Ro introduces a GLP-1 insurance coverage checker to assist patients in managing expenses.

• Ro, a direct-to-consumer health-care startup, introduced a new free tool that helps patients determine if their insurance will cover GLP-1s, a class of weight loss and diabetes medications.
• Some individuals might not receive treatment because they are unaware of their coverage.
• Ro aims to assist patients in comprehending their coverage options through its new tool, which may motivate some patients to enroll in its GLP-1 program.

Ro launched a new free tool on Tuesday to help patients determine if their insurance covers GLP-1 drugs, which are used for weight loss and diabetes management.

Insurance plans typically cover GLP-1s for diabetes treatment, which helps patients avoid the $1,000 monthly cost of the medication. However, coverage for weight loss treatments is less common, and doctors and patients may struggle to navigate the intricate insurance landscape when prescribing or using these medications.

Nearly half of Ro's patients have GLP-1 insurance coverage, according to its customer data.

Ro hopes its new tool will assist patients in comprehending their coverage options, enabling them to make informed decisions regarding weight loss pursuit. This could potentially benefit the digital health company, as it may encourage some patients to enroll in their GLP-1 program.

The demand for GLP-1s, including Wegovy and Ozempic, has exceeded supply in the U.S. over the past year. As a result, other drugmakers and digital health companies like Ro are rushing to take advantage of the growing GLP-1 market, which is projected to be worth over $100 billion by the end of the decade.

Ro's program allows patients to receive a GLP-1 prescription, and the company provides compounded versions of the medication when branded versions are unavailable. Compounded GLP-1s are tailored alternatives to brand drugs that cater to individual patient requirements.

The program offers patients the opportunity to meet with a doctor monthly, access an educational curriculum for weight management, and receive 24/7 messaging, one-on-one coaching with nurses, and assistance with insurance coverage.

"The main reason why patients do not take the first step is the burden of understanding the cost and obtaining coverage, according to Zachariah Reitano, co-founder and CEO of Ro, in an interview with CNBC. To address this issue, Ro aims to provide patients with the necessary information at the beginning of their journey to help them make informed decisions about their next steps."

How Ro's insurance tool works

Patients can access Ro's insurance checker online and enter their basic medical and insurance details.

In approximately one to three days, patients will receive a customized report detailing their coverage, prior authorization needs, and estimated copay for each major GLP-1 medication, sourced directly from insurers.

The tool provides the patient with a detailed analysis of their health and suggests next steps, such as starting Ro's GLP-1 program or sharing the findings with their doctor.

Improving the patient journey requires providing as much information to patients as early as possible, as it significantly impacts the path that follows, according to Reitano.

Ro's report on a patient's insurance coverage, drug availability, and estimated copay included information on Wegovy, Ozempic, Zepbound, and compounded semaglutide, the active ingredient in Novo Nordisk's GLP-1s.

The patient has insurance coverage for Wegovy and meets the eligibility requirements for their plan's prior authorization, including a certain body mass index and other health conditions such as diabetes and heart disease.

The report stated that the patient should not face significant challenges in receiving coverage.

According to a report, if the patient's prior authorization is approved, their estimated copay will be $0, as stated by a representative from their insurer, Blue Cross Blue Shield.

The patient's report contained a table showing the estimated out-of-pocket cost for Wegovy over the next 12 months. Based on the drug's list price of $1,350 per month and an estimated yearly deductible of $2,000, the table indicated that the patient would pay $1,350 for the first month, $650 for the second month, and nothing for the third month and beyond.

The report states that some doses of Wegovy are currently in short supply, as indicated by the Food and Drug Administration's drug shortage database and Ro's GLP-1 supply tracker. Additionally, the report reveals that a significant portion of Ro patients on Wegovy are unable to obtain the treatment within 14 days of their prescription being sent to a pharmacy.

"Reitano believes that the first step for someone interested in GLP-1s should be to understand their options, whether they choose to go to Ro or their in-person doctor."