The direct-to-consumer healthcare startup Ro launched a latest free tool Tuesday to assist patients work out if their insurance covers a hot class of weight-loss and diabetes drugs called GLP-1.
Most medical health insurance plans cover GLP-1 when used to treat diabetes, saving patients the roughly $1,000 monthly cost. However, coverage for weight-loss treatments is less common. The complex insurance landscape will be difficult for patients and time-consuming for doctors who prescribe the drugs.
Some patients may forego treatment just because they don't know they’ve insurance. According to Ros's client data, nearly half of the corporate's patients have some type of insurance coverage for a GLP-1.
Ro hopes the brand new tool may also help patients understand their insurance options so that they can determine easy methods to shed weight. It could also profit the digital health company, because it could entice some patients to affix the corporate's GLP-1 program.
The demand for GLP-1, including Novo Nordisk's weight-loss drug Wegovy and diabetes shot Ozempic have outsold supply within the U.S. over the past yr. Other drugmakers – and digital health corporations like Ro – are desperately attempting to capitalize on the booming GLP-1 market, which analysts say may very well be price greater than $100 billion by the tip of the last decade.
Patients in Ro's program can get a prescription for a GLP-1, and the corporate also offers compounded versions of the drug when the brand-name versions are in brief supply. Compounded GLP-1s are customized alternatives to brand-name drugs which can be tailored to a selected patient's needs.
The program also allows patients to fulfill with a health care provider 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
Ro's insurance checker is accessible online and requires patients to enter a few of their basic medical and insurance information.
After about one to a few days, patients receive a personalised report that shows whether or not they are covered, whether prior authorization is required, and what their expected copayment will probably be for every major GLP-1 drug. All information within the report comes directly from the insurers.
The tool also describes next steps the patient can take, comparable to joining Ro's GLP-1 program or sending a link with the outcomes 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 every drug, including Wegovy, Ozempic, Eli Lilly's weight-loss injection Zepbound and compounded semaglutide, the energetic ingredient in Novo Nordisk's GLP-1s.
For example, the report states that the patient has insurance for Wegovy and meets the necessities for approval by the plan, comparable to a certain body mass index and other health problems comparable to diabetes or heart disease.
This signifies that the patient “should be able to obtain cost coverage without major difficulties,” the model report states.
The patient's estimated deductible will probably be $0 if his prior authorization is approved, in response 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 subsequent 12 months, based on the drug's list price of $1,350 per thirty days and an estimated annual deductible of $2,000. The table estimated that the patient would pay $1,350 for Wegovy in the primary month, $650 within the second, and nothing within the third month and beyond.
Another a part of the report states Some doses of Wegovy are in brief supply, in response 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 select up the drug inside 14 days after their prescription is shipped 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.”
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