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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 was a phase 3b trial in over 1,400 adults with obesity, randomized to semaglutide 7.2 mg, 2.4 mg, or placebo for 72 weeks. Mean weight loss was 18.7% on 7.2 mg versus 15.6% on 2.4 mg and 3.9% on placebo. Among people who actually stayed on the drug, it was 20.7% versus 17.5%.
So the honest headline is about three extra percentage points for tripling the dose — real, but smaller than the marketing implies. The surprise is on the safety side: serious adverse events were loweron 7.2 mg (6.8%) than on 2.4 mg (10.9%), against 5.5% on placebo. That is not what you would predict from a higher dose, and with these group sizes it is more likely noise than a real protective effect — but it does undercut the assumption that the high dose is obviously harsher.
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.