Hims’s Chief Executive Officer Andrew Dudum said that price isn’t patients’ only concern.

“Aside from the convenience and costs saved by not having to travel to the doctor or pharmacy, you gain access to a personalized consultation with a physician,” Dudum said. The company sells its drugs on a cash basis, outside of insurance that will sometimes cover costs of a doctor or drug through the regular system.

Roman declined to comment.

“They might never knowthey could have gotten itfor five bucks.”

Pfizer Inc., which brought Viagra to market, and Merck & Co., which sold Propecia, spent years and millions of dollars convincing men they needed the drugs. In 2017, in the final months before generics hit the market, Viagra cost $61.54 per 100 milligram pill, while Propecia cost $2.51 per pill before it lost its patent in 2013. Once the drugs went generic, the companies’ marketing and branding efforts essentially stopped. The startups have stepped into the gap, rebuilding the brand—and the price.

“The genius isn’t the product; it’s how they’re offering it,” said Nelson, the hair patient, who deleted his own Instagram account after a photo of his regrown hair that Hims reposted on the company’s account resulted in a flood of messages.

The companies have also faced questions about some of their practices, in particular the promotion of prescription drugs for off-label uses. Hims advertises an antidepressant for premature ejaculation, and a blood pressure drug, propranolol, to stop stage fright. Neither use has been approved by the Food and Drug Administration.

There's also nothing to stop people from taking advantage of Hims’s and Roman’s low-cost doctor consultations, then moving their prescription elsewhere to be filled. Both Hims and Roman say they will send prescriptions to another pharmacy, raising the possibility that the startups will take the expense of gathering new customers, then lose their long-term business.

Drug Unicorn
Investors have shoveled money at the startups. After a new fundraising round in January, Hims was valued at about $1 billion, according to PitchBook. Last month Roman raised $85 million, valuing the company at $500 million, according to PitchBook.

Their success has also attracted competition. Blink Health, a drug-discount startup that pitches low prices on generic drugs, recently added a men’s health telemedicine offering that undercuts Hims and Roman, charging $6.95 for 10 sildenafil pills and $8.95 for a month’s supply of finasteride. There’s also Chickpea, which sells supplements to women with cystitis; Cove, for migraines; Kick Health for propranolol; and Keeps for hair loss.