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A general pattern: Cardiovascular outcomes: semaglutide has stronger evidence Weight loss and glucose control: orforglipron is competitive and sometimes leads Convenience: orforglipron is simpler to use Medicare coverage If you have Medicare, you can get a pharmacy benefit card to buy Foundayo for $50 a month

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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

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