How insurance works with the Body Program

Ro does not accept insurance for the Body Program, which is cash pay only. Insurance concierge services for the cost of medications are provided through the Body Program. Our partner will work directly with your insurance provider to help with the process of determining coverage for your GLP-1 medication, which is paid for separately from the Body Program. At this time, those with any form of government healthcare coverage (including programs such as Medicare, Medicare Supplement Plans, Medicaid or TRICARE), whether primary or secondary, are not eligible for the Body Program. These plans typically do not cover the type of medication the Body Program may prescribe. Unfortunately, this means that those on Medicare or eligible for Medicare cannot join the Body Program.

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

If for some reason your insurance will not cover the cost of your medication, you’ll have the option to either pay for the medication out of pocket (typically $900–$1,600/month, depending on the medication) or cancel your Body Program membership. Given the cost of initial diagnostics, ongoing provider support, and insurance assistance, we are unable to offer refunds for previously incurred monthly membership fees.

Due to significant demand, Novo Nordisk — the manufacturer of Wegovy, Ozempic, and Saxenda — expects supply shortages of some of these medications. Novo Nordisk is anticipating that demand for Wegovy will continue to outpace supply. Patients may have difficulty filling Wegovy prescriptions at the lower doses of 0.25 mg, 0.5 mg, and 1 mg and Saxenda prescriptions through the remainder of 2023 and potentially beyond. We’ve seen that around half of patients are still unable to get access to the impacted Wegovy doses or Saxenda doses after 1 month of waiting.

We know these supply shortages are frustrating. If you’re prescribed a GLP-1 medication and there’s more than a 30-day delay from the time your prescription is sent to the pharmacy to when it is filled, we’ll issue a credit to your account so that your next month of the Body Program is free. Read eligibility requirements here.

We’re also taking additional steps to support new and existing patients on their weight loss journey. For example, our insurance concierge partner is frequently contacting pharmacies to look for available medication on your behalf. Our Ro-affiliated providers are also reaching out to patients to discuss how to manage their treatment plans in light of the shortages.

For patients just getting started, the first steps of the Body Program, before a prescription is filled, are unaffected by the supply shortage — including taking a metabolic lab test and connecting with a provider to review your health history.

The first step is to study the fine print of your current plan. Our insurance concierge reviews it to see if your GLP-1 costs can be covered without prior authorization (specific approval from your insurance company to cover your medication). This is the benefits verification stage, and at this point, nothing has been submitted to your insurance.

If the fine print doesn’t show automatic coverage for your GLP-1 medication, the next step is to submit a prior authorization request to your insurance company. Prior authorization is a decision by your health insurer that your medication is medically necessary. This allows your insurer to evaluate if the treatment is covered as a plan benefit (and if they can assist with payment).

It can be a complicated process that varies by insurer. That’s why we work with our insurance concierge to do the hard work of gathering your information, submitting your prior authorization request, and going back and forth with your insurance company.

It can take about 2–9 days, but once your insurer reviews the request, there are a few possible outcomes: 

• Approved with co-pay

• Approved with no co-pay

• Denied

Our partner works on locating a pharmacy with an available supply of GLP-1 medication to fill your prescription. (Unless you opt to send the prescription straight to a pharmacy of your choice.)

Our partner will continue to explore all possible options. At this point, your provider will determine whether another GLP-1 medication is clinically appropriate for you. If so, your provider will write a new prescription and the prior authorization process begins again. If all attempts for coverage have been denied and there are no other options, we’ll help you understand cash pay options to see if continued treatment is right for you.

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 can take about 2–3 weeks, but could take 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.

GLP-1 medications typically cost between $900–$1,500 per month when not covered by insurance. There are savings cards that drug manufacturers provide to help reduce costs. Each pharmacy may apply these savings cards differently, so your final costs can vary depending on where the medication is ultimately filled.

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.

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

At this point, our partner starts locating a pharmacy that has the medication in stock and will accept and fill the prescription based on your pharmacy benefits. Once confirmed, your prescription will be sent to the pharmacy to fill. 

Please note that our partner may need to restart the process of finding a pharmacy and sending the prescription if the initial pharmacy runs out of stock or decides they cannot accept the prescription for any reason (i.e., they have specific rules or limitations around which prescriptions they accept and fill, they only fill for certain plans, etc.). 

