💵 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:

  • $349/mo for 2.5 mg dose

  • $499/mo for 5 mg dose

  • $499/mo for 7.5 mg and 10 mg doses (with manufacturer offer)

• You can pay cash for Wegovy pens through our integration with NovoCare® Pharmacy– they’re half the retail price and ship directly to you.

  • $199 for your first month (limited-time offer)

  • $499/mo thereafter

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

• Higher-cost branded GLP-1s (Ozempic and Zepbound pens):

• The price ranges from $900–$1,100/mo

Important: These prices do not include the $145/month Ro Body membership fee.

Manufacturer savings cards may help lower costs for branded GLP-1 pens, but discounts vary by pharmacy. If you're paying cash, check with your pharmacy about available savings programs.

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.

If prior authorization is denied, you can:

1. Switch to another cash-pay medication (if your provider approves).

• These options are more affordable, in stock, and usually ship in 1–4 days once prescribed. Ro offers:

  • Zepbound vials: Starts at $349/mo (plus membership fee)

  • Wegovy: $199 for your first month for a limited time (plus membership fee, $499/mo (plus membership fee) thereafter

  • Compounded semaglutide: $254/mo (plus membership fee)

  • Daily Weight Loss Kit: $119/mo ($357 billed every 3 months and includes membership)

2. Possibly appeal the decision

• We’ll work with our insurance concierge to determine if there’s an option to appeal. For those that we are able to appeal, about 30% get approved. 

  • If an appeal is possible for you, we’ll message you to walk through next steps.

  • If we can’t appeal, we’ll walk you through your options to pay cash.

3. Pay cash for higher-cost options 

• Ozempic and Zepbound pens can be expensive, ranging from $900–$1,100/mo. (plus the $145/mo Body membership fee). 

• If you go this route, we’ll help you explore manufacturer savings cards that may reduce the price.

We know this isn’t the news you were hoping for, and we understand how frustrating and overwhelming it can feel. 

You’re not alone — your provider is here to help you. Message them in your Ro account if you want guidance on which option is best for you. 

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 denied, you have 3 options. You can:

Switch to paying cash for another medication available to ship in 1-4 days through Ro (if your provider approves)

• Zepbound vials: Starts at $349/mo (plus membership fee)

• Wegovy: $199 for your first month for a limited time (plus membership fee, $499/mo (plus membership fee) thereafter

• Compounded semaglutide: $254/mo (plus membership fee)

• Daily Weight Loss Kit: $119/mo ($357 billed every 3 months and includes membership)

These options are more affordable, in stock, and usually ship within 1–4 days once prescribed.

Pay cash for higher-cost options

• Brand-name medications like Ozempic or Zepbound pens can be expensive, ranging from $900–$1,100/mo.

• If you go this route, we’ll help you explore manufacturer savings cards that may reduce the price.

Cancel your Ro Body membership

• If continuing treatment isn’t the right fit right now, you can cancel anytime through your Ro account. 

We know this isn’t the news you were hoping for, and we understand how frustrating and overwhelming it can feel. 

You’re not alone — your provider is here to help you. Message them in your Ro account if you want guidance on which option is best for you.

Ro can’t help coordinate coverage for GLP-1 medications for government insurance plans — but depending on your plan, you may still have options to get started.

If you have Medicare, a Medicare supplement plan, or TRICARE: You can join the Ro Body membership and pay out of pocket for Zepbound vials or compounded treatments. Once you submit a treatment request, a provider will review your info to find the best fit if you’re eligible.

If you have Medicaid or any other government-funded plan: Unfortunately, you can’t join the Ro Body membership or pay out of pocket for treatment through Ro.

If you have a plan through the Federal Employee Health Benefits Program (FEHB): You can join the Ro Body membership and access our insurance concierge. They’ll coordinate your coverage and handle any approval paperwork!

Compounded GLP-1s are only available as a cash-pay option. Compounded semaglutide costs $254 per month. These costs do not include the monthly Ro Body membership fee.

Zepbound single-dose vials are only available as a cash-pay option. The costs vary by dose:

• $349/mo for 2.5 mg dose

• $499/mo for 5 mg dose

• $499/mo for 7.5 mg and 10 mg doses (with manufacturer offer)

These costs do not include the monthly Ro Body membership fee.

More on the manufacturer offer: LillyDirect is offering the 7.5 mg and 10 mg doses of Zepbound vials at a discounted $499 price—for first fills and refills.

To keep this discounted price for 7.5 and 10 mg refills: You must complete your next refill check-in within 45 days of your last delivery.

What happens if you miss the 45-day window? You’ll be charged the full price of $599 for a 7.5 mg refill or $699 for a 10 mg refill.

Once prescribed, both options ship directly to you in 1-4 days!