Enlarge iconOutward pointing arrows
Direct-to-consumer healthcare startup Ro launched a new free tool Tuesday to help patients determine whether their insurance covers a much-discussed class of weight-loss and diabetes drugs called GLP-1.
Most health insurance plans cover GLP-1 when used to treat diabetes, saving patients the approximately $1,000 monthly cost. However, coverage for weight-loss treatments is less common. The complex insurance landscape can be challenging for patients and time-consuming for doctors who prescribe the drugs.
Some patients may forego treatment simply because they don't know they have insurance. According to Ros's client data, nearly half of the company's patients have some form of insurance coverage for a GLP-1.
Ro hopes the new tool can help patients understand their insurance options so they can decide how to lose weight. It could also benefit the digital health company, as it could entice some patients to join the company's GLP-1 program.
The demand for GLP-1, including Novo Nordisk's weight-loss drug Wegovy and diabetes shot Ozempic have outsold supply in the U.S. over the past year. Other drugmakers – and digital health companies like Ro – are desperately trying 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 a prescription for a GLP-1, and the company also offers compounded versions of the drug when the brand-name versions are in short supply. Compounded GLP-1s are customized alternatives to brand-name drugs that are tailored to a specific patient's needs.
The program also allows patients to meet with a doctor once a month and access a weight management education program. It includes 24/7 messaging, one-on-one coaching with nurses and help finding insurance coverage.
“The burden of understanding the costs, as well as the burden of getting coverage, is the main reason patients don't even take the first step,” Ro co-founder and CEO Zachariah Reitano said in an interview with CNBC. “We really just wanted to make sure patients had that information as early as possible in their journey to be able to decide the best next step.”
How Ro's insurance tool works
Enlarge iconOutward pointing arrows
Ro's insurance checker is available online and requires patients to enter some of their basic medical and insurance information.
After about one to three days, patients receive a personalized report that shows whether they are covered, whether prior authorization is required, and what their expected copayment will be for each major GLP-1 drug. All information in the report comes directly from the insurers.
The tool also describes next steps the patient can take, such as joining Ro's GLP-1 program or sending a link with the results to their doctor.
“One of the things that needs to be improved throughout the patient care journey is trying to get as much information as possible to patients as early as possible, because that really impacts the rest of their care,” Reitano said.
A sample patient report provided by Ro showed a summary of insurance coverage, supply availability, and estimated copayment 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 states that the patient has insurance for Wegovy and meets the requirements for approval by the plan, such as a certain body mass index and other health problems such as diabetes or heart disease.
This means that the patient “should be able to obtain cost coverage without major difficulties,” the model report states.
The patient's estimated deductible will be $0 if his prior authorization is approved, according to the report, based on information from a representative of his insurer, Blue Cross Blue Shield.
The patient report also included a table listing the potential out-of-pocket costs for Wegovy over the next 12 months, based on the drug's list price of $1,350 per month and an estimated annual deductible of $2,000. The table estimated that the patient would pay $1,350 for Wegovy in the first month, $650 in the second, and nothing in the third month and beyond.
Another part of the report states Some doses of Wegovy are in short supply, according to the Food and Drug Administration's drug shortage database and Ro's recently launched GLP-1 supply tracker. Most Ro patients taking Wegovy are unable to pick up the drug within 14 days after their prescription is sent to a pharmacy, the report said.
“I think this should be the very first step in the journey of someone who is interested in GLP-1,” Reitano said. “Because whether they want to go to Ro or their primary care doctor, they want to better understand what their options are.”
Comments are closed.