Direct-to-consumer health startup Ro launched a new free tool Tuesday to help patients determine whether their insurance covers a class of weight-loss and diabetes drugs called GLP-1s.
Most insurance plans cover GLP-1 when it is used to treat diabetes, so these patients can usually avoid the drug’s cost of about $1,000 a month. But weight loss treatment coverage is less widespread, and navigating the complex insurance landscape can be challenging for patients and time-consuming for doctors who prescribe the drug.
Some patients may miss out on care because they don’t know they have coverage. Ro said almost half of the company’s patients have some form of insurance coverage for GLP-1, according to its customer data.
Ro said he hopes the new tool can help patients understand their coverage options so they can decide how to pursue weight loss. Digital health companies could also benefit, as it could lead to some patients participating in the company’s GLP-1 program.
GLP-1 demand, incl Novo NordiskBody weight treatment ‘s Wegovy and diabetes injection Ozempic, has outstripped supply over the last year in other US drugmakers – and digital health companies like Ro – who are scrambling to capitalize on the booming GLP-1 market, which analysts say could be worth more. of $100 billion by the end of the decade.
Patients in the Ro program can be prescribed GLP-1, and the company also offers a compounded version of the drug when the brand-name version is in short supply. Compounded GLP-1 is a custom-made alternative to brand-name drugs designed to meet specific patient needs.
The program also allows patients to meet monthly with their 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 of understanding the cost, as well as the burden of obtaining coverage is the No. 1 reason why patients don’t take the first step,” Ro co-founder and CEO Zachariah Reitano told CNBC in an interview. “We really just want to make sure that at the earliest moment in their journey, patients have that information so they can decide the best next step.”
How the Ro insurance tool works
Ro’s insurance checker is available online, and patients must enter some basic medical and insurance information.
After approximately one to three days, patients will receive a personalized report indicating 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 the insurance company.
The tool also outlines the next steps the patient can take, such as starting the GLP-1 Ro program or sending a link with the findings to the doctor.
“One of the things that needs improvement for the overall patient journey … is trying to get as much information to the patient earlier in the journey, because it really affects the downstream path,” Reitano said.
One sample report involving patients, provided by Ro, shows a summary of insurance coverage, supply availability and copay estimates for each drug, including Wegovy, Ozempic, Eli Lily‘S weight loss injection Zepbound and semaglutide compound, the active ingredient in Novo Nordisk GLP-1s.
For example, the report said patients had insurance coverage for Wegovy and met eligibility requirements for the plan’s prior authorization, such as having a certain body mass index and other health conditions like diabetes and heart disease.
That means patients “must be able to receive coverage without significant challenges,” the sample report said.
The estimated patient copay is $0 if prior authorization is approved, based on information from representatives at the insurance company, Blue Cross Blue Shield, according to the report.
The patient report also includes a table that outlines the potential costs for Wegovy over the next 12 months. That’s based on the drug’s list price of $1,350 per month and an estimated annual deductible of $2,000. The table estimates that the patient will pay $1,350 for the first month in Wegovy, $650 for the second and nothing for the third month, and more.
Another part of the report said some doses of Wegovy in short supply, which is based on the Food and drug shortage database together with Ro’s recently opened GLP-1 source tracker. Most Ro patients in Wegovy are unable to receive treatment within 14 days after the prescription is delivered to the pharmacy, according to the report.
“I think this should be the first step in someone’s journey if they are interested in GLP-1,” Reitano said. “Because regardless of whether they want to go to Ro or they want to go to a private doctor, you want to know better what their options are.”