The General Eligibility Framework
FDA approval criteria for GLP-1 weight loss medications are based on BMI, with or without weight-related health conditions. The general thresholds are a BMI of 30 or higher with no additional conditions required, or a BMI of 27 or higher with at least one weight-related comorbidity such as Type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, or cardiovascular disease.
These are the FDA criteria for approved indications — but individual physicians make prescribing decisions, and many doctors prescribe GLP-1 medications off-label for patients who fall slightly outside these parameters when the clinical picture supports it.
Who Should Not Use GLP-1 Medications
Key contraindications include a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, pregnancy or planned pregnancy, a history of pancreatitis in certain cases, and severe gastrointestinal conditions. Your doctor will review your full medical history before prescribing.
Insurance Coverage and Access
Without insurance coverage, brand-name medications like Wegovy and Zepbound can cost over $1,000 per month. Coverage varies significantly by plan. Medicare Part D now covers Wegovy for cardiovascular risk reduction following the SELECT trial results, but coverage for weight management alone remains inconsistent across private insurers. Manufacturer savings programs and patient assistance programs are worth exploring.
How to Talk to Your Doctor
Come to your appointment prepared. Know your current BMI and any weight-related health conditions you have been diagnosed with. Be ready to discuss your history with other weight loss attempts and your goals. Ask specifically about semaglutide and tirzepatide by name, and ask whether your insurance is likely to cover them.
Telehealth and Weight Loss Clinics
A growing number of telehealth platforms and medical weight loss clinics prescribe GLP-1 medications with a streamlined intake process. Choose a provider who conducts a thorough medical evaluation and monitors you appropriately over time — not simply writing prescriptions without proper clinical oversight.