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For weight management, the typical OptumRx step therapy sequence: Step 1: Lifestyle modification (diet and exercise) for 3 to 6 months, documented in medical records Step 2: Tier 1 or 2 medication trial Phentermine (generic, $5 to $15/month) for 3 months, OR Orlistat (Alli, Xenical, $25 to $75/month) for 3 months Step 3: If Step 2 fails (defined as less than 5% body weight loss or intolerable side effects), approval for Tier 4/5 GLP-1 (Wegovy, Saxenda, or Zepbound) Step therapy adds 3 to 6 months to the approval timeline

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“He’s setting up a YouTube channel for me,” Lewis said