This is a fantastic idea and could do a lot of real good. Any plans to get your hands on a distribution agreement for small molecule or peptide oral formulations?
I write a GLP1 newsletter and would love to learn more about what you’re building and how you see the landscape.
Reta looks like it will make it out by early next year but I personally think they’ll squeeze in to end of this year — there will likely never be a undersupply of GLP1s again and I wonder if the customization loopholes will hold (Lilly will certainly fight Reta compounders harder than they have others), interested to hear your thoughts and chat.
I think most people on gray market GLPs will vary their dose, take tolerance breaks, etc to meet their personal weight loss goals, this stuff isn't that complicated. Where I think where the real technology opportunity is, is having a personalized endocrinologist for TRT/HRT. Bodybuilders have incredibly sophisticated trackers with hormone/ester PK models and the ability to adjust and tune your personal model based on bloodwork results. Most men's clinic, online or in person, are nowhere near as advanced. Prescribing for most of these guys is binary, or adjusting your dose is something that's done in response to some sort of a problem like hematocrit or gyno, rather than trying to keep levels in-line with whatever health goal you have. I don't think most guys really need the full TRT dose of 140 mg/week to feel energetic again, but depending on your fitness goals you can go well beyond that safely as long as you are paying close attention. There have been a couple of "high tech HRT" apps but I don't think they are really all that sophisticated, maybe daily dosing or includes a tasso device or whatever, but nothing afaik with multi-hormone PK modeling and testing feedback, so it could be right up your alley.
The dosing starts out surprisingly simple. The magic is in the feedback loop: asking the patient how they're feeling, if they're getting the effects they want, and then having their doctor review and approve a new dose.
Point taken that RUO people are just yoloing this, I was one of them. Now, I can tell you that having a doctor in the loop with my health is very helpful.
I guess I'm trying to figure out what the secret sauce is that makes this a YC company, there are at least dozens, probably hundreds of telehealth GLP prescribers, manufacturing it yourself doesn't really seem like a value-add, all of them will compound with B12 for the reasons you mention elsewhere, it's hard to believe that "tell your doctor you're having side effects and they will adjust your dose" is a YC-worthy innovation. What am I missing?
Previous YC founder so they’re already connected and vetted. Since then they’ve proven another 0-1 success with masks and manufacturing. Now they’re onto something very obviously hitting tailwinds.
The investment is peanuts to the fund. You’re missing the full-story deck and if they’ve shown traction it seems like a no brainer.
(btw for Lloyd the founder, Jason hired me right here from HN for ownlocal. It was my first professional software job. You guys made my career. Thank you)
This 100% aligns with my experience. Peptides are easy and you can mix different GLP1s to get the desired effect of appetite suppression, food noise and metabolic boost via Tirz, Reta and Elora (don't use Cagri btw), but things start to get hairy with TRT/HRT. You really have to do blood work and getting it wrong has serious consequences.
You know the answer was obvious and I didn’t think to submit this to ycombinator since the idea is basically you’re front running a compounding pharmacies. This is combining a compounding pharmacy and an MSO.
At the same time, nothing is stopping you from hiring a fractional medical director and doctors alongside NP. I ran the numbers and 50k is is all you need to get a service agreement with a compounding pharmacy, back office tasks, incorporation, social media marketing policy to essentially drop ship your product as you use off the shelf products for charting and then begin expanding state coverage.
The July Medicare glp1 coverage also makes this most opportune.
Biggest barrier I thought was / is the credit card processing. You need to carry a certification for that.
HIPAA not an issue, BAA with most orgs that offer a saas products.
So damn. The glue isn’t really hard. Really didn’t think this would qualify as an ycombinator mvp. But here I am used
To pitch decks promising exponential growth of subscription for cloud services.
As for personalized peptides in general, are you going to be marketing non FDA approved ones?
Or just stick with what’s already popular, generic wegovy, zepbound, etc. the market seems highly thin as a new MSO appears everyday using smartiq alongside med spas that offer more questionable inpatient services.
