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Common Aetna step therapy sequences for weight loss: First step: Lifestyle modification (6 months documented) plus trial of orlistat, phentermine, or naltrexone-bupropion Second step: Semaglutide (Wegovy) for at least 3 months Third step: Tirzepatide (Zepbound) if semaglutide fails or is not tolerated For type 2 diabetes, step therapy typically requires metformin first, then allows choice among GLP-1 options (semaglutide or tirzepatide) without requiring one before the other