ℹ️ Overview
We’re excited to share a transcript of our talk with with Sahir Jaggi (SEAS'17), the founder & CEO of Forus. Sahir shared with us some insights behind his founding journey, his approach to fundraising, and Forus's positioning on medication access.
🗞️ Transcript
CIT:
Good evening everyone. Thank you for being here. We’re excited to host Sahir Jaggi, Founder and CEO of Forus. Forus has built one of the most ambitious companies in healthcare infrastructure, rethinking how medications actually reach patients in a system where prior authorizations, appeals, specialty routing, and affordability layers often determine whether a prescription ever gets filled.
In just a few years, Forus has scaled rapidly and recently crossed unicorn status, not by building another point solution, but by embedding directly into clinical workflows and tackling one of the most painful operational bottlenecks in care delivery. Tonight, we’ll explore Sahir’s founding journey, what it really takes to build in regulated healthcare, how Forus moved from early traction to durable scale, and where he believes the future of medication access is headed.
Sahir, you spent years at Oscar Health thinking deeply about care delivery and payer mechanics. When did you know it was the right time to leave Oscar and start Forus?
SAHIR:
At Oscar, there was a signal that when we made things simpler, people really loved it, and that was why we got to keep the company in the first place. Oscar now has a couple million members as an insurance company, and a lot of it's just because it's simpler to work with in some ways. So if we could replicate that in some way that wasn't inextricably tied to the insurance company, that would resonate.
In 2022, a couple of things happened. One was that LLMs started showing a lot of promise, and in particular, they seemed like they were really good at two things that were really relevant. The first is digesting a lot of heterogeneous information, and the second is brute-forcing through stuff that would be annoying to do yourself. And those two things felt like, okay, well, if you package this together somehow, you can build an abstraction layer for people on top of complex and annoying processes. That felt really aligned with what I was hoping to do.
The second thing was that GLP-1s, Ozempic, started becoming really big. Historically, taking a medication you inject yourself with was a thing that a very small number of people thought about, a rare thing that people didn't think too much about. Actually, it wasn't that rare, but if you didn't have those conditions, you wouldn't think so much about it. And GLP-1s and Ozempic kind of brought that to the front and center of everyone's attention. For me, I spent a lot of time, for a number of reasons, reading a lot about what challenges people were facing with that part of the ecosystem. Even once they had a prescription, they couldn't get their medication. And I learned that that wasn't just specific to that one type of medication, but really prevalent across a lot of different types of medication that were becoming more and more common in the US. So there was a lot of searching over that year for me, but eventually it clicked on this business, which we ended up starting at the beginning of 2023, so we just turned three this month.
What we do, as Amesh mentioned, is we help people get access to medicine faster, easier, and cheaper. We're most impactful for people with high-cost and complex conditions: think things like autoimmune diseases, COPD, cancers — anything where the drugs are unaffordable without insurance coverage or financial assistance, or complicated supply chains, and where it might take a doctor and patient weeks of phone calls, research, and paperwork to get their medicine on time and affordably. What we're doing is using AI to take on all that complexity and abstract it from them, so people get their medicine without any of the burden falling on their shoulders.
What's great here is that we do all this entirely for free, because we use this core product to build a network of doctors, patients, and the data and transactions between them. We're actually using that network on the other side of our business to generate revenue through partnerships with life science companies — companies like Pfizer, Merck, Johnson and Johnson — helping them develop and commercialize new drugs faster and more efficiently. It's really a two-sided model.
We've been working with real doctors and patients for a little over two years. That part of the business, we've been lucky, has grown almost entirely through word of mouth, largely because it's free. We now support almost 10,000 new patients every day, so we'll reach several million people this year. On the back of that momentum, we started partnering with biopharma companies about a year ago, and now work with a broad range of companies — ranging from some of the largest companies in the world, Johnson and Johnson, Eli Lilly, all the way through fast-growing biotechs. The company is still super early. We're about 85 people, all based in Soho. The whole office is like five blocks from here.
CIT:
That's fantastic. Thank you for walking us through that. Was there an impetus you had when you were at Oscar? It seems like it was a culmination of a lot of introspection, research, being out in the field, learning about care delivery and payment mechanics. Was there something like, "hey, it's time to pull the trigger and start Forus"?