While manufacturing controls supply chain / logistics, the external pressure from every compounding pharmacist scaling into peptides now makes me wonder the longevity abo it this. You can literally pop on subreddits and see the flavor of the month telemedicine practice offer teaser rates of $99 for 60mg/month tirezepatide.
Oh and not forgetting the elephant in the room, gray market and china manufacturing which allows anyone with a telegram account to directly order whatever chemical name they read with no doctor oversight. It’s what, sub $1/mg now from the major vendors for tirezepatide?
You seem to know a lot about this, and I was nodding along with a lot of your points as I was reading.
I was Stripe's first customer in 2010, so we solved the credit card processing issue :) it turns out that being in YC is good for more than just money.
You are right about HIPAA, everyone thinks this is much harder than it actually is, but GCP, OpenAI, Linq, everyone has given us a BAA.
We're definitely not trying to go after the market of people that are comfortable buying from Chinese suppliers and risking their health. When I built my mask factory, our masks were absolutely more expensive than Chinese masks, but what people were buying was a guarantee that it would meet certain filtration requirements. Some people are willing to pay for safety, but it's not important to everyone.
The only thing I really disagree with with you on is that this isn't a YC-scale company.
We are growing 56% compounded week -over-week, and I have every expectation we'll do $10 million this year, $100 million next.
We are making something that people are already buying and getting it to them in a safer, more cost-effective way.
Hey, I love the idea and the fully integrated approach! The feedback loop sounds great, and overall far better than the pretty generic companies I've dealt with for GLP before.
I've led building an EHR totally from scratch at one company and currently advising another as they build their EHR, both totally integrated approaches in industries where you usually have lots of disconnected care (adolescent serious mental illness and ABA/autism care). The state-by-state regulatory challenges are very real! If you want to chat, my email is in my profile!
Fascinating. I work in this space sort of, there's still a ton I don't understand. What is the legal space like? Are you at risk of being shut down on a dime if the FDA decides Lilly can meet demand? Are you able to compound small molecules legally like orfoglipron? Are you only going after tirzepatide, or are mono agonists too available to justify? Are you ready for the retatrutide gold rush when that gets approved?
My experience with semaglutide has been incredible. I went on it to help lose weight while waiting 6 months to get an appliance for newly diagnosed sleep apnea. My primary care didn't have appetite to prescribe it so I went through a telehealth. The telehealth at least gets you a prescription but it's a really impersonal funnel. Then you get locked into a really rigid process. The 1.5 mg oral was amazing. But then I hit the plateau. The obvious things to do was up the dose. I did that - the next dose was 4 mg and after a couple weeks had total gastroparesis and vomiting for 1-2 weeks. During this time I couldn't take the drugs, had to drop the dose to titrate back up, and gained some weight back over the next month or so. I was able to up the dose again but you can't cut the pills due to the coating so I instead alternated 1.5 mg and 4 mg pills for a couple weeks. I had to do this by not taking the 1.5 mg pills for a few weeks to build up enough of a reserve. The company I was using was totally inflexible with regard to helping me gradually ramp the dose up. The alternating eventually got me to 4 mg and I was steady on that for a while but ultimately had a couple incidents of puking. I really need something like a 3mg pill. I tried skipping a day every few because the long half life should in theory make that a reasonable way to lower the daily average dose, but then the food noise comes right back. I really need like a 3 mg pill but I cannot get one. I decided that I was done with it and went to cancel but found out that if I cancel early I need to pay $450 cancellation fee. :)
Despite having a PhD and working in obesity drug r&d I have found this one of the most complicated, stupidly inflexible, frustrating spaces I've ever seen. If I'm getting my ass kicked like this, I can only imagine what everyone else is experiencing.
The frustrating thing is I really want to be on this drug. I have latent/sub clinical HS which results in chronic low grade armpit pain - I have not had that on glp1s, my sleep apnea has improved, I've lost weight, my anxiety and ADHD have improved. But I just can't get the right dose.
Looks interesting. What's your plan on the legal front? Bet the company on the compounding lawsuits breaking in your favor, or do you have a backup plan?
BTW: when you say you manufacture the drugs, I assume that means you're buying from an API supplier, but do you actually mean you're synthesizing it yourself?
