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The CVS Caremark standard step therapy protocol for obesity medications follows this sequence: Step 1: Generic oral weight-loss medications (must try for 90 days minimum) Phentermine 37.5 mg daily, OR Orlistat 120 mg three times daily, OR Naltrexone/bupropion ER (Contrave) Step 2: Preferred GLP-1 agonist (if Step 1 fails or contraindicated) Depends on plan formulary Some plans require trying Ozempic off-label before Wegovy Others require trying liraglutide (Saxenda) first Step 3: Wegovy (if Steps 1 and 2 fail) Requires documentation of inadequate response (less than 5% body weight loss after 90 days) OR intolerable side effects OR documented contraindication "Failure" is defined as: Less than 5% total body weight loss after 90 consecutive days at therapeutic dose, OR Intolerable side effects documented by prescriber, OR Medical contraindication (documented allergy, drug interaction, or condition that contraindicates use) You cannot skip steps by saying you don't want to try phentermine

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These studies also indicate beneficial effects on lipid metabolism and liver fat reduction

Trial Evaluating Cardiovascular Outcomes With Sitagliptin (TECOS) study group