GLP-1 Step Therapy Requirements (2026)
Published 2026-07-01 · Updated 2026-07-08 · MetaDose Research
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Insurers often require 3–6 months of metformin, intensive lifestyle intervention, or cheaper weight-loss drugs before approving Wegovy or Zepbound. Step therapy can delay GLP-1 access by months — exceptions exist for intolerance or contraindication.
Common step therapy steps
- 3–6 months documented lifestyle program
- Metformin trial if prediabetic
- Orlistat or phentermine trial on some plans
- Prior auth after steps
How to skip step therapy
Document metformin intolerance (GI side effects)
PCOS, kidney contraindication to metformin
Peer-to-peer review with prescriber
GLP-1 cost by state
Frequently Asked Questions
Can I skip step therapy?
Yes with documented contraindication or failed trial — your doctor must submit evidence.
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