We are co-manufacturing the API, and then we are bringing it in-house in the next 9 months.
The legal cutout that we have is on the personalization front, which is very well protected. The trick is that most compounders are not actually personalizing, and we are. Our feedback loop allows us to do real personalization on a week-by-week basis.
Congrats on the launch. I had a vague idea about personalized medication, did not know it was the VC style scaling of 10m$->100m$ ARR business!
There are some messages here complaining about the website being claude(ish). I know HN has people that care about this. They should. Mostly they would be right. But i don't see it being relevant here. Complaining about this business's website is like fluid-mechanics engineers at NASA complaining about friction dynamics on office floor-carpeting instead of rockets.
This is a really beautiful site. Thank you for sharing it.
I think the only thing that separates us is that we manufacture the drugs and probably own more of the supply chain than they do. But they're doing a much better job on the front end.
Yeah, they are pretty polished. But I've been with them for a few years and in the beginning their site was very much not polished, however, their products, service, and focus were a beacon.
Haha, entirely my fault but the default font greys out the text so I always just click through to the site instead of reading the Launch HN / Show HN copy. Regardless, I will take my well-deserved brickbats.
The path to RonanRx is fairly unconventional. During the pandemic, I built one of the largest mask manufacturing factories in the US. We could make a million masks in a day. We converted raw polypropylene pellets into finished pallets of masks.
Building a startup, everything is important, but you do have to stack rank. This is getting to the point where it's probably the most important thing. And it won't take that long to fix.
Please have a human rewrite your site copy. Literally every second sentence is a Claudish rhetorical contrastive. Maybe shallow/unfair, but especially when dealing with something medical I’d love to know that it’s not slop all the way down.
It’s funny, it’s obviously understandable why someone would vibe code a placeholder website, we’ve all probably done it. But I’m realizing a basic unstyled html thing with minimal copy is probably a better signal at this point for startups, it makes it clear you are still working on it rather than giving up the impression you might think your vibeslop is the finished product.
Fair criticism. It is AI slop all the way down. The only thing we focused on was the clinical aspects of the onboarding and the technical ability to be able to legally write a prescription and make and ship drugs, which was very complicated. We were able to accomplish this in less than 10 weeks. But I have not had time to go through all the marketing, and I apologize.
>Around the same time, I decided to try and lose the weight I had gained while building the factory. I ate nothing but chicken for six months. While this diet got some results, I plateaued. My doctor suggested tirzepatide, a GLP-1 medication.
This is a poor diet, where are the carbs and fats? So you dieted badly, and your conclusion from this is to use GLP drugs?
Did you ever try a moderate deficit over long periods of time?
We run a public benefit app called macrocodex which is completely free, no paywall, no subscription, and it produces guaranteed weight loss or gain within 2 to 4 weeks.
Most people never see a weight loss plateau; you can read the reviews if you are skeptical of the claims.
Problem with GLP-1 agonists is that it's very easy for a person to crash their diet.
In GLP-1s drug use, the primary cause of weight loss by reduction in appetite/desire to eat -> you eat less -> calorie deficit -> weight loss
Deficit doesn't really go away! So it's funny when people say "calorie deficit doesn't work but GLP drugs do", I wonder if they believe GLP-1 have secret fat melting property or something.
This is a fantastic idea and could do a lot of real good. Any plans to get your hands on a distribution agreement for small molecule or peptide oral formulations?
I write a GLP1 newsletter and would love to learn more about what you’re building and how you see the landscape.
Reta looks like it will make it out by early next year but I personally think they’ll squeeze in to end of this year — there will likely never be a undersupply of GLP1s again and I wonder if the customization loopholes will hold (Lilly will certainly fight Reta compounders harder than they have others), interested to hear your thoughts and chat.
