Wegovy, step by step: dosing, side effects, and coverage realities
Wegovy is semaglutide approved specifically for chronic weight management. Here is the titration schedule, the side effect arc, and what to expect when you call your insurer.
Key points
- Wegovy titrates over 16-20 weeks from 0.25 mg to a 2.4 mg maintenance dose.
- STEP-1 showed ~15% average weight reduction at 68 weeks with lifestyle support.
- Coverage varies widely — even with commercial insurance, a prior authorization is the norm.
- Many patients use a manufacturer savings card to bring the cash cost into range.
The dosing ladder
Wegovy uses a fixed five-step titration: 0.25 mg weekly for four weeks, then 0.5, 1.0, 1.7, and finally 2.4 mg, each for four weeks. The titration is not optional — moving too fast is the single biggest driver of people stopping therapy because of nausea.
Once you are on 2.4 mg, that is your maintenance dose. You can sometimes hold at a lower dose if it is working and tolerated.
Side effects, honestly
Expect nausea, mild fatigue, constipation, and occasional reflux in the first week after each step-up. Hydration, smaller meals, protein-forward eating, and fiber help most of these.
Serious side effects are uncommon but real: pancreatitis, gallbladder issues, and rarely, bowel obstruction. Severe abdominal pain is always a reason to stop dosing and get evaluated.
The insurance maze
Commercial insurance coverage for Wegovy is inconsistent — many plans require documentation of prior weight loss attempts, a BMI threshold, or a weight-related condition. Medicare generally does not cover GLP-1s for weight loss (though this is shifting).
A good telehealth provider will know which plans cover it in your state and will submit the prior authorization for you. If coverage is a dead end, compounded semaglutide or cash-pay options become part of the conversation.