Procedure
If Medicaid denies the drug, the appeal is called a fair hearing. It is a state process with a federal floor under it.
The single most important thing is the deadline, and it is not the same everywhere.
Federal rules cap the filing window at 90 days from the date the notice was mailed. States are allowed to set shorter deadlines, and many do, so use the date printed on your notice.
Say you are requesting a fair hearing, name the denial and its date, and keep a copy of what you sent and when.
Expedited decisions are due within seven working days.
That is the federal standard for the agency to act on your request.
If your coverage runs through a managed care plan, you may need to finish that plan's internal appeal before the state hearing. Ask which applies.
What to say on the phone
I am requesting a fair hearing on the denial dated [date] for [drug name]. Please confirm my deadline to file in this state, whether I must complete a managed care plan appeal first, and the address to send the request.
Ask them to confirm the deadline in writing. Federal rules allow up to 90 days, but your state's own limit is what binds you.
Every number above comes from one of these. If a deadline here decides something for you, read the source, not our summary of it.
Federal rules require the agency to allow a reasonable time, not to exceed 90 days from the date the notice of action is mailed, to request a hearing.
42 CFR §431.221(d) · source · read August 2026
The agency must ordinarily take final administrative action within 90 days, and within seven working days for an expedited hearing.
42 CFR §431.244(f) · source · read August 2026
Thirteen state Medicaid programs covered GLP-1s for obesity under fee-for-service as of January 2026, so in most states the denial you are appealing reflects a statewide policy rather than a decision about you.
KFF, effective January 2026 · source · read August 2026
If the appeal fails, or you cannot wait
Cash-pay telehealth is the fallback, not the bargain: you pay the whole cost yourself, and a covered prescription is almost always cheaper than any of these. Use this route when coverage has actually been exhausted, or when you need to start while an appeal runs.
These companies pay us a commission if you start care through the links below. That is how this site is funded, and it does not change what is written above. How we pay for this.
Prices in those notes were read from each company's own site in August 2026 and change often. Check the current number before you buy.
Other procedures are listed on the procedures page, and the coverage matrix shows where your state stands.