What it means
Insurers call it "fail first" in some cases. For weight-management drugs, a plan might require that you try a structured lifestyle program, an older medicine or one preferred GLP-1 before covering another.
Step therapy rules are part of the plan's coverage policy and are often enforced through prior authorization. If you have already tried the required option, or it is unsafe for you, your prescriber can ask for an exception.
Many states have laws that set rules for step therapy exceptions. Your plan documents, or your state insurance department, can tell you which apply to you.
Ask your prescriber's office whether your chart already shows the earlier treatments the plan wants to see. Missing notes are a common reason for an avoidable denial.
Why it matters
Step therapy can add months before coverage starts, which changes your real cost and timeline.