Wegovy (Semaglutide) Prescribing Requirements

Patient Eligibility Criteria

• The American Gastroenterological Association and other societies recommend Wegovy for chronic weight management in adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity, used as an adjunct to reduced-calorie diet and increased physical activity 1, 2, 3
• Patients with BMI ≥27 kg/m² must have at least one weight-related comorbidity, including type 2 diabetes 4, hypertension 5, dyslipidemia 3, obstructive sleep apnea 6, or cardiovascular disease [4] [1, 2, 3]

Mandatory Screening and Contraindications

• The American Diabetes Association recommends screening for personal or family history of medullary thyroid carcinoma (MTC) and Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) before initiating Wegovy 7, 8
• Pregnancy is a contraindication for Wegovy, and reliable contraception is required during treatment 6, 9

Required Baseline Assessments

• The American Heart Association recommends assessing renal function (eGFR/creatinine clearance) and hepatic function before initiating Wegovy, although no dose adjustment is needed for renal impairment 4, 2
• Lipid panel and hemoglobin A1c assessments are recommended for patients with dyslipidemia or diabetes 3, 8

Dosing Protocol Requirements

• The American Association of Clinical Endocrinologists recommends a gradual dose escalation of Wegovy to minimize gastrointestinal adverse effects, starting with 0.25 mg subcutaneously once weekly and increasing to 2.4 mg once weekly (maintenance dose) 10

Efficacy Assessment Requirements

• The Obesity Society recommends assessing efficacy monthly for the first 3 months, then at least quarterly thereafter, and considering discontinuation if there is inadequate response (<5% weight loss after 3-4 months) 6, 9

Concomitant Medication Management

• The American Diabetes Association recommends reducing doses of insulin or insulin secretagogues when initiating Wegovy to minimize hypoglycemia risk 7, 10
• Oral medications with narrow therapeutic index (e.g., warfarin) should be monitored closely due to delayed gastric emptying affecting absorption 9

Special Populations

• The National Kidney Foundation recommends using caution when initiating or escalating doses of Wegovy in patients with renal disease due to potential acute kidney injury risk from dehydration secondary to GI side effects 9
• The American Heart Association recommends monitoring blood pressure and heart rate in patients with cardiovascular disease, as semaglutide may cause modest increases 3, 9
• The American Diabetes Association recommends prioritizing semaglutide over other anti-obesity medications in patients with type 2 diabetes due to added cardiometabolic benefits 8

Blood Work and Screening Requirements for Wegovy Initiation

Mandatory Baseline Laboratory Tests

• Urinary albumin-to-creatinine ratio should be obtained if diabetes or prediabetes is present, as this is part of comprehensive diabetes evaluation, according to the American Diabetes Association 11
• Hemoglobin A1c is required if the patient has diabetes or prediabetes, serving as baseline for monitoring glycemic control, as recommended by the American Diabetes Association 11
• Serum potassium should be checked if the patient is on ACE inhibitors, ARBs, or diuretics, as recommended by the American Diabetes Association 11

Critical Screening Requirements

• You must screen for personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) before prescribing Wegovy, as recommended by the American College of Cardiology 12
• Document any history of pancreatitis, as this is a contraindication to GLP-1 receptor agonist therapy, according to the American College of Cardiology 12

Additional Baseline Assessments

• Patients should undergo guideline-recommended eye examinations if not done within the last 12 months, as recommended by the American College of Cardiology 12, 13
• Baseline blood pressure and heart rate should be documented, as GLP-1 receptor agonists can modestly lower blood pressure but may increase heart rate, according to the American Diabetes Association 11 and the American College of Cardiology 14

Monitoring Schedule After Initiation

• Recheck serum creatinine, eGFR, and potassium within 1-2 weeks if the patient has pre-existing renal impairment, as recommended by the American College of Cardiology 13 and the American College of Physicians 15
• Renal function and electrolytes should be monitored at least annually, or more frequently if chronic kidney disease is present, according to the American Diabetes Association 11
• Hemoglobin A1c should be rechecked every 3 months if the patient has diabetes, as recommended by the American Diabetes Association 11
• Lipid panel annually unless on lipid-lowering therapy requiring more frequent monitoring, according to the American Diabetes Association 11

Common Pitfalls to Avoid

• Do not initiate in patients with active gallbladder disease, as GLP-1 receptor agonists increase risk of cholecystitis, as warned by the American College of Cardiology 13, 14
• Reduce insulin or sulfonylurea doses by 20-30% at initiation if the patient is on these medications to prevent hypoglycemia, as recommended by the American College of Cardiology 12, 13