SAHIR:
My story is actually a little funny. I actually tried to start a different company a full year earlier than I started this one. I actually quit my job, sent an email out to everyone being like, "I'm leaving, see you later." And then as I was doing that, I actually started fundraising, too, and I had a specific investor, who I owe a lot to, basically tell me, "This idea is not good. People are going to let you fundraise, but you're going to waste your own time working on something that's not good enough. And I can see in your face that you don't believe it's that good."
So I was actually at Oscar for a full year and a half before I started this company, ready to go, looking for stuff to do, and almost rushed it because I felt like I was behind. I had a bunch of friends who had started companies, really wanted to do something, and knew kind of conceptually what I was excited about — it was something in a similar range — but the business model didn't make sense. It wasn't going to grow quickly. It was okay. And he helped me see that I didn't want to have a company I didn't believe in, and I was kind of rushing it.
I actually ended up spending almost another full year at Oscar, but I'd already kind of quit — I moved off my team and all that other stuff. So I had this very weird scenario where I was like an employee emeritus. I didn't have any actual team, I didn’t have any actual role, I didn’t have a manager in Workday. I was just a floater. They were paying me a lot to not really do that much work — I really had like six or seven hours of real work a week. So I spent a ton of time that year basically just researching, digging around different stuff. I tried not to be too disciplined about it, because I wanted it to be organic. And eventually, when this idea clicked, I had just such a strong gut feeling after researching for a little while, which made it feel viscerally different from anything else I'd looked into. And so I felt really clear: this is something I'm excited about, this is something I really strongly believe will work, and if it works, I'd be excited to work on this forever.
CIT:
Healthcare is such a complex field to work in; there’s so many stakeholders. When you first started, was there something that you saw that people really didn't understand about the market? Were there early learnings you didn't expect — things you were maybe trying to debunk when you went from Oscar to founding Forus?
SAHIR:
There’s a ton of stuff. Even now, we're constantly learning stuff we didn't expect. I think there are two big parts that come to mind. One is things we believed were true that other people were skeptical of, and then things we thought were true that turned out not to be true at all.
On the first side, the thing that was really different about our business, which I just mentioned, is that we are giving away AI software instead of charging for it. For any of you who read the news or have your own companies, you're probably aware that AI software companies are making a ton of money when it's clicking, growing super fast, generating a ton of revenue. We felt confident that what we were putting together could also generate a lot of revenue and sell to a lot of providers and grow really quickly. But we had this view that long term, AI was going to cause software to increasingly become commoditized, increasingly become easier to create, and increasingly there would be general tools like Claude that would do a lot of stuff anyway. So you were kind of running really fast, but what you would be able to consider durable in the long term was unclear. Eventually the software would be free, or at least very inexpensive, and the high prices people are charging right now won't sustain. We’ll see how quickly that becomes true, but that was our belief.
So what we figured was, on the flip side, whatever we're doing right now that might be expensive to deliver in terms of the software service will also eventually become free, because AI will continue getting better and cheaper. We basically made a bet that we're going to give that away for free immediately — kind of like betting on that future — and instead try to front-run everybody else on distribution, get to as many doctors and patients as possible. So by the time everything becomes free, we're already there, and our business is built on the network we've built, as opposed to having slightly better software than the next guy.
I think that was fairly non-consensus initially, and people were a little scared of the costs, a little scared of how long it would take to get revenue. We didn't have a single dollar of revenue from our core customer until almost two years in, and people were like, "How long will this take? Five years?" It's a lot to bet on. It also made us a company very dependent on venture funding to exist — we just couldn't have built it without funding.
On the flip side, things we didn't understand: we thought the problem would be fairly tackleable with AI and software from the get-go, given our experience in the one insurance company we had worked at. It turns out the problem is way, way harder than we thought. It is unbelievable. I think we've been pretty radicalized at this point. We came from the side of a novel insurance company — we were like, "Oh, doctors commit a lot of fraud or whatever." And now our view is totally flipped: it's criminal what is happening to people in this country. It's kind of insane that this stuff is allowed and there's no plan on how to clean it up. So that's been interesting. We've constantly had to reinvent and reconsider how our product looks and how it works as we expand into new geographies, new specialties, and new types of patients, because there's just so much heterogeneity out there.
