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What You Will Pay If Anthem approves your prior authorization, your cost depends on your plan: Anthem Plans in Virginia Employer-sponsored plans: Coverage determined by your employer's plan design Individual/ACA marketplace plans: Coverage varies by metal tier and plan Medicare Advantage: Anthem Medicare plans have their own formularies (PEAK does not accept these plans) Medicaid (Anthem HealthKeepers): Weight loss medication coverage is limited (PEAK does not accept these plans) How We Help Anthem Members Benefits verification We contact Anthem to verify your specific coverage before your first visit Prior authorization submission We complete and submit PA requests with required documentation Step therapy navigation We help document previous treatments to satisfy requirements Appeals when appropriate We file appeals if we believe a denial was incorrect Alternative pathway exploration We explore cardiovascular or sleep apnea indications if standard coverage is unavailable What If Anthem Denies Coverage