A telehealth startup that sells erectile dysfunction pills online has raised $88 million to tackle another common health problem: smoking. But doctors have expressed concern about the price of the new service.
Roman was founded 11 months ago by 27-year-old CEO Zachariah Reitano, Saman Rahmanian and Rob Schutz. It raised $3 million in 2017 to sell erectile dysfunction medication over the internet. A competitor, Hims, which also sells anti-wrinkle creams and prescription hair-loss medications, raised some $97 million around the same time, according to Pitchbook.
But Roman—renamed “Ro”—is raising its own big series A from investors like Reddit cofounder Alexis Ohanian’s Initialized Capital, and General Catalyst, among others, for the stop-smoking subsidiary, dubbed Zero. Men’s Health will remain Roman, a second subsidiary of Ro. (Forbes Media has an investment in Ro.)
“No one’s ever combined the prescription, the over-the-counter medication, and then asked to help people track their progress in a system that’s integrated with the physician, the EMR, and with the pharmacy all under one roof,” says Reitano. “It’s trying to take the luxury of in-person clinical medicine and spread it throughout the country.”
Zero will sell a “Quit Kit” online consisting of three items: prescription medication bupropion, a nicotine gum and a behavioral support app that will let users track their progress, communicate with their physician and read “personalized physician treatment guides.” Potential customers are screened by a Zero-employed physician to determine whether their smoking habits and medical history allow them to qualify for a kit. The cost: $129 a month.
“Wow, that’s expensive,” says Carlos Jaén, head of family and community medicine at the University of Texas Health Science Center at San Antonio. Patients could get treatment for much less. He says, though, it is a good thing for there to be more places where smokers can receive evidence-based help.
Under the Affordable Care Act most health insurance plans are required to cover at least 90 days of an FDA-approved smoking cessation medication. Some are also required to cover individual, group or phone counseling too. Ro does not accept health insurance for its ED medications or its Quit Kit, Reitano says, though it’s something the company plans to add in the future.
Neal Benowitz, a leading researcher in nicotine addiction at the University of California, San Francisco, pointed to the National Cancer Center Network’s guidelines that recommend combining behavior therapy with either varenicline (brand name Chantix) or combination nicotine replacement therapy, which includes the use of a nicotine patch and a short-acting NRT like a nicotine gum, lozenge or inhaler. (Benowitz consults for Chantix manufacturer Pfizer and was an author of the 2018 NCCN smoking cessation guidelines.)
Zero’s Quit Kit, which Reitano says was developed by “medical experts in the field,” instead uses bupropion, which is also recommended according to 2008 guidelines developed by the Tobacco Use and Dependence Guideline Panel. The Quit Kit uses the nicotine gum, the company’s medical experts say it is easier to titrate than a nicotine patch or lozenge.
Reitano decided not to offer Chantix because it’s more expensive than bupropion. Chantix retails for $490 on average for a one-month supply while bupropion is closer to $30, according to GoodRx. Bupropion is an antidepressant that can have side effects ranging from dry mouth to seizures. The screening process that Zero uses before writing a prescription aims to weed out anyone who is at risk for experiencing serious side effects of using bupropion. The company also notes that patients can talk with their physician through their app at any time if they’re experiencing less severe side effects like dry mouth or insomnia. (Chantix also has side effects such as seizures or, more commonly, sleep problems or nausea.)
“I think it’s an interesting product, but it probably wouldn’t be my first choice to say that every smoker should go out and buy it,” says Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital and a professor at Harvard Medical School. Rigotti said that she likes how the Quit Kit combines both a medication and a behavioral therapy, noting that some doctors may prescribe their patients a medication but fail to connect them to a behavioral therapy to compliment their medication.
Reitano founded Roman after dealing with ED himself, which turned out to be the first sign of an underlying heart condition he had, and later, a side effect of a medication he took for his heart. He says he’s always been passionate about medicine, though. In high school he invented and patented a “cane tip device” to help his parents who both used canes get around more comfortably. Reitano says he decided to focus on getting people to quit smoking when he found that a “double-digit percentage” of Roman customers who had purchased ED medication were also smokers. (Reitano would not disclose how many total customers Roman has had.)
“We really do view treating patients for life and building members for life. If we weren’t concerned about the underlying health of our members, we wouldn’t start to attack things that could potentially cannibalize existing business,” says Reitano, referring to smoking being one of the causes of erectile dysfunction. “I think we're putting our money where our mouth is and saying, ‘These are the things we want to help people solve. We want to get them healthier, and we want to help them remove the health roadblocks of their life.’ "
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