CIT:
You touched on a lot of good points I want to double-click on. For those who don't work in healthcare, it's also a very fragmented landscape, which makes it even harder to scale and come up with a nice go-to-market narrative. How do you think about operating in such a fragmented marketplace? It's very difficult to replicate one strategy in one geographic region with another, due to the insurers that exist there, the different hospital systems, there's so many core differences. And you also made a very bold decision to be free for providers. Can you touch on how you're thinking about that complexity in a fragmented marketplace?
SAHIR:
It's not clear the approach we took was correct, but it got us where we are, so it was good enough.
The thing we decided on early was: there are a ton of players, as you’re mentioning, and a lot of different types of players. We needed to pick a core customer — who are we serving, and what do we want to represent to them? That's going to be not only part of our brand messaging but also our differentiation in the short and long term. What we decided was: we are here to serve doctors and, by extension, their patients. For those people, we want to be a universal solution — you start working with us and you never have to worry about any part of the problem again. No constraint: any patient, any insurance, any geography, any pharmacy, any drug. We wanted there to be no constraint, because we wanted to be a no-brainer. That was very important, both from a brand identity and philosophy perspective, but also in terms of making it as easy as possible for us to grow. We didn't want anyone to have a reason to say no. We wanted it to be crazy to not use our product.
Committing to that meant we had to deal with that level of complexity. The way we did it was, we initially started very small — calling friends whose parents were doctors, cousins or something else, and getting a few of those folks on. We only worked with very small doctor's offices. Then when we started growing, we tried to do regional concentration, to really grow. One of our first biggest states was Kansas — random. We don't have any particular relationship there. We just happened to get a collection of practices in that area.
In parallel, we looked to find one way to really test ourselves. In addition to this focused stuff, we went and found a telemedicine company — a startup that was telemedicine-based and national — which meant they would basically immediately force us to deal with all sorts of random situations. What's interesting about telemedicine companies is not only are they nationwide, but the types of people who tend to use telemedicine are either tech-forward or people who don't have other good options. The people in the second category often have very weird or limited insurance situations, cost situations, financial situations. So you put a lot of different types of pressure on the system. But the good news was that the company was itself a startup, so we got to have a shared Slack channel with them. They were really understanding and flexible. And so we found these different ways to push ourselves really aggressively on how to get better and better at digesting all of this.
The one thing I probably would change looking back is: in addition to saying we would handle anything, we also said we would handle everything. Meaning, from the moment you wrote the prescription, all the communication, all the pricing, all the insurance coverage work, every single step in the process, we would do — all the way through to figuring out which pharmacies had the drug in stock. We were doing way too much stuff. Looking back, we probably should have done the universal thing, but done less initially. We ended up having to cut stuff back almost a year in, because we were growing too fast and couldn't keep all of it going without a lower quality of service. We probably would have been okay had we started a little bit narrower, but still universal, and then stepped forward from there.
CIT:
I love how product-obsessed you've been, and how intentional you've been with your decisions. It seems like it's also about honing in a little more narrowly on what's going to lead to long-term value creation. Are you guys still going to continue to be free for providers? That's a great way to build early distribution, and then over time, as you build this network out, you can start generating revenue. Now that you've had your recent fundraise, how is that strategy going to change?
SAHIR:
Think about the business — it's a network-based business. What matters most for us is: how big is the network, how many doctors and patients are using it, how healthy is the network, how consistently are they using it? That's the most important thing. All that matters is how big the network is.
An interesting analogy for our business is YouTube. If you think about it, doctors are kind of like our creators, patients are kind of like our viewers, and our clients are kind of like the advertisers. We're not doing ads per se, but they care more depending on how many patients and doctors are there. If YouTube didn't have any advertisers and they all suddenly pulled their contracts, YouTube kept growing and eventually a bunch of new advertisers replaced them, because it's so valuable to be able to talk to those people. On the flip side, if all the creators dropped away and they had a lot of advertisers, the business is finished. Our business is very much the same way.
