direct to consumer Healthcare startup Ro launched a New free tools Tuesday to help patients determine if their insurance covers a popular category weight loss and diabetes medications It’s called GLP-1.
most insurance plans Covers GLP-1s When they are used to treat diabetes, these patients can often avoid the drug’s monthly price tag of about $1,000. But coverage for weight loss treatments isn’t widespread, and the complex insurance landscape can be challenging for patients and time-consuming for doctors who prescribe them.
Some patients may miss treatment because they simply don’t know they have insurance. Ro said that based on its customer data, nearly half of the company’s patients have some form of GLP-1 insurance.
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 by enrolling some patients in the company’s GLP-1 program.
The need for GLP-1, including Novo NordiskLast year, demand for weight loss treatment Wegovy and diabetes injection Ozempic outstripped supply in the United States. This number will exceed $100 billion.
Patients in the Ro plan can get a prescription for GLP-1, and the company also offers a compounded version of the drug when demand for the branded version exceeds supply. Compounded GLP-1 is a customized alternative to brand-name drugs designed to meet the needs of specific patients.
The program also allows patients to meet with their doctor monthly and receive educational sessions on weight management. It includes 24/7 messaging, one-on-one coaching with a nurse and help understanding insurance coverage.
“Understanding the burden of cost and the burden of getting insurance is the number one reason patients don’t take the first step,” Ro co-founder and CEO Zachariah Reitano told CNBC. “We really just want to make sure patients are on the right side of the journey. Get this information as early as possible so you can decide on the best next steps.”
How Ro’s insurance tool works
Ro’s insurance checker is available online and requires patients to enter some basic medical and insurance information.
In approximately one to three days, patients will receive a personalized report showing whether they have coverage, whether prior authorization is required, and the estimated copay for each major GLP-1 drug. All information in the report comes directly from insurance companies.
The tool also outlines next steps patients can take, such as starting Ro’s GLP-1 program or sending a link with results to their doctor.
“One of the things that needs to improve throughout the patient journey … is trying to provide as much information as possible to patients early in the patient journey, because it does impact the pathway downstream,” Reitano said.
A sample report involving patients provided by Ro shows a summary of insurance coverage, supply availability and estimated deductibles for each drug, including Wegovy, Ozempic, Eli Lilly and CompanyThe weight loss injection Zepbound and the compound semaglutide are the active ingredients in Novo Nordisk’s GLP-1s.
For example, patients had Wegovy insurance and met their plan’s prior authorization eligibility requirements, such as having a certain body mass index and other health conditions such as diabetes and heart disease, the report said.
This means patients “should be able to obtain coverage without significant challenges,” the sample report said.
If the prior authorization is approved, patients’ out-of-pocket costs are estimated to be $0, the report said, based on information from representatives of their insurance company, Blue Cross Blue Shield.
The patient report also includes a table outlining potential out-of-pocket costs for Wegovy over the next 12 months. That’s based on the drug’s monthly price of $1,350 and an estimated deductible of $2,000 per year. The table estimates patients will pay $1,350 for the first month on Wegovy, $650 for the second month, and no fees for the third month and beyond.
Another part of the report says Some doses of Wegovy are in short supply, based on the U.S. Food and Drug Administration’s Drug Shortage Database and Ro’s recent launch GLP-1 Supply Tracker. The report said most Ro patients taking Wegovy were unable to receive treatment within 14 days of the prescription being sent to the pharmacy.
“I think if someone is interested in GLP-1, this should be the first step in their journey,” Reitano said. “Because whether they want to go to Lowe Hospital or see a doctor, you want to better understand their options.”
