💵 Insurance Coverage

Benefits verification is the process by which we determine whether your insurance company covers specific medications and, if so, whether it requires an approved prior authorization.

We work to get this information as quickly as possible, so this benefits verification typically happens electronically with no direct interaction with your insurance company.

During benefits verification, we might find that prior authorization is needed. In that case, our concierge will interact directly with your insurance company to submit all the necessary information on your behalf.

Prior authorization is a decision by your health insurer or plan that a health care service, treatment plan, or prescription drug is medically necessary. In our case, prior authorizations allow your insurance company to evaluate if a GLP-1 medication is covered.

The process for obtaining prior authorization varies by insurer, but involves submission of administrative and clinical information by the treating practitioner. Behind the scenes, our insurance concierge partner does the hard work of gathering your information, submitting your prior authorization request, and going back and forth with your insurance company.

Our top priority is getting patients insurance coverage, so our partners and affiliated providers do their best to maximize the likelihood of approval.

The prior authorization process usually takes 2-3 weeks but it can be longer if the initial coverage request is denied.

Our partner submits to your insurance company right away. But the process can take longer if more information about your insurance or pharmacy benefits is needed or if there's a secondary plan you want to try.

If your insurance company approves your GLP-1 treatment after that first step, great! If they don't, our partner will continue to work on your behalf. Our partner will see if your insurer requires additional information or will cover a different GLP-1 medication if prescribed.

It depends on which medication is prescribed, as some medications are only available when paying cash:

• Zepbound single-dose vials are FDA-approved and contain the exact same active ingredient (tirzepatide) as Zepbound pens, and are fulfilled through our integration with LillyDirect. The costs vary by dose:

  • 2.5 mg dose – $399/month

  • 5 mg dose – $549/month

• Compounded semaglutide, offered through Ro, costs $254 per month of treatment.

You may also opt to pay cash for branded GLP-1s such as Ozempic, Zepbound, Wegovy, and Saxenda pens. Without insurance coverage, branded GLP-1s typically cost about $900–$1,500 per month of treatment. There are savings cards that branded GLP-1 drug manufacturers may provide to help reduce costs. The use of a manufacturer savings card may require having commercial insurance. Each pharmacy may apply these savings cards differently, so your final costs can vary depending on where the medication is ultimately filled.

These medication costs do not include the monthly Body membership fee of $145/mo.

Due to several factors, it's difficult to say precisely when you'll get medications after prior authorization is approved. Our partner works with a nationwide network of pharmacies to find the fastest way of getting you started with your medication.

We understand that an insurance denial can be frustrating, but we want you to know that our partner will exhaust all options on your behalf. There are a few possible options if your request is denied: 

1. Your provider will determine if you’re eligible for another GLP-1 medication and, if clinically appropriate, write a new prescription. Then, our partner will see if the new medication is covered or if you’ll need to go through prior authorization again. If you do, our partner will take care of the coverage request. 

2. You can choose to pay cash for FDA-approved branded medication. 

   • Ro is working with LillyDirect to offer Zepbound single-dose vials, the exact same active ingredient (tirzepatide) as the pen. The vials are in stock and ready to ship within 1-4 days once prescribed. The costs vary by dose:

     • 2.5 mg dose – $399/month

     • 5 mg dose – $549/month

3. Costs for branded GLP-1 pens like Ozempic, Zepbound, Wegovy, and Saxenda range from $900–$1,500 per month of treatment. If you go this route, we’ll help you navigate your options. Drug manufacturers may provide savings cards to help reduce costs. We'll help you through the best next steps if applicable. Learn more about compounded semaglutide. These costs do not include the monthly Body membership fee of $145/mo.

Prior authorization requests can be denied for a few different reasons: 

• A patient may not meet the insurance company's requirements for treatment.

• An insurance company may require that patients have tried other medications before approving coverage for GLP-1s. 

• Some prior authorization requests are for using a medication off-label (for a reason other than what was FDA-approved) at the discretion of the prescribing provider. Insurance companies may deny their use.