So the most important thing for us is to continue to grow providers. We could definitely charge — some amount of providers will pay, and could pay a lot in absolute terms — but relatively speaking, the benefit for us of having an incremental 5% of the market is so much more valuable than whatever we could eke out, from a revenue perspective, from those people. We basically don't want to create any friction at all. We're trying to get to as close to 100% of providers in the country as possible. So yeah, it's free forever.
CIT:
I love that analogy. What would you define as success for medication access three to five years from now?
SAHIR:
The bigger picture on the company: what are we trying to do as we build this network? Make it easier for more medicine to be available to more people. We want to accelerate medicines that today are stuck at the molecule level and haven't been brought to market. We want to make it easier for those drugs to get into market, and once they're in market, we want to make it easier for those drugs to reach the people who need them.
When we think about success, as we grow and grow, we're getting to the point where, in some of our specialties, we already have a quarter of all doctors and patients in the country. By the end of this year or early next year, we're hoping to have as much as half of certain specialties. At that level of penetration, you can help with basically every step in the process.
Today, when making a drug, there are four big steps. There's discovery, where you come up with the molecules — that's all the AI drug discovery stuff you probably see in the news. Then there's development, where you run those drugs through clinical trials to improve efficacy and safety. Then there's launch, where you introduce those drugs to the market and doctors choose to adopt them or not, deciding their first, second, or third line therapy. And then the fourth is called accessibility — making sure patients who are prescribed them can actually afford them, negotiating with insurance companies, creating subsidy programs, et cetera.
There's a ton of stuff happening at the molecule piece, where you come up with a bunch of potential drugs. But to get through the other steps, you need a lot of data and decision-making, and then a lot of connectivity back to individual patients and physicians to move things through the process. That's the part that's really hard today, because these companies are reliant on low-quality data, a ton of consulting firms telling them what to do, armies of people on the ground with clipboards, and then the ads you probably see during the Super Bowl, on Instagram, and on the subway, to get people to participate in clinical trials, learn about new drugs, and make sure they’re aware when there are savings opportunities or financial assistance available.
Our goal is to make it so that the gap between what medicines exist for a patient and what medicines they actually have access to is only the science, and none of the complexity that sits in between. We started here and we're moving further and further back in the chain. Long term, our expectation is that in the specialties where we have the majority of doctors in the country, we will actually be the people who make it faster, easier, and cheaper to bring drugs to market, so more molecules will be translated into drugs that are actually available to people, and more people will get the right one faster.
CIT:
For anyone not in the healthcare space — and this might even be a naive question even for someone who works in it — this fourth part of the process, the accessibility part: prior authorizations are a big part of where you guys come in to help streamline. Is that something that's fundamentally broken, or is it something that just needs better infrastructure?
SAHIR:
For people who are not familiar: prior authorization is one step in getting certain things covered by your insurance company. Really what it looks like is there are a lot of things that are very expensive — expensive for the insurance company, or relatively expensive — and in order to make sure there's not a lot of waste in the system, insurance companies create a process through which a doctor needs to explain why they are ordering or prescribing or doing some procedure for a patient based on their clinical situation, what's worked, what hasn't worked, and why this is the right next step and why it's better than other things that might be cheaper or preferred by the insurance company.
At an abstract level, it's a reasonable thing, it makes sense. There's a lot of waste and fraud and abuse in the system, and it's also actually a good check on certain doctors who are a little trigger-happy — doctors who just love doing surgery because it makes money, you want some checks on them so they’re not abusing the system and abusing their patients. The challenge is that implementing it is very challenging, and today it's become this nightmare morass of paperwork where nobody knows what the rules are. The whole point is you should follow the rules, do the right thing, but the rules are not even clear, so people can't even do the right thing anymore. It's just this weird guess-and-check model that makes things slower.
The really negative outcome is that even people who are going through the process — which everyone agrees is the right process — are still getting delayed for no reason, or sometimes fall off the process entirely and never get the therapy or treatment they're supposed to get.
