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The typical Anthem step therapy sequence for obesity medications: Step 1: Phentermine (generic, costs $10 to $30 per month) Required trial duration: 90 days Failure definition: Less than 5% weight loss or intolerable side effects documented in medical record Step 2: Phentermine-topiramate combination (Qsymia) or naltrexone-bupropion (Contrave) Required trial duration: 90 days Failure definition: Same as Step 1 Step 3: Wegovy (semaglutide 2.4 mg) becomes available after documented failure of Steps 1 and 2 Step therapy does not apply if you have a documented contraindication to the step-1 medication (for example, uncontrolled hypertension or cardiovascular disease for phentermine, or seizure history for topiramate)

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doi: 10.2337/diabetes.54.9.2674