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Standard BCBS prior authorization criteria (commercial plans that cover obesity medications): Diagnosis code: ICD-10 code E66.01 (morbid obesity due to excess calories) or E66.9 (obesity, unspecified) BMI documentation: Current BMI ≥30 kg/m², or BMI ≥27 kg/m² with at least one of: Hypertension (on medication) Type 2 diabetes or prediabetes (HbA1c 5.7% to 6.4%) Dyslipidemia (on medication) Obstructive sleep apnea (documented with sleep study) Cardiovascular disease Lifestyle modification documentation: Letter from prescriber documenting patient participation in a structured weight management program for at least 12 weeks, including: Dietary counseling or supervised diet plan Physical activity plan Documentation of adherence (food logs, activity logs, or attendance records) Step therapy (67% of plans): Documentation that patient tried and failed one of: Phentermine (at least 12 weeks at therapeutic dose) Phentermine/topiramate (Qsymia, at least 12 weeks) Naltrexone/bupropion (Contrave, at least 12 weeks) "Failed" means either intolerable side effects documented in medical record, or less than 5% total body weight loss after 12 weeks