A lot of what we're doing on that side is making it so that the gap between what someone should get and what they are getting comes to zero — not skipping past the process. I think it's good to have someone checking the system. You just want to make it so that all that needs to be true for the person to get what they need is actually the right answer. All the data that needs to be captured, the processes you go through — all that can happen automatically, without requiring any individual to bear the burden of waiting for someone with a lot else on their plate to finally get to some manual task. My guess is the problem will probably go away, not because they get rid of it, but because it's running more smoothly in three to five years, and then all the challenge will just be in the policies: how strict or loose is the insurance company, and how closely does the doctor follow them? But the good thing is that can be much more based on regulation and research, and no longer just about complexity.
CIT:
That totally makes sense. When it was the end of the 20th century, you had a lot of entities come up, like pharmacy benefit managers, designed to reduce drug costs. Part of it was having checks to make sure drug spend didn't go so high. But now what we've seen is more of a monopoly. There have been a lot of lawsuits and regulations. It seems like exactly what you guys are building really helps take the burden off the patient and gives them the access they need.
I want to change gears, because we have a lot of founders, operators, and investors in the audience. I want to learn a little more about your fundraising journey — how you thought about it from the first round, the seed, versus some of the more recent rounds, how you thought about it, what you were optimizing for and looking for when raising the first round versus your most recent fundraise.
SAHIR:
One thing I’ll say before I jump into this is fundraising is very situational, that's what I've learned. The right way to do it depends a lot on your specific circumstances: what you're doing, who you are, who you're trying to raise money from, what's happening in the market at that time. So it's hard to have great generic advice. You can have some, but I think it’s always murky. You hear tips like, "do this or that," or "halve the slide deck," or "send it in advance or don't." Those rules vary a lot depending on what's going on, so I'll talk about what happened for us, but I wouldn't tell you that this is advice for how you should operate yourself.
We've raised three rounds of funding to date: our seed, Series A, and Series B. We raised them each roughly a year apart — well, the last one was almost a year and a half.
We raised the seed in early 2023. That was a kind of interesting time, because it was right after a big lull in 2022. Even though people had kind of come back — this was after the big crash post-COVID — VCs in 2023 came in like, "I'm ready to go again." There just weren't that many companies fundraising, because people felt like the market was tough. So we had a relatively easy time fundraising then because VCs just didn't have a lot going on; they were bored. People were just excited to have a meeting with somebody! We got more attention in that round than I've ever gotten in my entire life, even before we had any business — just because there was nothing going on.
That helped a ton, and at that point I had nothing. It was just me and a loose idea. I had theoretical people I would hire — people I'd worked with at Oscar — but I didn't have specific names, just a list of like 10 people, and I figured half of them would say yes. The fundraise was basically just me with a set of slides.
I did it a little atypically in that I did about half the process before I even quit my job, because I was in that murky situation, and I had a bunch of investors I was very friendly with, like Kevin [Zhang (CC’14)], especially because I'd done that process a year before, where I’d thought about starting a different company. So I got to know a bunch of investors, and they'd been checking in with me. I had this nice thing, which I think is really valuable, which is when I was going in, a lot of the relationships I wasn't going into cold, they kind of had gotten to know me.
One of the things I think about a lot in investing is: how many new things are you forcing the investor to get comfortable with? In my mind, there are three things they have to get comfortable with in order to make an offer. Number one is you. Number two is your business. And number three is the funding round, how much money you need and at what price. If they have to meet all three of those at the same time, the burden for them to get to ‘yes’ is higher. But if you've knocked some of those things out beforehand, you only need them to get comfortable with one or two things. That makes things a lot easier.
At that point, people had gotten comfortable with me, but they didn't know my business or the amount. And the amount is probably the easiest of the three at seed, because for most investors it's just not that big of a deal — whether it's 3 million or 5 million or 7 million, people mostly don't care that much, most important is the person and the company. So a lot of that was hinging on people attesting that I was a person worth investing in, so those relationships helped a ton for me, and the process was fairly quick.