I think most people on gray market GLPs will vary their dose, take tolerance breaks, etc to meet their personal weight loss goals, this stuff isn't that complicated. Where I think where the real technology opportunity is, is having a personalized endocrinologist for TRT/HRT. Bodybuilders have incredibly sophisticated trackers with hormone/ester PK models and the ability to adjust and tune your personal model based on bloodwork results. Most men's clinic, online or in person, are nowhere near as advanced. Prescribing for most of these guys is binary, or adjusting your dose is something that's done in response to some sort of a problem like hematocrit or gyno, rather than trying to keep levels in-line with whatever health goal you have. I don't think most guys really need the full TRT dose of 140 mg/week to feel energetic again, but depending on your fitness goals you can go well beyond that safely as long as you are paying close attention. There have been a couple of "high tech HRT" apps but I don't think they are really all that sophisticated, maybe daily dosing or includes a tasso device or whatever, but nothing afaik with multi-hormone PK modeling and testing feedback, so it could be right up your alley.
The dosing starts out surprisingly simple. The magic is in the feedback loop: asking the patient how they're feeling, if they're getting the effects they want, and then having their doctor review and approve a new dose.
Point taken that RUO people are just yoloing this, I was one of them. Now, I can tell you that having a doctor in the loop with my health is very helpful.
I guess I'm trying to figure out what the secret sauce is that makes this a YC company, there are at least dozens, probably hundreds of telehealth GLP prescribers, manufacturing it yourself doesn't really seem like a value-add, all of them will compound with B12 for the reasons you mention elsewhere, it's hard to believe that "tell your doctor you're having side effects and they will adjust your dose" is a YC-worthy innovation. What am I missing?
Previous YC founder so they’re already connected and vetted. Since then they’ve proven another 0-1 success with masks and manufacturing. Now they’re onto something very obviously hitting tailwinds.
The investment is peanuts to the fund. You’re missing the full-story deck and if they’ve shown traction it seems like a no brainer.
(btw for Lloyd the founder, Jason hired me right here from HN for ownlocal. It was my first professional software job. You guys made my career. Thank you)
This 100% aligns with my experience. Peptides are easy and you can mix different GLP1s to get the desired effect of appetite suppression, food noise and metabolic boost via Tirz, Reta and Elora (don't use Cagri btw), but things start to get hairy with TRT/HRT. You really have to do blood work and getting it wrong has serious consequences.
You know the answer was obvious and I didn’t think to submit this to ycombinator since the idea is basically you’re front running a compounding pharmacies. This is combining a compounding pharmacy and an MSO.
At the same time, nothing is stopping you from hiring a fractional medical director and doctors alongside NP. I ran the numbers and 50k is is all you need to get a service agreement with a compounding pharmacy, back office tasks, incorporation, social media marketing policy to essentially drop ship your product as you use off the shelf products for charting and then begin expanding state coverage.
The July Medicare glp1 coverage also makes this most opportune.
Biggest barrier I thought was / is the credit card processing. You need to carry a certification for that.
HIPAA not an issue, BAA with most orgs that offer a saas products.
So damn. The glue isn’t really hard. Really didn’t think this would qualify as an ycombinator mvp. But here I am used To pitch decks promising exponential growth of subscription for cloud services.
As for personalized peptides in general, are you going to be marketing non FDA approved ones?
Or just stick with what’s already popular, generic wegovy, zepbound, etc. the market seems highly thin as a new MSO appears everyday using smartiq alongside med spas that offer more questionable inpatient services.
While manufacturing controls supply chain / logistics, the external pressure from every compounding pharmacist scaling into peptides now makes me wonder the longevity abo it this. You can literally pop on subreddits and see the flavor of the month telemedicine practice offer teaser rates of $99 for 60mg/month tirezepatide.
Oh and not forgetting the elephant in the room, gray market and china manufacturing which allows anyone with a telegram account to directly order whatever chemical name they read with no doctor oversight. It’s what, sub $1/mg now from the major vendors for tirezepatide?
You seem to know a lot about this, and I was nodding along with a lot of your points as I was reading.
I was Stripe's first customer in 2010, so we solved the credit card processing issue :) it turns out that being in YC is good for more than just money.
You are right about HIPAA, everyone thinks this is much harder than it actually is, but GCP, OpenAI, Linq, everyone has given us a BAA.
We're definitely not trying to go after the market of people that are comfortable buying from Chinese suppliers and risking their health. When I built my mask factory, our masks were absolutely more expensive than Chinese masks, but what people were buying was a guarantee that it would meet certain filtration requirements. Some people are willing to pay for safety, but it's not important to everyone.
