Truepill is a business-to-business telehealth startup that's quietly managing a tech-driven, seamless operation behind the scenes of the booming digital healthcare industry

From mobile OBGYN care to personalized vitamins, the direct-to-consumer model has taken off in pharmaceutical healthcare retail.  In fact, the global ePharmacy market is expected to reach $109.2 billion by 2025, growing at a CAGR of 14.8%. Technology is elevating the healthcare retail experience, and it's only set to grow. Thanks in part to successful marketing campaigns aimed at destigmatizing certain areas of healthcare, brands like hims and hers have successfully pioneered the telemedicine industry, while digital pharmacies like Capsule have taken off in New York City.

Operating behind the scenes of all these telehealth brands is an emerging powerhouse from San Fransisco, the business-to-business ePharmacy infrastructure Truepill.  PSFK caught up with founders Sid Viswanathan and Umar Afridi to learn more about Truepill's sophisticated technology, including automation and robust APIs, and why functioning as the man behind the curtain for the DTC pharmacy industry was the perfect strategy:

PSFK: What are some of the broader trends you see impacting healthcare retail today, and that you're leveraging in your work?

Sid Viswanathan: The pharmacy industry is a really large category. It's about a 350 to 400‑billion dollar category. In many ways, a lot of what's being done in pharmacy hasn't changed for several decades.

It's the same retail pharmacies that we've all become familiar with. It's the same insurance players that have really dominated the market.

In the last three years or so since we came onto the scene, there's been a massive shift in healthcare where patients can go online, consult with a physician around a range of clinical and therapeutic topics and receive a prescription for a specific condition.

The missing piece in all this has always been how to get the medications to the patients. How can we do it reliably and in a scaleable way across all 50 states in the country?

Similar to companies like Nurx in the birth control space or Hims in the hair loss space, we are the pharmacy partner behind the scenes that's actually bringing the medication to the patients' doors.

What we've seen in the last few years is a huge emergence of a number of other brands, like Hims and Roman, that are actually getting the product sent out. We've done this, too, at scale through a combination of our APIs, our software dashboards and our fulfillment centers.

PSFK: Why did you decide to focus on pharmacy healthcare? What gaps did you notice in the industry, and how did that lead you to found Truepill?

Umar Afridi: My background is in pharmacy. I was a retail pharmacist for 10 years before starting this company. During my time working as a retail pharmacist, I was basically taking note of all the manual processes that we do in pharmacy that result in the terrible experience our patients have.

From the outside, customers see lines in the pharmacy. Behind the scenes, there are things happening causing these kinds of problems. For example, as a pharmacist, if I have a question about a prescription, the way that I would contact the doctor is print the prescription off, scribble a note on it and then fax it to the doctor. It's like this black hole. We never know if we're ever going to get a response, or when.

The patient, however, will turn up expecting the prescription to be ready. No one can find it, because we haven't received a response on it. There's like a $600 copay or something. Then the customer is stuck. They have to wait another day for the doctor to reply. All of these types of elements created a really bad experience for both patients and everyone else working in that environment.

With delivery, it's more convenient. You can even consolidate all of the volume and have low cost. You can increase access to medication to areas where certain ones might not be available. You don't need 10 retail pharmacies within a square mile. You might need one or two and can move everything else over to home delivery.

This is essentially the direction that things are going to move in. By building the infrastructure as well as the technology, we're positioning ourselves to be the entity that powers that transition.

We started talking to founders in the space who were producing these kind of direct‑to‑consumer physician experiences where patients can go through this magical experience of having a consultation with the physician and having a prescription written at the end of it.

The idea formed that if there was a super‑efficient fulfillment center connected via API to these existing direct‑to‑consumer companies, we could make it one seamless service. From start to finish, patients would just have this super convenient, easy‑to‑use system.

In 2016, we set out to open the pharmacy. We went through the whole regulatory compliance process to set up our fulfillment center. We continued to talk to customers, figuring out more pain points around the software to solve those issues.

We have a facility in New York that should be live in the next few months. We just got our pharmacy license approval for our facility in Manchester in the U.K. We are expanding our capacity internationally as well as combining that with automation, with the aim to be able to fill 100,000 prescriptions a day in the U.S.

PSFK: Truepill is a business‑to‑business company. Who is the Truepill consumer? Who is reaching out, and what is the process for when they do?

Sid: When we refer to our customers, we're talking about the brands like a Nurx, or a Hims. In many ways, the way we position ourselves in the market is we go to our partners and say, “We are effectively your pharmacy infrastructure component. We are your white label pharmacy. We are here to represent your brand.”

If you went online and shopped at Nurx for a product and received medication at your door in the following days, the existence of Truepill is actually obfuscated from the whole experience.

We quietly operate behind the scenes to get all of the infrastructure, the heavy lifting of securing the medication, the supply chain for the medication, the delivery, the packaging. It comes to consumers in a neatly packaged design in a box that represents the brand. Really, we are the white label pharmacy that operates behind the scenes.

If you asked a consumer or the end patient, they might not even know who Truepill is. And that's fine, because we're here to power these existing businesses who are trying to build their own brands.

This is the key piece that differentiates us from every other pharmacy on the market. We're allowed to stay very clear in our value prop that we're not doing anything direct‑to‑consumer.

We're not like a retail pharmacy that's trying to get in front of customers and build our brand presence. We're not like some of the other newer direct‑to‑consumer pharmacies that are also trying to build a brand presence. We actually are happy and excited to be in our world where we think it's a much larger opportunity to power these existing brands with large patient populations. We're only just scratching the surface with some of the initial customers that we're working with.

PSFK: Truepill uses a technology-first approach, an important strategy in the digital age. Could you speak to how this serves current consumer expectations?

Sid: I think about what we experience every single day in our ecommerce lives in terms of our experience shopping on Amazon, dealing with subscribing, saving and Prime. Those ideas haven't been translated over to the experience in the pharmacy world.

If you are a mail order customer of an existing insurance network, we can point to a number of examples online where you would go to their website, you would download a form, you would fill out that form and you would fax it back to get onboarded into the mail order program.

That gap is where we see the biggest opportunity of growth for our business. Coming from a software angle, we know how to build this experience. We have already built them, and we know how to translate this to a legacy industry.

To us its a huge miss when customers are dealing with chronic-illness and life‑saving medications. The experience is just so poor. We think that a technology-first approach is what will solve that.

PSFK: Looking to the future, where do you see Truepill in 3-5 years?

Umar: Right now, we've been focused on the direct‑to‑consumer customers. We're talking to drug manufacturers about powering their DTC, helping them get more distribution when they come out with new medications. We're talking to smaller PBMs, the Pharmacy Benefit Managers, powering their mail order so that they can compete against some of these other big PBMs. It's clear that they want to assume mail order, but they've never come across a service  that their patients actually want to use. It's always a terrible experience, and they never get anyone using it.

It's a clear benefit that if we come in, we can fill that gap and provide an amazing ecommerce‑like experience for their patients. It'll cost their employers and sponsors a lot less money versus having patients pick up at retail. It's also massively more convenient. You'll see massive improvements in adherence when the patients are getting their medications every month delivered directly to them.

Across the whole ecosystem, it's basically lacking in technology. We are approaching all of these problems in a technology first way, combining all of that with automation to make it a lot more efficient, and figuring out ways so that we can add more value.

Umar Afridi, co-founder and CEO, and Sid Viswanathan, co-founder and president.


Truepill is improving the pharmacy experience by making ecommerce possible for telehealth brands. For more from similar inspiring services, see PSFK's reports and newsletters