I had a pretty complicated idea, and I spent a lot of time trying to make it simpler. The hardest part for me in that process was not the conversations. I had this really full idea in my mind and would talk about it in a way that was too complicated — trying to tell people too much of my story. What I needed to do was dial it way back and make it much simpler. The best advice I got was to make slides where each slide only had a max of eight to ten words on it — just the headline. Somebody told me you should make a deck where there’s no content, just the headlines, and if someone just goes through the headlines, that's enough. So the biggest thing for me in the seed was learning how to simplify the story. I'm still not great at it, I still get in the weeds, but I've gotten a lot better.
We ended up raising seven and a half million dollars in that round. Thrive Capital, which was also the primary investor in Oscar, where I used to work, led that round. Part of what was exciting was they had led that big OpenAI round in 2022 and were already very motivated and had been looking into the space. They'd already gotten comfortable with the market a little, which helped me a bunch. There weren't a lot of companies selling into pharma at that point, so it was also a new market to educate people on. It wasn't trivial, but it was definitely the easiest of the three rounds I've done so far. Seed is always, I think, the easiest one of the three.
The Series A we did a little over a year later, when we had around 10 people and maybe 100 to 200 doctors using the product. But we had a big waitlist — something between 1,000 and 2,000 people on the waitlist on the doctor side. We were like, "Okay, this is a really good sign that people want to use this." We'd kind of proven one of the sides of the business. The problem was that our business didn't have any revenue, and it wasn't clear when we would. We thought we might not have revenue for another two years. So the challenge was: I had a business with a couple hundred users, no revenue, and I needed a lot of money to support the business for multiple years without revenue.
That round was much harder. We ended up having a great outcome — we raised $30 million led by General Catalyst, and then Thrive put in more, and some other folks invested. Kevin actually participated in all of our rounds to date—thank you, Kevin. But in that round, there was this kind of crazy dynamic where a lot of people felt like the business was looking good and they'd missed out, so they wanted to invest but were not willing to invest at the amount I needed. They were willing to invest half as much, and therefore also at half the price. So I ended up with basically two tranches of offers — a bunch for around $15 million, and a small number for $30 million or so, even maybe $25 [million]. So it was very painful, because a lot of the people we really wanted to work with just couldn't get there. They were like, "You're asking for too much risk, you haven't proven that much, and it's unclear how long this will take to bear out, because there’s a lot of risk in this."
What ended up happening was the firm we worked with, GC [General Catalyst], just had a lot more conviction in the market, and that's been the story for us the whole time. The business is complicated, the market is new to people, the model is weird, and it's capital-intensive. We really need people to believe in the long term to get comfortable investing, because we need a lot of money and don't have a ton to show for it yet.
The Series B we did most recently, in October/November. For the first two rounds, I did a real process — going out and pitching 20 plus people each time. The Series B was the first time we kind of had people poking around on their own, being like, "Hey, this seems like things are going well." They heard on the street that we were actually starting to make money, which made people feel like, "Okay, maybe it's real." That got people interested, and so people started sniffing around and poking at us. We were like, we want to prove a little bit more and get to a certain number of dollars before we ask for more money.
Between 2024 and 2025, the biggest difference was the market got crazy. Everything is moving so fast all the time, and people are copycatting. All the Claude and OpenAI and ChatGPT stuff is moving super fast. You just can't move slowly, because you're going to lose even if you're crushing it. If you're not moving quickly enough, you're going to get squashed. I'd heard when I first started that people would tell you, "Don't worry about competition, you'll lose from your own mistakes." But now I think that's no longer true. You actually have to be looking all around you and moving as quickly as you can.
I just felt we weren’t moving as quickly as we could. We needed more money to move faster, and so the Series B was much tighter. We basically spoke with a small number of folks initially — literally two firms who were really interested, firms I hadn't worked with at all before, which is was different, because the first two rounds involved people I'd known for a really long time. For the [Series] B, we had two firms who were interested. We had this cat-and-mouse thing where you want to get them interested but you don't want to give away too much information. You don't really know them, you're not sure where the information is going, and you want everyone to get information at the same time. You want everyone to feel FOMO but also not know if others are saying ‘yes’ and ‘no’ before they make their own decision.
