How Nurx built a business by giving users back control of their healthcare
When Nurx was getting off the ground, one of Edvard Engesaeth’s biggest fears was that someone would steal the idea. That, it turned out, was the least of their worries—and the only reason Nurx exists today is through simply getting the work done.
“What I’ve learned is, it’s all about execution,” Engesaeth said. “Perseverance is the most important characteristic of an entrepreneur. When you’re literally shoved into a corner, and everyone around you is saying no, you just keep going. You try to build up and maintain a positive attitude. Tap into friends, family, resources, just try to keep on going.”
Nurx is a telehealth platform looking to reimagine healthcare, though it is early in that journey and may seem a bit narrow right now. Nurx offers products delivered straight to your door: birth control, STI testing, HPV screening, and an HIV prevention drug called Truvada for PrEP (sometimes just referred to as PrEP). There’s an immediate trend that stands out in that list, though: they’re wrongfully stigmatized areas of health that Nurx wants to make more widely available, Engesaeth said. But like many other companies trying to collapse the friction between a patient and the treatment they need, Nurx focused on one thing from the get-go—birth control.
Nurx started in 2014 over a conversation between Engesaeth and his co-founder Hans Gangeskar, who he knew from high school. Engesaeth came to the U.S. from Norway— which has a single-payer system where there are neither major issues around accessing birth control nor any stigma associated with it.
Engesaeth has a clinical background, but that decision to move forward marked just the beginning of the process. The next weeks were filled with long emails sent blindly to experts in the field and professors around the country, like at the University of California, San Francisco. And they were almost taken aback when those experts started responding to their emails, offering their advice and encouragement (though there were plenty of “no”s along the way).
“Even though I was a doctor and we’d heard about the challenges behind getting birth control, we didn’t feel like we knew anything,” he said. “I’ll say about the Bay Area; there’s this culture of forward-thinking—you don’t necessarily get shut down with crazy ideas. It would have been very difficult to get where we are if we didn’t have help.”
The Nurx experience is simple: the patient downloads an app, is connected with a provider, does a brief consultation, and then gets access to the prescription delivered to their door. The conversation doesn’t end there, Engesaeth said. Just like any patient-provider relationship, Nurx aims to be a source of truth for any questions that a patient might have. All that is in an attempt to empower the user to take control of their healthcare and ensure they have the best possible healthcare experience.
“We need to see a shift in control from the provider to the end-user,” he said. “Right now the patient has a medical need, and then they’re at the mercy of a provider. When you go into the doctor’s office, in many cases, you don’t know what labs are being ordered, why they’re being ordered, and don’t know how much it costs. We want to put the user in the front seat and let them see what’s happening, and why it’s happening, and ask questions. Putting the patient in control is core to the company.”
That relationship-building is one of the keys to the success of Nurx, and really applies to any company, he said. Entrepreneurs need to gather as much information as possible when they are just getting started. Building those key relationships, which may one day turn into partnerships or investments, is one of the most important things to get right early.
It’s a deceptively simple user experience that obscures all the work that goes on behind the scenes. Like many products that seem straightforward on top, Nurx requires a complex network of partnerships and relationships with providers, partners, insurance providers, drug manufacturers, pharmacies, and plenty of other moving parts. Hiding those complexities behind a simple in-house build interface is what makes services like Nurx possible in the first place.
The company went through Y Combinator as a way to get up and running, as it was hard to get the attention of investors. After all, it’s in the healthcare space—a notoriously tricky industry—and it was a bit of a hard sell initially. Y Combinator served as an opportunity to get access to a big network of advisors and the attention of investors.
Within three days of launching, the product ended up getting national attention on a variety of channels. Nurx was growing 30% every week and shifted its focus to finding as many ways to stay in touch with their user base as it continued to expand rapidly. Those lines of communication are critical to the company’s success, Engesaeth said, and part of the reason why it sustains a high Net Promoter Score in the 90s.
Nurx earlier this year brought on early investor and former COO of Clover Health Varsha Rao as CEO. Rao said she felt it was a natural fit when they asked her to join.”When I saw the [NPS and size of the customer base], I thought wow, there's something amazing going on here and wanted to help take it to the next level."
Birth control and Truvada PrEP are just two drugs of many that have a stigma around them. They can be both logistically and socially hard to get, Engesaeth said. Access to those drugs varies around the country as well. All this leads to millions of patients who need a wide array of drugs but can’t get access to them.
That also means that access to Truvada PrEP and contraception are just one slice of medicine that Nurx hopes to address. Nurx also now offers an STI detection kit and hopes to continue to address those holes in treatment that millions of patients need. There are around 20 million women who live in areas considered to be “contraceptive deserts,” Engesaeth said, and 1.1 million Americans that should be on PrEP.
Access is also just one part of the problem. Healthcare costs are increasingly getting out of control, and fewer people are getting access to the care they need, he said. That’s made it more important to try to shift the balance of power back to the patient when it comes to their coverage.
That, in the end, is just going to require more work and more perseverance. It means finding more help, working with more partners, building better networks, tools, and more of those invisible pipes that are hidden away behind an app. And at the end of the day, the best thing an entrepreneur can focus on is just doing the work, he said.
“Don’t give up—it’s gonna be better the next day,” he said. “There are lots of people that want to see you succeed. Surround yourself with the right people. All founders have been in the exact situation as you, they just want to help you, and they want to see you succeed.”