The direct-to-consumer health-care startup Ro launched a latest free tool Tuesday to assist patients determine whether their insurance covers a buzzy class of weight reduction and diabetes drugs called GLP-1s.Â
Most insurance policy cover GLP-1s after they are used to treat diabetes, so those patients can normally avoid the roughly $1,000 monthly price tag of the medications. But coverage of weight reduction treatments is less widespread, and navigating the complex insurance landscape will be difficult for patients and time consuming for doctors who prescribe the medications.Â
Some patients could also be missing out on treatment because they simply do not know they’ve coverage. Ro said nearly half of the corporate’s patients have some type of insurance coverage for a GLP-1, based on its customer data.Â
Ro said it hopes its latest tool might help patients understand their coverage options in order that they can determine methods to pursue weight reduction. The digital health company may profit too, because it could drive some patients to affix the corporate’s GLP-1 program.
Demand for GLP-1s, including Novo Nordisk‘s weight reduction treatment Wegovy and diabetes injection Ozempic, has outstripped supply during the last 12 months within the U.S. Other drugmakers — and digital health corporations like Ro — are scrambling to capitalize on the booming GLP-1 market, which analysts say could possibly be value greater than $100 billion by the tip of the last decade.Â
Patients in Ro’s program can get prescribed a GLP-1, and the corporate also offers compounded versions of the medication when the branded versions are briefly supply. Compounded GLP-1s are custom-made alternatives to brand drugs designed to satisfy a particular patient’s needs.Â
This system also allows patients to satisfy monthly with a health care provider and access an academic curriculum for weight management. It includes 24/7 messaging, one-on-one coaching with nurses and help with navigating insurance coverage.Â
“The burden to know the price, in addition to the burden to get coverage is the No. 1 reason why patients don’t even take step one,” Ro co-founder and CEO Zachariah Reitano told CNBC in an interview. “We actually just desired to be certain that on the earliest possible moment in a journey, patients have that information to give you the chance to determine one of the best next step.”
How Ro’s insurance tool works
Ro’s insurance checker is out there online, and patients might want to input a few of their basic medical and insurance information.
After around one to 3 days, patients will receive a customized report that shows whether or not they have coverage, whether a previous authorization is required and what their estimated copay will likely be for every major GLP-1 medication. All of the knowledge within the report comes directly from insurers.Â
The tool also outlines next steps the patient can take, like getting began with Ro’s GLP-1 program or sending a link with the findings to their doctor.Â
“Considered one of the things that need improvement to the general patient journey … is attempting to get as much information to patients as possible earlier of their journey, since it really does influence the trail downstream,” Reitano said.Â
One sample report involving a patient, provided by Ro, showed a summary of the insurance coverage, supply availability and estimated copay for every drug, including Wegovy, Ozempic, Eli Lilly‘s weight reduction injection Zepbound and compounded semaglutide, the lively ingredient in Novo Nordisk’s GLP-1s.Â
For instance, the report said the patient has insurance coverage for Wegovy and meets the eligibility requirements for his or her plan’s prior authorization, equivalent to having a certain body mass index and other health conditions like diabetes and heart disease.Â
Which means the patient “should give you the chance to receive coverage without significant challenges,” the sample report said.Â
The patient’s estimated copay is $0 if their prior authorization is approved, which relies on information from a representative at their insurer, Blue Cross Blue Shield, based on the report.Â
The patient’s report also included a table that outlined the potential out-of-pocket cost for Wegovy over the subsequent 12 months. That relies on the drug’s list price of $1,350 monthly and an estimated yearly deductible for $2,000. The table estimated that the patient would pay $1,350 for the primary month on Wegovy, $650 for the second and nothing for the third month, and beyond.Â
One other a part of the report said some doses of Wegovy are briefly supply, which relies on the Food and Drug Administration’s drug shortage database together with Ro’s recently launched GLP-1 supply tracker. Most Ro patients on Wegovy should not capable of pick up the treatment inside 14 days of their prescription being sent to a pharmacy, based on the report.
“I believe this must be the very first step in someone’s journey in the event that they’re concerned about GLP-1s,” Reitano said. “Because no matter whether or not they wish to go to Ro or they wish to go to their in-person doctor, you should higher understand what their options are.”