Eventually they were very close but wanted some data. At that point, rather than giving the data, we brought in a few more folks we knew well, and did a very quick process with a single-digit number of firms, as opposed to going with 20 or 30 people. Luckily, this actually ended up being our most competitive round, because it clicked and we had enough momentum in the business. Again, though, we still had that bimodal outcome — almost everyone said yes, but we had two different ranges. Some people said they'd invest at around half a billion, and a bunch said they'd invest at a billion. Very different, and similarly, the dollar amounts are very different. But, luckily, each time we had someone who was willing to take that plunge.
So in this most recent round, we raised $125 million. So we have a bigger war chest to really invest and tackle with. We have almost the whole thing in the bank now. That's really what our focus is this year, using that to grow as quickly as we can. And I'm sure we'll do another round soon, for better or worse, because that's what you've got to do.
CIT:
I love how you pivoted on strategy based on how things are changing. Are there any characteristics that you’ve learned through these three fundraising rounds about what else they [investors] can provide to you and the team? Do you like when they’re more involved with some of the decision making, or do you like it when they’re more hands-off? Anything you look for — that you will look for in another fundraising round — beyond just the capital?
SAHIR:
We've been pretty close with our investors. Like I mentioned, I knew a lot of them, and they've been very involved. I'm generally pro trying to get people who are as helpful as possible. In my experience, building a company is very hard, and if people are willing to help you, you should take the help, as long as they're competent and genuine.
Some amount of it is advice, but a lot of what we get is connections — help with recruiting and finding talent, which is basically the hardest part of building a company: just getting people to work for you, getting really good people to work for you, and then getting better people to work for you. We've also gotten a lot of help with different aspects of being pushed to change — re-evaluating something we didn't realize we should be evaluating. One of the nice things investors have is they just see a lot of stuff and have a lot better pattern matching than you do. I've only ever seen three companies: one place I interned, my last job, and then this one. That's not a lot. My investors have seen tons of companies and seen inside them. So when I'm telling them, "Here's what's going on," they have a spidey sense: "This sounds weird," or "This is the kind of thing that's going to blow up in your face." I might not know that, so that's quite helpful.
The things that are more important to me are basically, A, people I feel like I can get along with. If I don't trust them and can't be friends with them, we're just not going to talk that much, and it's never going to be that useful. B, is that they really understand the business. Our business is complicated. Some people sort of understand it, and some people might not fully understand it and still be willing to invest — that's actually quite scary. You really want people to understand it, because eventually things are going to go wrong and you're going to need people to believe in it. In order to believe in it, they have to understand it. They have to be understanding and believing in the long term, and that being worth whatever pain or cost you're going to go through in the short term to get there.
Third, I do a ton of references. This is an easy thing you end up realizing is particularly valuable for this specific purpose. You can get on the phone with basically any founder at any company to get advice on how it's been to work with X investor, and they'll be very direct with you. There's a mutual trust that you use that information in good faith, even with investors that are currently on their board. At this point, I've probably done 70 of those calls in total, across different firms and investors, and you actually end up wanting to redo the calls on the same firm between Seed and [Series] B, because the people working at the firm change, and how they are useful for you at different stages of the company changes.
CIT:
It's so important to have people that understand the business to help you with damage control as things come from left field. Thank you. I want to open it up to the audience for any questions.
AUDIENCE MEMBER:
Thanks so much. You mentioned that in three to five years, you see the complexity of prior authorizations coming down to essentially policy and how doctors are implementing it. I’m sure you have opinions about how that policy should be implemented and whatnot. Do you see a world where Forus has either the data or the influence to change that policy and direct it in a way that would be most beneficial for consumers?
SAHIR:
Great question. Interestingly, right now, there's actually a ton of energy around this problem in the government. We and a bunch of other companies I know are spending a lot of time with CMS in particular — the Center for Medicare and Medicaid Services, which manages Medicare, Medicaid, and Obamacare — which, by trickle-down effect, influences a lot of how the rest of the system operates. We're specifically talking through this problem of coverage, identifying what insurance people have, authorizations, all these pieces, and talking through what it should look like, what the big problems are right now, what rules they should put in place, how those rules should be implemented, who should be involved.
