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Step 2: Gather Supporting Documentation Updated medical records documenting BMI, comorbidities, and treatment history Letter of medical necessity from the prescribing provider Peer-reviewed literature supporting the clinical need for the specific medication Documentation of failed alternative treatments Evidence that obesity is contributing to other medical conditions that Medicaid is currently treating (and paying for) Step 3: File the Appeal Most state Medicaid programs allow at least two levels of internal appeal before an external fair hearing