The only thing I really disagree with with you on is that this isn't a YC-scale company.
We are growing 56% compounded week -over-week, and I have every expectation we'll do $10 million this year, $100 million next.
We are making something that people are already buying and getting it to them in a safer, more cost-effective way.
Off by one letter compared to "Roman", which is a GLP prescriber farm, but you already knew this :). Hoping for a lawsuit to boost your fame?
https://en.wikipedia.org/wiki/Ro_(company)
I guess I don’t look at company Wikipedia pages very often but this one seems particularly “written by corporate”.
Hey, I love the idea and the fully integrated approach! The feedback loop sounds great, and overall far better than the pretty generic companies I've dealt with for GLP before.
I've led building an EHR totally from scratch at one company and currently advising another as they build their EHR, both totally integrated approaches in industries where you usually have lots of disconnected care (adolescent serious mental illness and ABA/autism care). The state-by-state regulatory challenges are very real! If you want to chat, my email is in my profile!
I will reach out. Thank you!
Fascinating. I work in this space sort of, there's still a ton I don't understand. What is the legal space like? Are you at risk of being shut down on a dime if the FDA decides Lilly can meet demand? Are you able to compound small molecules legally like orfoglipron? Are you only going after tirzepatide, or are mono agonists too available to justify? Are you ready for the retatrutide gold rush when that gets approved?
My experience with semaglutide has been incredible. I went on it to help lose weight while waiting 6 months to get an appliance for newly diagnosed sleep apnea. My primary care didn't have appetite to prescribe it so I went through a telehealth. The telehealth at least gets you a prescription but it's a really impersonal funnel. Then you get locked into a really rigid process. The 1.5 mg oral was amazing. But then I hit the plateau. The obvious things to do was up the dose. I did that - the next dose was 4 mg and after a couple weeks had total gastroparesis and vomiting for 1-2 weeks. During this time I couldn't take the drugs, had to drop the dose to titrate back up, and gained some weight back over the next month or so. I was able to up the dose again but you can't cut the pills due to the coating so I instead alternated 1.5 mg and 4 mg pills for a couple weeks. I had to do this by not taking the 1.5 mg pills for a few weeks to build up enough of a reserve. The company I was using was totally inflexible with regard to helping me gradually ramp the dose up. The alternating eventually got me to 4 mg and I was steady on that for a while but ultimately had a couple incidents of puking. I really need something like a 3mg pill. I tried skipping a day every few because the long half life should in theory make that a reasonable way to lower the daily average dose, but then the food noise comes right back. I really need like a 3 mg pill but I cannot get one. I decided that I was done with it and went to cancel but found out that if I cancel early I need to pay $450 cancellation fee. :)
Despite having a PhD and working in obesity drug r&d I have found this one of the most complicated, stupidly inflexible, frustrating spaces I've ever seen. If I'm getting my ass kicked like this, I can only imagine what everyone else is experiencing.
The frustrating thing is I really want to be on this drug. I have latent/sub clinical HS which results in chronic low grade armpit pain - I have not had that on glp1s, my sleep apnea has improved, I've lost weight, my anxiety and ADHD have improved. But I just can't get the right dose.
Looks interesting. What's your plan on the legal front? Bet the company on the compounding lawsuits breaking in your favor, or do you have a backup plan?
BTW: when you say you manufacture the drugs, I assume that means you're buying from an API supplier, but do you actually mean you're synthesizing it yourself?
We are co-manufacturing the API, and then we are bringing it in-house in the next 9 months.
The legal cutout that we have is on the personalization front, which is very well protected. The trick is that most compounders are not actually personalizing, and we are. Our feedback loop allows us to do real personalization on a week-by-week basis.
Congrats on the launch. I had a vague idea about personalized medication, did not know it was the VC style scaling of 10m$->100m$ ARR business!
There are some messages here complaining about the website being claude(ish). I know HN has people that care about this. They should. Mostly they would be right. But i don't see it being relevant here. Complaining about this business's website is like fluid-mechanics engineers at NASA complaining about friction dynamics on office floor-carpeting instead of rockets.
