their Part D plan may cover a GLP-1 for those conditions.10 Details are in our Medicare GLP-1 coverage guide.

Do I qualify for Ozempic if I don't have diabetes? Not under its label, which covers adults with type 2 diabetes.3 A prescriber may still prescribe off-label if they judge it appropriate.6

How do I get approved for Ozempic or Wegovy through insurance? Through your plan's prior authorization. UnitedHealthcare's weight-loss program, for example, checks BMI, weight-related conditions and use alongside lifestyle changes.9

Can you buy Ozempic over the counter? No. It is prescription-only in the US.3,7

Does a BMI of 27 qualify for Zepbound? Yes, if you also have at least one weight-related condition such as high blood pressure, type 2 diabetes or high cholesterol.5

What is the minimum BMI for Wegovy? 27, with at least one weight-related condition, or 30 without one.2

If you meet the criteria and want a prescription, compare vetted telehealth programs on our best GLP-1 programs ranking, or see options without a monthly fee on our no-membership GLP-1 list. Cash prices for the brand-name drug are on the Wegovy cost page.

This article is for information only and is not medical advice. GLP-1 medications are prescription drugs with real risks and side effects. Talk to a licensed clinician to find out whether a GLP-1 is right for you.