Direct-to-consumer healthcare startup Ro launched a new, free tool Tuesday to help patients determine whether their insurance covers a popular class of weight-loss and diabetes drugs called GLP-1s.
Most insurance plans cover GLP-1s when they’re used to treat diabetes, so these patients can typically avoid the roughly $1,000 monthly drug cost. But coverage for weight-loss treatments is less widespread, and navigating the complex insurance landscape can be challenging for patients and time-consuming for doctors who prescribe the drugs.
Some patients may miss out on the treatment simply because they don’t know they have insurance coverage. Ro said about half of the company’s patients have some form of insurance coverage for GLP-1, according to its customer data.
Ro said it hopes its new tool will help patients understand their coverage options so they can decide how to pursue 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-1s, including: Novo NordiskOther pharmaceutical companies — and digital health companies like Ro — are trying to tap into the booming GLP-1 market, which analysts say could reach more than $100 billion by the end of the decade.
Patients in the Roe program can get a prescription for GLP-1, and the company also offers compounded versions of the drug when brand-name versions are not available. Compounded GLP-1s are specially designed alternatives to brand-name drugs designed to meet the needs of a specific patient.
The program also allows patients to meet with a physician monthly and benefit from an educational approach to weight management. The program includes 24/7 messaging, one-on-one coaching with nurses and assistance navigating insurance coverage.
“The burden of understanding the cost, as well as the burden of getting coverage, is the number one reason why patients don’t take the first step,” Zacharias Reitano, co-founder and CEO of Rowe, told CNBC. “We really wanted to make sure that as early in the journey as possible, patients had that information so they could decide what the best next step would be.”
How does Ro insurance work?
Ro's insurance verification tool is available online, and patients will need to enter some basic medical and insurance information.
After approximately one to three days, patients will receive a personalized report explaining whether they are covered, whether prior authorization is required, and what their estimated cost will be for each key GLP-1 medication. All information in the report comes directly from their insurance companies.
The tool also outlines next steps a 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 journey … is trying to get as much information to patients as possible early in their journey, because that really impacts the final trajectory,” Reitano said.
One typical patient report, provided by Ro, showed a summary of insurance coverage, supply availability, and a co-pay estimate for each medication, including drugs like Wegovy and Ozempic. Eli LillyWeight loss injection from Zepbound and complexed semaglutide, the active ingredient in GLP-1s from Novo Nordisk.
For example, the report stated that the patient had insurance coverage for Wegovy and met eligibility requirements for pre-approval from his plan, such as having a certain body mass index and other health conditions like diabetes and heart disease.
This means that the patient “should be able to receive coverage without significant challenges,” according to the sample report.
The patient's co-pay is estimated at $0 if his or her prior consent is approved, which is based on information from a representative of his or her insurance company, Blue Cross Blue Shield, according to the report.
The patient report also included a table showing the patient’s potential out-of-pocket cost for Wegovy over the next 12 months. This was based on the drug’s list price of $1,350 per month and an annual deductible of about $2,000. The table estimated that the patient would pay $1,350 for Wegovy in the first month, $650 in the second month, and nothing in the third month and beyond.
Another part of the report said that some doses of Wegovy are in short supply, based on the FDA’s drug shortage database and Ro’s recently launched GLP-1 supply tracking tool. According to the report, most Ro patients using Wegovy are unable to get their medication within 14 days of sending their prescription to the pharmacy.
“I think this should be the first step in the journey for anyone interested in GLP-1s,” Reitano said. “Because whether they want to go to Ro or they want to go to their personal physician, you want to better understand what their options are.”
