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These reactions are uncommon, mild, and treatable

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

Rarely, patients may experience hypersensitivity reactions to cobalt or vitamin B12, including rash, itching, acneiform eruptions, or in exceptional cases, anaphylaxis

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Whether the legal routes carved out for compounders can really fit this circumstance is bound to be hotly debated in court cases to come, Feldman says