The direct-to-consumer health-care startup Ro launched a new free tool Tuesday to help patients determine whether their insurance covers a buzzy class of weight loss and diabetes drugs called GLP-1s.
Most insurance plans cover GLP-1s when they are used to treat diabetes, so those patients can usually avoid the roughly $1,000 monthly price tag of the medications. But coverage of 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 medications.
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 it hopes its new tool can help patients understand their coverage options so they can decide how to pursue weight loss. The digital health company may benefit too, as it could drive some patients to join the company’s GLP-1 program.
Demand for GLP-1s, including Novo Nordisk‘s weight loss treatment Wegovy and diabetes injection Ozempic, has outstripped supply over the last year in the U.S. Other drugmakers — and digital health companies like Ro — are scrambling to capitalize on the booming GLP-1 market, which analysts say could be worth more than $100 billion by the end of the decade.
Patients in Ro’s program can get prescribed a GLP-1, and the company also offers compounded versions of the medication when the branded versions are in short supply. Compounded GLP-1s are custom-made alternatives to brand drugs designed to meet a specific patient’s needs.
The program also allows patients to meet monthly with a doctor and access an educational curriculum for weight management. It includes 24/7 messaging, one-on-one coaching with nurses and help with navigating insurance coverage.
“The burden to understand the cost, as well as the burden to get coverage is the No. 1 reason why patients don’t even take the 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 in a journey, patients have that information to be able to decide the best next step.”
How Ro’s insurance tool works
Ro’s insurance checker is available online, and patients will need to input some of their basic medical and insurance information.
After around one to three days, patients will receive a personalized report that shows whether they have coverage, whether a prior authorization is required and what their estimated copay will be for each major GLP-1 medication. All of the information in the report comes directly from insurers.
The tool also outlines next steps the patient can take, like getting started with Ro’s GLP-1 program or sending a link with the findings to their doctor.
“One of the things that need improvement to the overall patient journey … is trying to get as much information to patients as possible earlier in their journey, because it really does influence the path downstream,” Reitano said.
One sample report involving a patient, provided by Ro, showed a summary of the insurance coverage, supply availability and estimated copay for each drug, including Wegovy, Ozempic, Eli Lilly‘s weight loss injection Zepbound and compounded semaglutide, the active ingredient in Novo Nordisk’s GLP-1s.
For example, the report said the patient has insurance coverage for Wegovy and meets the eligibility requirements for their plan’s prior authorization, such as having a certain body mass index and other health conditions like diabetes and heart disease.
That means the patient “should be able to receive coverage without significant challenges,” the sample report said.
The patient’s estimated copay is $0 if their prior authorization is approved, which is based on information from a representative at their insurer, Blue Cross Blue Shield, according to the report.
The patient’s report also included a table that outlined the potential out-of-pocket cost for Wegovy over the next 12 months. That is based on the drug’s list price of $1,350 per month and an estimated yearly deductible for $2,000. The table estimated that the patient would pay $1,350 for the first month on Wegovy, $650 for the second and nothing for the third month, and beyond.
Another part of the report said some doses of Wegovy are in short supply, which is based on the Food and Drug Administration’s drug shortage database along with Ro’s recently launched GLP-1 supply tracker. Most Ro patients on Wegovy are not able to pick up the treatment within 14 days of their prescription being sent to a pharmacy, according to the report.
“I think this should be the very first step in someone’s journey if they’re interested in GLP-1s,” Reitano said. “Because regardless of whether they want to go to Ro or they want to go to their in-person doctor, you want to better understand what their options are.”