Yes, and it’s done for you! Ro-affiliated providers survey the clinically appropriate medication options between Ozempic, Zepbound, Wegovy, and Saxenda. If your insurer denies your request for coverage for one of those medications, your provider will check if another is clinically appropriate for you. If another one is, they’ll write a prescription, and our insurance concierge will submit another prior authorization request.

The branded GLP-1 medications available through the Body membership that may be eligible for insurance coverage are approved for different primary indications. Ozempic is FDA-approved for treating type 2 diabetes, while Zepbound and Wegovy are FDA-approved for weight management.

Given the varied conditions covered for each medication, some plans may deny one medication but approve the other based on a patient's medical history. If your insurer denies coverage for one medication, your Ro-affiliated provider may find it clinically appropriate to write you a new prescription for a different medication.

Please note that Zepbound single-dose vials and compounded semaglutide are only available when paying cash, so they are not eligible for insurance coverage.

Submitting another coverage request and receiving a decision can take about 2–3 weeks and vary based on the insurer. We know waiting can feel frustrating. Know that our partner is working on your behalf, and we’ll keep you updated every step of the way.

Great! Let us know by messaging the pharmacy information to your healthcare team via your Ro account chat, and we’ll look into whether that pharmacy can fill your prescription.

If an insurance company decides to deny the request for coverage of a medication officially, patients always have the option to appeal the decision. This can involve sending additional information and requesting that the insurance company reevaluate the decision.

Yes, you can. Please get in touch with your insurance carrier to see what the process entails and update us with the outcome so we can help with next steps. If your appeal is approved, we can help locate a pharmacy to fill. If your appeal is unfortunately denied, we can help review cash pay options or cancel your plan. We are here to assist with any questions or concerns along the way.

If your appeal is unfortunately denied, you have a few options:

•  You can choose to pay cash for the medication you were prescribed: Costs for branded pens can range from approximately $900-$1,500 per month of treatment. If you go this route, we’ll help you navigate your options — like savings cards. If you have commercial insurance, you may be able to use savings cards provided by the drug manufacturer to help reduce costs. We'll help you through the best next steps if applicable.

• You can choose to pay cash for Zepbound vials (pending provider approval): Ro is working with LillyDirect to offer Zepbound single-dose vials (the exact same tirzepatide formulation as the pen). The vials are in stock and ready to ship within 1-4 days once prescribed. The costs vary by dose:

  • 2.5 mg dose – $399/month

  • 5 mg dose – $549/month

• You can switch to compounded semaglutide (pending provider approval): We’re now offering access to a compounded option for $254 per month of treatment to help you get medication in hand. It’s in stock and ready to ship within 1-4 days once prescribed. Learn more about compounded semaglutide. These costs do not include the monthly Body membership fee of $145/mo.

• The last option is to cancel your Body membership: Should you choose to cancel your subscription, you can do so through your Ro account. Learn more.

Unfortunately, you cannot join the Body membership if you have government insurance (regardless of whether you have additional commercial/employer insurance or are willing to pay cash out of pocket).

This includes those with any form of government healthcare coverage (including programs such as Medicare, Medicare Supplement Plans, Medicaid, or TRICARE), whether it’s your primary or secondary coverage. Certain federal government insurance programs impose mandatory billing requirements on providers when they treat beneficiaries. Because of this, Ro-affiliated providers are unable to work with beneficiaries of these programs.

Federal employees who receive their health insurance through the Federal Employee Health Benefits Program (FEHB) may participate in the Body Program.

Compounded GLP-1s are only available as a cash-pay option. Compounded semaglutide costs $299 per month. These costs do not include the monthly Body membership fee.

While Zepbound single-dose vials are the authentic Zepbound medication, they are only available as a cash-pay option. The costs vary by dose:

• 2.5 mg dose – $399/month

• 5 mg dose – $549/month

These costs do not include the monthly Body membership fee.