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.

Ro and Ro-affiliated providers are taking additional steps to support new and existing patients on their weight loss journeys.

If you’re prescribed Wegovy or Saxenda:

• Your pharmacy will add you to their waitlist for medication if they don’t have supply.

• Your provider may also make adjustments to your treatment plan if they determine it’s clinically appropriate. These adjustments may include prescribing alternate GLP-1 medications (if appropriate), working with you to create a personalized treatment plan, or recommending adjustments to diet, lifestyle, and current fitness activities.

If you’re just getting started:

• The first steps in the Body Program are unaffected by the supply shortages — including taking a metabolic lab test and connecting with a provider to review their health history. If a provider ultimately determines Wegovy or Saxenda is a good fit, the sooner you join the program, the sooner our team can send your prescription to get filled at your preferred pharmacy.

• Remember that we’re also expanding our medication offerings to include Zepbound and compounded semaglutide. Contact your provider in your Ro account chat if you’re interested in either medication.

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

Due to several factors, it’s difficult to say precisely when you’ll get medications after prior authorization is approved. One we learn that you’re approved, we’ll send your prescription to your preferred pharmacy and they’ll confirm that there’s medication in stock. If your pharmacy doesn’t have supply, they’ll add you to a waitlist for when medication becomes available.

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 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:

• Compounded semaglutide costs $450 per month of treatment.

• Branded GLP-1s (like Ozempic, Zepbound, Wegovy, and Saxenda) typically cost about $900–$1,500 per month of treatment without insurance.

There are savings cards that branded GLP-1 drug manufacturers may 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 we’ll look into whether that pharmacy can fill your prescription.

If you’re prescribed a branded GLP-1 (like Ozempic, Zepbound, Wegovy, or Saxenda) and your coverage is approved, we’ll send your prescription to your preferred pharmacy and they’ll confirm that there’s medication in stock. If your pharmacy doesn’t have supply, they’ll add you to a waitlist for when medication becomes available.

Due to medication shortages, patients prescribed Wegovy and Saxenda are often waiting more than a month for their medication to be filled.

To help you get medication faster, we’ve expanded our medication offerings to include:

• Zepbound: A new FDA-approved medication for weight loss. The active ingredient is tirzepatide, which is the same as Mounjaro. If prescribed, you’ll get it at your preferred pharmacy.

• Compounded semaglutide: The active ingredient is semaglutide, which is the same as Ozempic and Wegovy. If prescribed, it will be shipped to you within 5-7 days.

• If you’re interested in either of these options, send your provider a message in your Ro account chat. They’ll walk you through the next steps to see if another medication is right for you.

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.

Ro can only offer compounded semaglutide that is filled at one of our partner compounding pharmacies at this time, as they have been vetted for quality. If you're interested in switching to the compounded medication offered by Ro, you can reach out to your provider in your account chat.

If you’re prescribed a branded GLP-1 (like Ozempic, Zepbound, Wegovy, or Saxenda), we’ll send your prescription to your preferred pharmacy. Once sent, we’ll reach out with the pharmacy’s details (name and phone number) in your Ro account chat.

If you’re prescribed compounded GLP-1, we’ll send your prescription to our partner compounding pharmacy to be filled. You’ll get it shipped to you within 5-7 days.

If you’re prescribed a branded GLP-1 (like Ozempic, Zepbound, Wegovy, or Saxenda), we’ll send your prescription to your preferred pharmacy and they’ll confirm that there’s medication in stock. If your pharmacy doesn’t have supply, they’ll add you to a waitlist for when medication becomes available. 

Due to nationwide medication shortages, patients prescribed Wegovy and Zepbound are often having trouble filling their prescriptions. 

To help you get medication faster, we've expanded our medication offerings in some states to include compounded semaglutide, which contains the same active ingredient as Ozempic and Wegovy. If prescribed, it will be shipped to you within 1-4 days.

If you’re interested in compounded semaglutide, send your provider a message in your Ro account chat.

If you’re using insurance to help cover medication costs, know that copays can range substantially and depend on your insurance coverage and fulfilling pharmacy. If your insurance company shares estimated copay information with our team, we'll pass it along to you.

If you decide to pay cash for your medication, costs are:

• Compounded GLP-1 offered through Ro: $450/mo of treatment

• Branded GLP-1(like Ozempic, Zepbound, Wegovy, and Saxend): ~$900–$1,500/mo of treatment

This does not include the one time cost of lab testing or monthly Body Program membership fee. To learn more about estimating medication costs, go to this section of your Body Program Guide.

Some drug manufacturers offer savings cards that can help offset the price of the medication. Review the information in the link carefully to see if you're eligible for savings.

For Ozempic, you cannot use the savings card from Novo Nordisk 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.

For Zepbound, Eli Lilly is offering a savings card program through the end of 2024. Through the program:

• People who have commercial insurance that covers Zepbound may be eligible to save up to $150/mo.

• People who have commercial insurance but don’t have coverage for Zepbound may be eligible to save up to $563/mo off of the full list price.

Savings cards 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.

Because compounded semaglutide is not made by the manufacturer of branded semaglutide, there are no savings cards available.

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.

Cash pay is always an option if:

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

• Prior authorization is denied, and there are no other options for coverage.

• You're uninsured or do not want to go through insurance (and also do not have a government health plan).

• You want medication quickly and are interested in compounded semaglutide (which is $450 per month and is not covered by insurance).

• You’re willing to pay about $900–$1,500 a month for branded GLP-1s like Ozempic, Zepbound, Wegovy, and Saxenda.

You can take your test at any Quest location or purchase an at-home blood collection kit through Ro for $75.

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

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.