Direct-to-consumer healthcare startup Ro on Tuesday launched a new, free tool to help patients determine whether their insurance covers a popular class of weight-loss and diabetes drugs called GLP-1.
Most insurance plans cover GLP-1s when used to treat diabetes, so those patients can usually avoid the roughly $1,000 monthly price tag for the drugs. But coverage for weight-loss treatments is less widespread, and navigating the complex insurance landscape can be a challenge for patients and a waste of time for doctors who prescribe the drugs.
Some patients may be missing out on treatment because they simply don't know they have coverage. Ro said nearly half of the company's patients have some form of insurance coverage for a GLP-1, according to its customer data.
Ro said he hopes his new tool can help patients understand their coverage options so they can decide how to achieve weight loss. The digital health company could also benefit, as it could prompt some patients to join the company’s GLP-1 program.
Demand for GLP-1, including New NordiskGLP-1 weight-loss treatment Wegovy and diabetes shot Ozempic have both outpaced supply over the past year in the U.S. Other drugmakers (and digital health companies like Ro) are scrambling to capitalize on the burgeoning GLP-1 market, which analysts say could be worth more than $100 billion by the end of the decade.
Patients participating in Ro’s program can receive a prescription for GLP-1, and the company also offers compounded versions of the drug when brand-name versions are in short supply. Compounded GLP-1s are personalized alternatives to brand-name drugs designed to meet a patient’s specific needs.
The program also allows patients to meet monthly with a physician and access a weight management education program. It includes 24/7 messaging, one-on-one counseling with nurses, and help managing insurance coverage.
“The burden of understanding cost, as well as the burden of getting coverage, is the number one reason patients don't even take that first step,” Ro co-founder and CEO Zachariah Reitano told CNBC in an interview. “We really just wanted to make sure that at the earliest possible moment, patients had that information so they could decide what the best next step is.”
How the Ro Insurance Tool Works
Ro's insurance checker is available online and patients will be required to enter some of their basic medical and insurance information.
After one to three days, patients will receive a personalized report showing whether they have coverage, whether prior authorization is required, and what the estimated copayment will be for each major GLP-1 medication. All information in the report comes directly from the insurers.
The tool also outlines next steps the patient can take, such as starting Ro’s GLP-1 program or sending a link to the results to their doctor.
“One of the things that needs to be improved in the overall patient experience… is trying to get patients as much information as possible in the early stages of their treatment, because it really influences the path down the road,” Reitano said.
A sample report involving a patient, provided by Ro, showed a summary of insurance coverage, supply availability, and estimated co-pay for each medication, including Wegovy, Ozempic, Eli LillyZepbound weight loss injection and the compound semaglutide, the active ingredient in Novo Nordisk's GLP-1.
For example, the report said the patient has insurance coverage for Wegovy and meets his plan's prior authorization eligibility requirements, such as having a certain body mass index and other health conditions like diabetes and heart disease.
This means the patient “should be able to receive coverage without significant challenges,” the sample report notes.
The patient's estimated copay is $0 if their prior authorization is approved, based on information from a representative of their insurer, Blue Cross Blue Shield, the report said.
The patient's report also included a table outlining the potential out-of-pocket cost of Wegovy over the next 12 months. This is based on the drug's list price of $1,350 per month and an estimated annual deductible of $2,000. The table estimated the patient would pay $1,350 for the first month of Wegovy, $650 for the second, and nothing for the third and subsequent months.
Another part of the report said Some doses of Wegovy are in short supply, according to the Food and Drug Administration’s drug shortage database, along with Ro’s recently launched GLP-1 supply tracker. Most Ro patients taking Wegovy are unable to pick up the treatment within 14 days of having their prescription sent to a pharmacy, the report said.
“I think this should be the first step in someone's journey who is interested in GLP-1s,” Reitano said. “Because regardless of whether they want to go to Ro or their doctor in person, it's important to better understand what their options are.”
