The UK Prescribing Guidelines for Wegovy: What They Mean for You

The NICE recommendation: what it permits and what it restricts

NICE's appraisal of semaglutide for weight management (Technology Appraisal TA875) is the document that governs NHS Wegovy prescribing. It recommends the medicine only within specialist weight management services, which in practice means tiers 3 and 4 of the NHS obesity pathway. That is a meaningful constraint: GPs cannot simply add it to a repeat prescription list, and patients cannot self-refer for it at a standard surgery appointment.

The eligibility criteria under TA875 require a BMI of 35 or above alongside at least one weight-related condition, or a BMI of 30–34.9 where a specialist referral is already appropriate. For people from South Asian, Chinese, Middle Eastern, Black African or African-Caribbean backgrounds, these thresholds are applied at 2.5 kg/m² lower. The NICE recommendation also specifies that treatment should be reviewed if a patient has not lost at least 5% of their body weight after six months on the maintenance dose, and that NHS prescribing runs for a maximum of two years.

That two-year ceiling is one of the most clinically significant parts of the semaglutide prescribing guidelines, and one of the questions our prescribers hear most weeks. Our page on prescribing Wegovy explains how this limit applies specifically to NHS commissioning under TA875 and why private and NHS prescribing operate differently within the same regulatory frame.

What the licensed indication actually says, the SmPC standard

Outside the NHS pathway, the legal standard is the Wegovy Summary of Product Characteristics approved by the MHRA. The NHS medicines page for semaglutide gives a patient-level summary, but the SmPC sets the prescriber's obligations: Wegovy is licensed for adults with a BMI of 30 or above, or 27–29.9 with at least one weight-related condition such as type 2 diabetes, hypertension, dyslipidaemia or obstructive sleep apnoea. It must be used alongside a reduced-calorie diet and increased physical activity, it is not a standalone intervention.

The titration schedule matters too. Treatment begins at 0.25mg weekly, escalating in approximately four-week steps through 0.5mg, 1.0mg and 1.7mg before reaching the 2.4mg maintenance dose. The MHRA also approved a 7.2mg maintenance dose in January 2026, with a dedicated single-dose pen approved in April 2026. Prescribers decide individually whether each dose increase is appropriate; a patient's tolerance, not a calendar, drives the pace. You can find more on how semaglutide prescribing information is applied in practice on a dedicated page.

Private prescribers at a service like nume follow the SmPC, meaning the clinical conversation covers your BMI, existing conditions, current medicines and contraindications, and a prescriber, not a questionnaire, makes the call. For context on what treatment costs in the private market, this Wegovy price comparison page sets out what different providers typically charge and what each price tends to include.

Contraindications and clinical cautions every prescriber weighs

The prescribing guidelines are not only about who qualifies, they are equally about who should not receive Wegovy, or should receive it with extra care. A personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 rules out semaglutide. A history of pancreatitis warrants serious consideration; the MHRA issued a Drug Safety Update in January 2026 highlighting acute pancreatitis as an infrequent but potentially serious risk, and prescribers are required to counsel patients on warning signs, severe stomach pain that radiates to the back, with or without vomiting, needs urgent medical attention.

Pregnancy, breastfeeding and trying to conceive are each grounds for not prescribing. Women using oral contraceptives do not face the same absorption interaction concern with semaglutide that exists with tirzepatide, though contraception remains an important discussion given the wash-out period recommended before attempting pregnancy. NHS guidance on weight management injections covers these safety considerations in detail. If you are planning surgery, the anaesthetic team needs to know you are taking semaglutide, this is part of the clinical disclosure a prescriber will flag.

Renal impairment, severe gastrointestinal disease and certain other conditions require individual assessment. Wegovy is not licensed for anyone under 18. A thorough medicines reconciliation is standard, other prescriptions, supplements and over-the-counter products all belong in that conversation. The Wegovy overview on this site summarises the most common side effects and what to expect during titration.

How private prescribing sits alongside NHS guidelines

Private prescribing does not bypass clinical guidelines, it operates within the licensed indication rather than the additional NHS commissioning restrictions. That distinction matters practically. There is no two-year cap, no mandatory specialist service, and no waiting list. The prescriber still follows the SmPC, still assesses suitability and contraindications, and still takes clinical responsibility for every prescription issued.

At nume, every consultation is reviewed personally by a GPhC-registered Independent Prescriber. There are no auto-renewals; each repeat order goes through a fresh clinical review. That structure exists because Wegovy is a prescription medicine, and the guidelines exist for good reasons, not as bureaucratic obstacles but as the framework that keeps treatment safe. If you are considering stopping treatment temporarily, it is worth reading about pausing Wegovy before making that decision unilaterally, because the clinical picture around breaks matters.

If you want to understand whether you are likely to meet the criteria, the straightforward next step is a free consultation with our clinical team. Start your free consultation and a prescriber will review your answers the same day.