Does this move the needle on affordability or insurance coverage for these drugs? $500/month for Tirzepatide is not something most people can afford.
edit: I see significantly lower pricing than e.g. LilyDirect. Does this work with HSA/FSA reimbursement, too?
I'm a big fan of, and customer of AgelessRx - https://agelessrx.com
Good luck with your venture!
This is a really beautiful site. Thank you for sharing it.
I think the only thing that separates us is that we manufacture the drugs and probably own more of the supply chain than they do. But they're doing a much better job on the front end.
You're welcome.
Yeah, they are pretty polished. But I've been with them for a few years and in the beginning their site was very much not polished, however, their products, service, and focus were a beacon.
I'm curious, when you say you're creating vertical integration—are you tackling GMP manufacturing and fill finish as well?
Really loved this approach. I want to ask what peps are you starting off with and how would this approach work competing with grey market ROU peps?
Also is there a way to contact you? I have some personal questions as a fellow pep user.
>so we took a software approach to building our factory.
I wouldnt step inside the building, its probably going to fall down every other sprint for the first few years.
I see what you did there, and I approve this joke.
Familiar name. Same guy who made the masks during COVID-19?
Second paragraph, “During the pandemic, I built one of the largest mask manufacturing factories in the US”
Haha, entirely my fault but the default font greys out the text so I always just click through to the site instead of reading the Launch HN / Show HN copy. Regardless, I will take my well-deserved brickbats.
Second paragraph:
Yeah. Armbrust Inc. It's me.
You manufacture the drugs yourself? That's impressive, and it feels like an interesting company.
Your website sucks though. We can tell you vibe coded it quickly and didn't put much thought into it.
Yes, we incorporated the business 10 weeks ago, and we've been focusing everything on the infrastructure of the actual product people are getting.
These messages are very helpful, though, to help motivate me to get our team to fix this, so I do appreciate it.
I think you should focus on the fundamentals, this kind of feedback is inevitable and I'm sure you anticipated it anyways.
Building a startup, everything is important, but you do have to stack rank. This is getting to the point where it's probably the most important thing. And it won't take that long to fix.
Please have a human rewrite your site copy. Literally every second sentence is a Claudish rhetorical contrastive. Maybe shallow/unfair, but especially when dealing with something medical I’d love to know that it’s not slop all the way down.
It’s funny, it’s obviously understandable why someone would vibe code a placeholder website, we’ve all probably done it. But I’m realizing a basic unstyled html thing with minimal copy is probably a better signal at this point for startups, it makes it clear you are still working on it rather than giving up the impression you might think your vibeslop is the finished product.
Fair criticism. It is AI slop all the way down. The only thing we focused on was the clinical aspects of the onboarding and the technical ability to be able to legally write a prescription and make and ship drugs, which was very complicated. We were able to accomplish this in less than 10 weeks. But I have not had time to go through all the marketing, and I apologize.
Ironically even this comment feels AI generated :/
My wife tells me all the time I sound like AI. I blame my childhood.
I blame your fine-tuning.
She’s been doing supervised fine-tuning since 2017.
>Around the same time, I decided to try and lose the weight I had gained while building the factory. I ate nothing but chicken for six months. While this diet got some results, I plateaued. My doctor suggested tirzepatide, a GLP-1 medication.
This is a poor diet, where are the carbs and fats? So you dieted badly, and your conclusion from this is to use GLP drugs?
Did you ever try a moderate deficit over long periods of time?
We run a public benefit app called macrocodex which is completely free, no paywall, no subscription, and it produces guaranteed weight loss or gain within 2 to 4 weeks.
Most people never see a weight loss plateau; you can read the reviews if you are skeptical of the claims.
Problem with GLP-1 agonists is that it's very easy for a person to crash their diet.
In GLP-1s drug use, the primary cause of weight loss by reduction in appetite/desire to eat -> you eat less -> calorie deficit -> weight loss
Deficit doesn't really go away! So it's funny when people say "calorie deficit doesn't work but GLP drugs do", I wonder if they believe GLP-1 have secret fat melting property or something.
Have you tried a GLP-1?