What is step therapy and how does it impact GLP-1 access?

Step therapy, also known as 'fail-first' policies, requires patients to try and fail on lower-cost or preferred medications before insurance will cover more expensive options like GLP-1s. For weight loss, this often means trying and documenting failure on lifestyle interventions, behavioral programs, or other FDA-approved weight loss medications like phentermine, orlistat, or naltrexone-bupropione.

This process can delay access to GLP-1 medications by months and requires extensive documentation. Some insurers require 3-6 months of documented weight loss attempts before approving GLP-1 coverage. While step therapy aims to control costs, it can be frustrating for patients who may benefit immediately from GLP-1 treatment and may face health risks from delayed effective therapy.