Digital health company Ro is launching a GLP-1 insurance test to help patients find the cost

Direct-to-consumer health care startup Ro launched a new free tool Tuesday to help patients find out if their insurance covers a surprising array of weight-loss and diabetes drugs. Glucose called GLP-1s.

Most insurance plans cover GLP-1 when used to treat diabetes, so those patients can often avoid the $1,000 monthly cost of the medication. But coverage of weight loss treatments is not very common, and navigating the complicated insurance process can be difficult for patients and time-consuming for prescribers.

Some patients may miss out on treatment simply because they don’t know they have coverage. Ro says that about half of the company’s patients have some form of immunity to GLP-1, according to its customer data.

Ro says it hopes its new tool can help patients understand their safety options so they can make the decision to follow their weight. A digital health company could also benefit, as it could drive more patients to join the company’s GLP-1 program.

The need for GLP-1s, incl Novo NordiskWegovy’s weight-loss treatment and diabetes vaccine Ozempic, continued to deliver last year in the U.S. Other drugmakers — and digital health companies like Ro — are scrambling to capitalize on the growing GLP-1 market, which analysts say could be even more important. exceeding $100 billion by the end of the decade.

Patients on Ro’s program can be prescribed GLP-1, and the company also offers compounded versions of the drug when popular brands are in short supply. Compounded GLP-1s are customized alternatives to generic drugs designed to meet specific patient needs.

The program also allows patients to meet monthly with a doctor and receive an educational program for weight management. It includes 24/7 messaging, one-on-one training with nurses and insurance processing assistance.

“The burden of understanding the cost, as well as the burden of finding 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 wanted to make sure that at the earliest possible point in the journey, patients have that information to be able to decide the best next step.”

Ro insurance coverage is available online, and patients will need to enter their basic medical and insurance information.

After about three to three days, patients will receive an individualized report showing whether they have coverage, whether prior authorization is required and their estimated amount. which will be for each major GLP-1 drug. All information in the report comes directly from the insurers.

The app also provides next steps for the patient to take, such as getting started with Ro’s GLP-1 program or sending a link and findings to their doctor.

“One of the things that needs improvement in the overall patient journey … is trying to get as much information to patients as possible earlier in their journey, because it really influences the bottom line,” Reitano said.

Another example of a patient report, provided by Ro, showed a summary of insurance coverage, availability and estimated copayments for each drug, including Wegovy, Ozempic, Eli LillyWeight loss vaccine Zepbound and combined semaglutide, the active ingredient in Novo Nordisk’s GLP-1s.

For example, the report stated that the patient has insurance coverage for Wegovy and meets the eligibility requirements for their plan’s initial approval, such as having a certain body mass index and condition. some health issues such as diabetes and heart disease.

That means the patient “should receive coverage without major complications,” the model report said.

The patient’s estimated copay is $0 if their first authorization is approved, based on information from a representative at their insurer, Blue Cross Blue Shield, according to the report.

The patient report also included a table detailing potential out-of-pocket costs for Wegovy over the next 12 months. That’s based on a list drug price of $1,350 per month and an estimated annual cost of $2,000. The table estimated 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 Wegovy’s other metrics are lacking, based on the Food and Drug Administration’s drug shortage collection as well as Ro’s recently announced GLP-1 supply tracker. Most of Ro’s patients in Wegovy are unable to receive treatment within 14 days after their prescription is sent 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-1s,” Reitano said. “Because it doesn’t matter if they want to go to Ro or they want to go to their doctor, you want to better understand what their options are.”