“When I was 17, I experienced erectile dysfunction.” My interviews with startup founders rarely start so candid. But to destigmatize the business of his new company Roman and empathize with customers, Zachariah Reitano is getting vulnerable.
“I think in a good way I’ve become numb to the embarrassment” says 26-year-old Reitano. “I remember the embarrassment of having the condition with no solution and that’s much worse than sharing the fact that I had it and was able to fix it myself.”
It’s the result of Reitano’s quest, a full-stack reimagining of the prescription process for men with issues maintaining an erection. Patients fill out Roman’s online medical history questionnaire that’s securely transmitted to a doctor for review, and if they’re a safe and appropriate candidate for erectile dysfunction (ED) medication, they can instantly get a prescription written for Viagra, Cialis, or generic drugs.
That prescription can be filled anywhere, or at Roman’s in-house cloud pharmacy that packs the pills by dose so they’re more mobile than those orange medicine bottles and you only take the right amount. Roman costs $15 for the online doctor’s review, with the pills competitively priced. It earns margins through volume and by ditching the retail pharmacy overhead. The speed and ease of the system could deter men from buying often-fake pills online.
Roman is funded by a $3.1 million round led by General Catalyst that also includes Initialized, Box Group, and Slow Ventures, as well as angels like Y Combinator partner Aaron Harris, Benchmark’s Scott Belsky, and the CEOs of Casper, Code Academy, and Pill Pack. With only 30% of men who have ED getting treatment, and 80% of Viagra bought online being counterfeit, these investors see how Roman could dramatically improve the men’s health experience.
From Patient To ePharmacist
Reitano’s first signs of ED at age 17 set off warning bells in his Dad, a sexual health doctor. The founder says “it’s like a men’s check engine light. ED is often a symptom of far more serious underlying conditions because [having an erection] requires many systems to work in harmony, including circulation and hormones.”
His dad knew this, and brought him in for a stress test at the doctor. While on the treadmill, Reitano’s heart stopped and he collapsed. After heart surgery, he was prescribed medication which had a side effect of ED. Reitano kept this private, and over the years his heart healed and he was able to go off the medication. Eventually he began his first serious romantic relationship. But this February some of his heart conditions returned while working as an Entrepreneur-In-Residence at Prehype.
“I was prescribed the same medication as after my initial heart procedure” Reitano glumly recalls. “It was one of those scenes in the movies where the doctor says something and you blur out everything else. I had a partner for three years and I knew this was going to affect my relationship with her.”
That’s when he realized the ED patient experience was so broken. It can take a month to get a doctor’s appointment, you have to travel there and have awkward conversations with receptionists and doctors, and then deal with pharmacy once prescribed medication. Avoiding all this leads men to buy Viagra without a prescription from sketchy unregulated online pharmacies, where pills are often adulterated with floor wax, paint, and printer ink.
So with his co-founders Saman Rahmanian, a co-founder of office management startup Managed By Q, and Rob Schutz, VP of growth for BarkBox-maker Bark & Co, Reitano started Roman.
20% of people in their 20’s experience ED. 30% of those in the 30s, 40% of those in their 40s. Reitano says his goal is to “educate the public about ED, that’s it’s less about sex and more about a person’s general health.”
Potential patients can check out Roman risk-free, as they’re refunded if they’re not ellgible for medication or have too complicated of a case for telemedicine. Roman now employs 20 doctors who keep the consultation fees but pay Roman a monthly subscription to work with its customers, who can request follow-up phone or video calls. Roman’s intake forms eliminate much of what doctors waste time doing during in-person visits. Its automation systems flag issues while streamlining obvious approvals or rejections so docs can focus on more complex cases.
Patients are typically prescribed four to ten doses per month, which can range in price from $2 to $65 per dose depending if they buy brand name or generic. But to combat abuse, Roman won’t send someone more than 10 doses per month.
Now with Roman’s patient, physician, and pharmacy apps ready for use, it’s not the code but the code of conduct that Reitano agonizes over. When asked what keeps him up at night, he told me “The first part of the Hippocratic Oath: do no harm.” Reitano says that before, if an app he made didn’t work, “the worst thing that happens is no one uses it.” The stakes are higher building a health company. But he’s confident that “we can build a platform where [doctors] make fewer mistakes than in person” because Roman’s systems are double-checking for medication interactions and other issues.
Roman will have to compete with the status quo of silent suffering, laborious doctor’s visits, dangerous online pharmacies, and other startups as it gets going. One site, Lemonade Health, serves ED prescriptions too, but it also handles birth control, flu, STDs, acne, and hair loss. Reitano stresses Roman’s focus on ED ensures patients work with expert doctors who can answer all their questions.
Now Reitano is Roman‘s first customer. As for him and his girlfriend, he tells me “We’ve overcome the challenge together. We’re both on board about sharing our experience. If my coming out makes it easier for someone without treatment to get treatment, my embarrassment pales in comparison.”
And while men might be scared to broach such a sensitive subject with their partners, Reitano happily concludes that “When you trust someone with something that personal, I think they are complimented by it, and she has reciprocated that trust. I think it has opened up our relationship even more.”