Semaglutide 2.4mg (Wegovy)

Semaglutide 2.4mg (Wegovy) is the most comprehensively studied obesity medication in history. A selective GLP-1 receptor agonist, it works by mimicking the hormone released after meals to reduce appetite, slow gastric emptying, and modulate reward pathways in the brain that drive food-seeking behavior. FDA approved for chronic weight management in June 2021, Wegovy launched the modern GLP-1 era for obesity and has accumulated more post-market safety data than any other agent in this class. The STEP-1 trial remains the foundational efficacy benchmark: 2.4mg semaglutide weekly produced 14.9 percent weight loss versus 2.4 percent for placebo at 68 weeks — a treatment difference that helped define what was clinically meaningful in obesity medicine. But it is the SELECT trial that truly elevated Wegovy from a weight-loss drug to a cardiovascular medicine. Enrolling 17,604 adults with established cardiovascular disease and obesity but without diabetes, SELECT demonstrated a 20 percent reduction in major adverse cardiovascular events (MACE) with a hazard ratio of 0.80. Heart failure hospitalization was reduced with HR 0.82, and all-cause mortality with HR 0.81. Crucially, these cardiovascular benefits appeared to be largely independent of the degree of weight loss itself — meaning the drug is protecting hearts through mechanisms beyond just reducing adiposity. Dosing begins at 0.25mg weekly, escalating over 16 weeks to 2.4mg. The list price of $1,200 to $1,349 per month is partially offset by NovoCare savings programs offering $199 to $349 self-pay. Insurance coverage remains broad for Medicare Bridge participants beginning July 2026. Wegovy is the strongest recommendation for patients who have both obesity and established cardiovascular disease, where the SELECT evidence provides a clear clinical mandate.