Startup Embraces Innovation and Tackles the Stigma of ED by Offering Treatment Online

JANUARY 09, 2018
Zachariah Reitano calls erectile dysfunction (ED) the male equivalent of a car's 'check engine' light.

“It’s the first sign of a far more serious underlying condition,” Reitano said. “It’s not sexual, but it manifests itself at that point in time because there are so many systems in the body that must work together for an erection to occur.”

Reitano, who first experienced ED at age 17, understands the embarrassment associated with the problem, and he wants nothing more than to eliminate the stigma and help other patients who have experienced ED. He recognizes that he is fortunate to have a father who is a physician and sexual health expert who helped him address the issue. He also realizes that not everyone has access to those resources. To that end, he and 2 business partners joined forces to found Roman, a cloud pharmacy for ED.

“It’s so stigmatized that men will often wait until less embarrassing symptoms reveal themselves because diminished erection is one of the first signs,” Reitano said. “It’s the only muscle in the body that grows in that way, and it’s visually recognizable. You’ll notice it first before the heart diminishes functionality.”

Why ED?
Reitano and his co-founders, Saman Rahmanian and Rob Schutz, created to be an end-to-end service for men’s health, handling everything from online diagnosis to treatment delivery. They are driven by the knowledge that less than one-third of men who experience ED seek treatment, and by an awareness that 80% of the Viagra that is purchased online is counterfeit. Most importantly, though, they recognize that ED can signal serious conditions like high cholesterol, high blood pressure, obesity, depression, diabetes, and heart disease. 

“These are basically the leading causes of death in the U.S.,” Reitano said. “For us, it’s about starting a conversation with someone at the earliest possible moment, when we could have a tremendous impact.”

Roman’s Design
Roman begins by asking patients a few questions about medical history and sexual health. Patients submit a photo and an ID, as well as a medication preference, if they have one. Within 2 hours, a physician licensed in the patient’s state of residence will determine whether a prescription is appropriate. If it is, the medication will ship to the patient’s home the next day. Patients also have an opportunity to speak with a physician if they choose. 

Roman is currently available in 14 states, and is accessible to 58% of the U.S. population. Because physicians must be licensed in the patient’s state, Roman is only available in those states where its doctors are already licensed.

Additionally, because there are layers of regulation that dictate telemedicine, pharmacy, insurance, and medications, Roman must satisfy a variety of state regulations prior to launching in additional states. If, for example, a state requires a video chat in order to establish a patient/physician relationship, Roman will expand to that particular state when it can satisfy that requirement. Because Roman does not accept insurance, the team is able to focus on other regulations.

“It’s complicated,” Reitano said, “but I think it goes to show that, unfortunately, complication is usually put on the patient. Our goal is to work hard to make sure we understand the regulatory landscape and to remove difficulty and confusion for the patient. We want to put all of that burden on Roman to make sure the patient has a unified experience.”

Reitano said the trend toward higher deductibles and lower insurance contributions creates unseen benefits for customers who will be paying more out-of-pocket. They will pay attention to how long they wait and whether the doctor follows up on time. Additionally, he said that in specialties where payment is generally out of pocket—like lasik for example—improving technology has resulted in diminishing cost.

What Roman Is Not
Roman isn’t a guaranteed place to get ED medication. In fact, some patients won’t be prescribed medications because their case is too complicated, or because treatment wouldn’t be appropriate, or because the symptoms don’t require it.

Reitano said the system is designed so that no one is financially incentivized to make a medical decision that wouldn’t benefit the patient. The physicians are completely disconnected from the pharmacists, and they are compensated for their treatment of the patient, regardless of the outcome. In the case of patients who aren’t given meds, they are referred to local qualified health centers that provide men’s health specialties, regardless of insurance.

“It doesn’t matter to us what happens as long as we take care of the patient,” Reitano said. “The goal of our company is to reduce every single barrier for patients. Any health issue is a speed bump preventing you from getting where you want to go. Roman’s mission is to remove those roadblocks as quickly and seamlessly and affordably as possible.”

Pharmacists at Roman
For pharmacists, the beauty of life at Roman is that no 2 days are alike. Because the entire process is designed to leverage technology, certain components of treatment can be automated, allowing pharmacists to spend more time on the nuances of their profession.

“They get to counsel, research on behalf of the patient, and make recommendations to optimize care,” Reitano said. “Leveraging software allows pharmacists to spend time on the patients instead of tasks.”

He hopes that Roman will be exciting for pharmacists because it offers them an opportunity to demonstrate the valuable medical expertise they have acquired. “When people ask questions about ED through Roman, they learn that it isn’t as simple as taking a pill to solve a problem,” Reitano said. “They talk with pharmacists about overall health and different lifestyle choices, and it’s amazing to see a pharmacist be able to spend 20 minutes helping a patient feel comfortable and safe.”

He also said that pharmacists aren’t defined by their ability to put pills in a bottle and ship it. In fact, he believes that’s the least interesting part of their job.

“Automation will take that off their plate,” Reitano said, “and they should be excited about that. It will allow them to focus on the reason they went into the healthcare profession: taking care of people. Amazon is great at shipping things, but it will not be great at what makes a pharmacist a pharmacist.”

He said though he isn’t a pharmacist, he believes the key to future success for the field is a focus on unique skills and value.

“Monitor the innovation to see where you fit within it, and look for things that can’t be automated.”

Alex Barker, PharmD
Alex Barker is the founder of The Happy PharmD, which helps pharmacists create an inspiring career, break free from the mundane "pill-flipping" life. He is a Full-time Pharmacist, Media Company founder, franchise owner, Business Coach, Speaker, and Author. He's also the Founder of Pharmacy School HQ, which helps students get into pharmacy school and become residents.
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