Don't worry—our partner is working hard to comb through all the options and reach out to multiple pharmacies on your behalf if that's what it takes.

Unfortunately, no. You can access and download a copy of your prescription in your Ro account, but it’s for reference only and cannot be used to fill or transfer your prescription.

Yes, but they may not be able to fill it. You can opt to send your prescription straight to a pharmacy of your choice during your online visit. You can also check with any pharmacy of your choice and let us know if they have your GLP-1 medication in stock. We'll work with our partners to see if it can be filled at that location.

No. If determined to be appropriate and in line with your healthcare goals, a Ro-affiliated provider will prescribe you an FDA-approved GLP-1 medication. Ro-affiliated providers are not prescribing compounded drugs for weight loss.

Once your prescription has been sent, a member of your Ro healthcare team will reach out with the pharmacy's details (name and phone number) via your Ro account chat. Note that the pharmacy could change due to several factors, so please be patient as we do our best to navigate these conversations with the pharmacy staff and find the best option for you, especially if it requires a few tries.

Our partner sends your prescription to a pharmacy and follows up to confirm that there’s medication in stock. If the pharmacy doesn’t have supply, our partner contacts others in your area to get your medication filled. On average, this process takes about a week. But if the medication is in short supply, this could lead to a delay in fulfillment up to a month.

Out-of-pocket costs from copays or cost sharing can range substantially. They depend on your insurance coverage and fulfilling pharmacy, especially if it's your local pharmacy. Your insurance company may share out-of-pocket cost estimations with us (but this only sometimes happens). If they do, we'll share it with you.

Novo Nordisk, the drug manufacturer of Ozempic and Wegovy, offers savings cards that can help offset the price of the medication. Review the information provided in the link carefully to see if you're eligible for savings.

In the case of Wegovy, you can use the savings card when you pay out of pocket and for insurance-approved prescriptions. When using the savings card, eligible patients can save up to $225/month on Wegovy.

In the case of Ozempic, you cannot use the savings card when you pay out of pocket — only for insurance-approved prescriptions. Eligible patients can save up to $150/month on Ozempic when using the savings card.

Please note that savings are not guaranteed and may vary by pharmacy. When coordinating payment for your medication, let the pharmacist know that you'll be using a savings card. Pharmacists usually require that you provide certain information detailed on the card.

Yes, we do this for you! Ro-affiliated providers survey the clinically appropriate medication options between Wegovy, Ozempic, and Saxenda. If your insurer denies your request for coverage for one of those medications, your provider will see if you’re eligible for the other (if clinically appropriate). Our insurance concierge will resubmit your prior authorization request if you’re eligible.

Yes, patients who are eligible for the Body Program can always pay cash for medication. This option makes sense if:

• GLP-1 medication is not a covered benefit under your plan.

• Your prior authorization is denied, and there are no other options.

• You're uninsured or don't want to go through insurance.

You get the same Body Program experience whether you pay cash for your medication or use insurance. Your Body Program includes our partner's help finding a pharmacy to fill your prescription as quickly as possible. It also includes ongoing support and coaching throughout your weight loss journey through the Ro messaging platform.

A quick reminder if you have government insurance:

At this time, you cannot participate in the Body Program if you have a government insurance plan, even if it's a secondary plan or you're willing to pay cash for medication.

Metabolic testing is required to participate in the program. It allows your provider to understand your metabolism to create a treatment plan that’s appropriate for you. Your provider will look at the following analytes: Hemoglobin, TSH, LDL Cholesterol, HDL Cholesterol, Total Cholesterol, Blood Urea Nitrogen (BUN), Creatinine, and Triglycerides.

Depending on how you choose to take your metabolic test, the price will vary.

You can use your insurance to test at any Quest location. Quest is in-network with most major insurers, but out-of-pocket costs will vary based on your insurance plan and deductible. Contact your insurance company to understand your coverage. If you test at Quest without using your insurance, the cash pay price is around $520.

You can also purchase an at-home blood collection kit through Ro for $75.

If you live in a state where Quest is not available (ND, SD, WY), we’ll automatically send you an at-home collection kit for no charge.