Procedures
What to do, in order
Each of these is a procedure with deadlines. Missing a deadline usually ends the route, so start with the one that matches where you are.
- Your plan said no. What now?The deadlines and steps for appealing a commercial or employer plan denial of a GLP-1, including external review by an independent body.
- How to ask Part D for an exceptionHow to request a formulary exception or get a step therapy or prior authorization requirement waived under Medicare Part D, and the deadlines that apply.
- How to ask for a Medicaid fair hearingHow to request a Medicaid fair hearing after a denial, the federal 90-day ceiling on filing, and why your state's deadline may be shorter.
Work out your own dates
If you have the notice in front of you, the appeal deadline calculator counts from the date printed on it and shows the rule and the source behind each date. The questions a denial raises — what the letter has to contain, who sets your appeal rights — are answered on the answers pages. For the vocabulary itself — what an adverse benefit determination is, how a grievance differs from an appeal, which clock a notice of action starts — the glossary quotes the regulation behind each term. And the policy timeline answers a different question: which of the state documents we have read were already in effect on a date you choose.
The four windows, to one scale
These are the outer limits for the four routes on this site. Which one applies to you depends on the plan that denied you — pick it above, or on the denial page.
Sources read August 2026; Medicare Part D — redetermination: October 2026.
Each figure is the outer filing limit, not a guarantee — a plan or a state notice can set a shorter one where the rules permit it. Read your notice and contact the plan promptly if its instructions conflict with the published rule.