Covered for GLP-1 treatment? Try Ro's new coverage tool

34% of employers are offering coverage of GLP-1 weight-loss drugs as demand increases, an 8% increase from last year, according to the International Foundation of Employee Benefit Plans (IFEBP). How can you check if your job provides coverage for this class of drugs, which experts are finding more and more use cases for than just weight loss?

Ro Co-Founder and CEO Zach Reitano joins Wealth! to discuss the direct-to-patient healthcare company's new tool, the GLP-1 Insurance Coverage Checker, providing patients with extensive and personalized reports on potential GLP-1 coverage.

"And when patients don't know if they're covered, what that ends up doing is it prevents people from seeking care in the first place, which is the number one reason why patients don't start that journey as sort of the unknown cost," Reitano tells Yahoo Finance. "So we built this tool to help patients understand whether or not they're covered. And how much they would have to pay to get access to GLP-1s."

Reitano underlines the significant price differences patients can see when pursuing GLP-1 treatment with and without insurance.

"The only people paying that list price, that $1,000, are patients without coverage or those that are uninsured," Reitano explains, noting an increasing number of patients finding coverage from employers: "You do see Medicare cover it. All federal employees and their families have coverage. So you are seeing coverage rise. You have over 50 million people in the US who are covered for Wegovy. So when people are covered... the average copay we're seeing on our platform is about $50."

For more expert insight and the latest market action, click here to watch this full episode of Wealth!

This post was written by Nicholas Jacobino

Editor's note: This headline and post have been updated to more accurately reflect the interview and to correct a misspelling of Mr. Reitano's name.

Video Transcript

Novo Nordisk, Eli Lilly hims and hers all seeing increased demand for diabetes and weight loss drugs.

In response, more employers are offering insurance coverage of these drugs up to 34% now from 26% in 2023.

That's according to a survey by the International Federation of Employee or International Foundation.

I should say of employee benefit plans, employers Overall medical claims spending on the medications also rose to 8.9% so far in 2024 from 6.9% in 2023.

So how do you know if your job provides coverage?

Our next guest has a solution.

And I'm joined by Zach Reitano, who is the co founder and CEO of road.

Yeah.

I mean, you also stand to benefit if more employers start to cover what they hadn't before here.

So take us into the thinking for Rose's business.

And are you seeing the same type in spike and demand here, uh, that we're hearing from companies like hims and hers who just raised their own guidance because of that demand for weight loss drugs?

Yeah.

Thanks for having me on Brad.

We we are seeing overwhelming demand for our robotic membership, which is high quality care centred around G LP ones.

Um, why we built this tool is because after helping hundreds of thousands of patients start their weight loss journey, we saw that the number one problem that they had was understanding their costs at the beginning at the beginning of their journey.

Um, and that should be table stakes in any experience, let alone health care.

And the difference between being covered and not is a few $100 a year.

If you're covered, usually versus 12,000, right?

And when patients don't know if they're covered, Um, what that ends up doing is it prevents people from seeking care in the first place, which is the number one reason why patients don't start.

That journey is sort of the unknown cost.

So we built this tool to help patients understand whether or not they're covered and how how much they would have to pay to get access to GOP ones.

You put 34% there.

We're actually seeing higher numbers than that on on our side.

We're seeing about 45% of our patients be covered, and when they are covered the vast majority are paying less than $100.

And so when you're covered, you're really covered.

And so we wanted to build this tool to increase access to these to these treatments.

Should those prices be even lower.

I mean, as of mid point this year, it sounded like, uh that the average price for G LP one drugs, I mean, and this is the list price, $1000.

But if you have insurance, obviously that comes down dramatically, depending upon what you're paying into insurance.

That that could be even, you know, $25 for a 1 to 3 month supply.

Uh, according to you know, some of the compilation of the American Journal of Management, Web, MD and so forth.

So what?

What is the true fair pricing for these drugs, given the demand profile that we're seeing?

Yeah, Brad, you're getting it sort of one of the largest sort of fundamental flaws of our health care system right now, the the the only people paying that list price that $1000 are patients without covered or without coverage or those that are uninsured.

Um, so patients with coverage which you you listed about 34%.

Again, we're seeing 45%.

Um, because you you'll have commercial payers.

You also have about 18, uh, states, uh, for Medicaid that are covering it.

You do see Medicare cover it.

All federal employees and their families have coverage.

So you are seeing coverage rise.

You have over 50 million people in the US who are covered for Wi Gobi.

So when people are covered, uh, which is tens of millions of people, you know, the the average copay we're seeing on our platform is about $50.

Um, so again, So So when you're covered, which is what this tool is trying to help people determine.

Are they covered or not At the earliest possible, uh, point in the journey to help them navigate next steps.

We're seeing a very, very affordable price with coverage, and then, hopefully, over time, we obviously see these coverage rates increase.

So that's again.

One of the challenges that list price is is unfortunately, it's way too high.

Um, we we want them to come down.

We're seeing more and more competition.

We're seeing savings cards, and we're seeing coverage increase.

So hopefully over the coming years, we will see fewer and fewer people actually pay that list price.

You know, when we think about the unknown costs of weight loss drugs, I mean, we know that, you know, it changes how you might eat changes the type of exercise you should be doing on the other side as well.

What what are some of those cost considerations?

Because of the change in lifestyle that people should be keeping in mind even as they're having these discussions.

Key discussions with their medical practitioner or doctors.

Yeah, we've We've seen a lot of really interesting things, and what we talk about internally related to GOP ones is we refer to them as a jet pack for positive behaviour Change.

Um, because what we see is this, uh, immediate and and positive feedback loop for patients in their life.

So it kick starts a lot of behavioural changes.

Right?

So you you traditionally see a reduction in about, uh, 20 to 30% of calorie consumption.

But it's not just patients are able to eat less and reduce intake.

Also, what they are eating dramatically shifts right?

They're eating more vegetables, more fish, more poultry.

They're eating far less snack food or confectioneries or, uh, soda and things like that.

Uh, and when they're able to do that, you're seeing them sleep more.

You're seeing them exercise more.

You're seeing them date more.

So you're seeing a lot of interesting positive behaviour chains that are kick started by starting gel he wants.

OK, so get so get ready to date more.

Get ready for those exceptions.

Zach.

Just lastly, while we have you, only we have about 30 seconds here.

But, uh, I'd be remiss if I didn't ask you about how the business is doing itself.

I know that your unicorn status as of right now and and your own story in itself is is something really to be talked about in your own evolution?

Uh, from what's selling?

Um, I. I think it was tacos or or or burritos or something like that from a friend's couch.

Uh, I mean, look, we could go into that another day, but how's the business doing in in this environment right now?

And And what is the next step?

Next major milestone you're anticipating.

It's a It's a great question for us.

We've been, uh, as as you mentioned, we've been really overwhelmed and excited by the demand for our our products and services and so growing Inc incredibly quickly.

Um, we've helped, uh, millions of patients across the country, one in almost every single county across the US and have helped hundreds of thousands of patients start their their weight loss journey.

And hopefully the, uh, just just the beginning.

For for Roe and the team, it was burritos, by the way, just for our viewers out there.

You're doing ghost, the good work of ghost kitchens.

But, uh, we're we're so glad that there's so much more work you're doing on the healthcare side as well.

Here.

Zacho Co-founder of C. Thanks so much, Rob and I thank you.

Appreciate it.