Procedure
How to ask for a Medicaid fair hearing
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.
The steps, in order
Read the notice of action for your state's deadline
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.
Request the hearing in writing
Say you are requesting a fair hearing, name the denial and its date, and keep a copy of what you sent and when.
Ask for an expedited hearing if waiting would harm you
Expedited decisions are due within seven working days.
Expect an ordinary decision within about 90 days
That is the federal standard for the agency to act on your request.
Check whether you are in managed care
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.
What each deadline rests on
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
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
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
Where this comes from
- 42 CFR §431.221(d) — www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E
- 42 CFR §431.244(f) — www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-431/subpart-E
- KFF, effective January 2026 — Open the document
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.
| Company | What we found on its own site |
|---|---|
| PartnerGala HealthCheck availability | One price at every dose. The advertised rate needs a yearly subscription. |
| PartnerDirect MedsCheck availability | One price at every dose from $147, with no monthly membership. The page states its discount two ways ($150 off in the banner, up to $200 off on the tiles), so check the total at checkout. |
| PartnerFoundCheck availability | Bills clinician visits to your insurance where it's in network, with the drug charged separately. Its Medicare offer, brand GLP-1s from $50 a month, doesn't count toward your Part D deductible or out-of-pocket maximum, and Extra Help doesn't apply. |
| PartnerEdenCheck availability | Semaglutide at $99 a month at every dose, with no membership on the page our link opens. Eden's own site pairs the same $99 with a required membership ($39 the first month, then $99), so check which one you're signing up for. |
| PartnerShedRxCheck availability | Injections plus needle-free drops and lozenges. You see a price only after the questionnaire, and the oral forms aren't sold in sixteen states. |
| PartnerHealthRXCheck availability | Compounded semaglutide at $133 a month on a three-month plan ($99 on twelve), tirzepatide from $209 ($179 on twelve). Its member reviews are labeled illustrative composites, not real patients. |
| PartnerMEDGmCheck availability | GLP-1 injections from $179 and tablets from $249. Brand options are a membership plus the drug's own cost: $99 for Zepbound or Wegovy, $171 for Ozempic. It discloses AI content and actor imagery. |
| PartnerBodybuilding Health+Check availability | Compounded tirzepatide at $174.67 to $209 a month, lower the more months you buy at once; semaglutide is tiered the same way. Operated by Dynamo Group LLC. |
| PartnerStrut HealthCheck availability | A telehealth storefront where weight loss is one of six categories. No GLP-1 price is published on the page our link opens. |
| PartnerRxSpan MDCheck availability | Multi-category telehealth that promises transparent pricing, then publishes no GLP-1 price on the page our link opens. |
| PartnerSnagRxCheck availability | Compounded semaglutide at $69 a month and tirzepatide at $119, the same at every dose, with no membership. Both are countdown sale prices, marked down from $299 and $399. Not available in Louisiana. |
| PartnerSkinnyRxCheck availability | Compounded semaglutide and tirzepatide injections at $99 for the first month, tablets at $149 and $199. No second-month price is printed for any of them. |
| PartneryourEraCheck availability | Compounded semaglutide at $79.20 a month and tirzepatide at $159.20. Both are six-month-plan prices, and the plan carries a six-month commitment. |
| PartnerbmiMDCheck availability | Compounded semaglutide from $119 a month and tirzepatide from $179. Both are limited-time sale prices, marked down from $228.60 and $349.20. |
| PartnerCollectiveCheck availability | Compounded semaglutide at $59 a month and tirzepatide at $69 at every dose, plus a required $199 yearly membership. It's free for 21 days, then billed for the full year at once, and it isn't refundable. |
| PartnerSprout HealthCheck availability | Compounded semaglutide from $149 a month and tirzepatide from $199, on plans that renew automatically. Also lists brand Wegovy and Zepbound. |
| PartnerWillowCheck availability | Compounded semaglutide at $299 a month (weekly injection or daily tablet) and tirzepatide injections at $399. HSA and FSA accepted; a full refund applies only if you cancel before the prescription reaches the pharmacy. |
| PartnerHumeCare+Check availability | A self-pay membership with no price shown before checkout, renewing automatically. The home page promises your money back if you don't lose 10 percent in six months; the terms limit that to 90 days, first-time users and no measurable loss. |
| PartnerEnhance MDCheck availability | Offers compounded semaglutide and tirzepatide with provider consultations and follow-up. Compounded drugs are not FDA-approved; ask which pharmacy will dispense your prescription and what continuing care includes. |
| PartnerCoreAge RxCheck availability | Compounded semaglutide advertised at $99 a month at every dose. The page our link opens has shown $149 instead, and a consultation fee can be added that may not be refundable. |
| PartnerOakCheck availability | One flat price at every dose, with shipping and supplies included free. |
Prices in those notes were read from each company's own site in August 2026, September 2026 and October 2026, and they 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.