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FDA approved March 2026 as a higher-dose Wegovy option for adults who tolerate 2.4 mg but plateau on weight loss. ~5-6 percentage points additional loss in STEP UP trial.
STEP UP enrolled 1,800 adults with BMI ≥ 30 who tolerated 2.4 mg Wegovy for ≥ 4 weeks and had not reached weight-loss goals. Randomized to 7.2 mg vs 2.4 mg for 72 weeks. Results: mean weight loss 20.6% at 72 weeks on 7.2 mg, 14.9% on 2.4 mg. Side-effect profile similar to 2.4 mg with slightly higher nausea incidence (~50% vs 44%).
Protocol: stay at 2.4 mg for ≥ 4 weeks, then escalate to 4.8 mg for 4 weeks, then 7.2 mg. Full titration adds 8-12 weeks. Many patients report a second wave of nausea at 4.8 mg, fading within 1-2 weeks.
NovoCare cash-pay: same $499/mo regardless of dose. Commercial insurance: PA approval requires documented 2.4 mg trial and plateau. Approvals running ~60-70% in early data (April-May 2026), expected to settle higher by Q3 2026.
For patients who hit a plateau on 2.4 mg Wegovy: Wegovy HD is now the alternative to a Zepbound switch. The 5-6 percentage-point additional loss is meaningful. Easier administratively than restarting titration on a different molecule. Worth asking your prescriber if you have plateaued and tolerate the 2.4 mg dose.
Editorial summary, not medical advice. STEP UP data published April 2026. Insurance PA patterns evolving; confirm before relying.