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"Prior weight-loss intervention" does not mean "patient tried to eat less." Acceptable documentation includes: Prescription records showing 90+ days of orlistat, phentermine-topiramate, or naltrexone-bupropion Enrollment records in a structured weight-loss program (e.g., Weight Watchers, Noom, hospital-based program) with attendance logs Bariatric counseling visit notes from a registered dietitian or behavioral health provider, minimum of four visits over 90 days Self-directed diet and exercise, even if documented in provider notes, does not satisfy step therapy in most eviCore reviews

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