The one wrinkle is that when trying to put stuff in place, the administration — rightly so — is still relatively risk-averse. Their default is to make things work based on the institutions that exist today. If you're a smaller or earlier company, it's very hard for them to rely on you for something infrastructural. They might let you participate in a new program, but they're not going to make you become humongous overnight, because that's very risky.
So it's kind of a two-part thing in my mind: A, we want to be influencing policy as much as we can by participating in the conversation, but B, we also just need to get bigger and bigger so it becomes clear that we can actually be part of — or the solution for — the part we want to impact. We're also spending a lot of time thinking about, what do we think this system is going to look like in a few years, and how do you work backwards from being in the right position? There’s an interesting thought on, are you trying to figure out a way to navigate today, but where do you think things are gonna land? And so for us, we're trying to imagine where things are gonna land and who we have to be partnered with to get there. So we're already building direct integrations with some of the plans, payers, and PBMs [pharmacy benefit managers], even though you might be surprised to hear we'd partner with those folks. We just need to get ahead of this kind of thing and make sure we're positioned the right way, so that in the long term, whatever ends up happening, we're able to, A, exist and B, create value.
AUDIENCE MEMBER:
I'm also building in clinical research, so this has been an incredible conversation to listen to. How do you keep the faith when you're building something so big that isn't turning revenue right away? I know you mentioned the waitlist of doctors, that’s an obvious and excellent data point. Were there other things you were paying attention to along the way?
SAHIR:
It's hard. A big thing is just making sure you have clarity on what value you're creating. For me, we felt really certain. We weren't sure exactly how we were going to package what we'd sell, exactly who inside the client was going to buy it, or exactly what they were going to pay. We felt really clear that we were driving impact and would be able to create something valuable. If you're doing something that's valuable for long enough, and enough people see it, rationally, someone will buy it. That's kind of how we’re thinking about it.
The thing that really helped the company stay motivated was the waitlist. Initially it was pretty stop-and-go in terms of how it was growing. Then there was kind of a flip about a year into the company, where it went from stop-and-go to very steady, and we could tell it was happening at an increasing pace. We hit some threshold where organic word of mouth was driving mild virality. It was growing organically and exponentially on its own. That means people really liked it and were telling other people they liked it. That alone was super powerful. It was like, okay, this core part is going to grow, and so part of our equation is working. Obviously, that was really important for us internally, but also really important for raising capital.
The other thing was we kept trying to explain the value prop to people and iterating on the pitch. There was a moment in May of 2024 when we went to a conference — we'd been to that same conference the prior year, and to another conference about three months before. At that conference, something about how we'd adjusted the pitch just started landing. We had around 20 conversations in three days and every single one landed. We were joking that had we waited an extra month and a half to do the fundraise and just played the recordings of those meetings, we would have been able to move all those people in this bucket over to invest, because it was so clear that people really saw the value, and we were going to have to go through the sales cycle, but people were gonna like it.
So all you need is to get to the point where you can convince yourself that there's a lot of value and that people want it, as quickly as you can — even if it's going to take another 12 months to get through all the paperwork and contracting and compliance with the client, which I think is important, especially in pharma or health.
CIT:
We have time for two more questions.
AUDIENCE MEMBER:
Sahir, thanks for doing this. You definitely understand how healthcare has a lot of different incentives, like insurance payers are incentivized differently, versus how a pharma company might be incentivized, versus a provider. My attention was really piqued when you talked about how you’re establishing connections with some payers, which don't inherently seem incentivized to establish connections with you. How do you navigate that conversation?
SAHIR:
The thing you learn when you spend a bit of time in the market is that most people and most entities — especially if you go far enough up in the organization — are just not that one-dimensional. Their goal, similar to ours, is success. There are a bunch of different ways that can move forward, and you just have to figure out what the right packaging is, and the right pitch is, to make it clear that by partnering, there's an opportunity for them to be more successful. What you’re saying is that you'd think a payer or insurance company would not want to partner with us, because we're making some of the process easier for doctors and patients — a process that they control — so theoretically we're letting more people through the system, and it's more expensive for them. True. But at the same time, one of their number one administrative costs is all the doctors and nurses on their side administering this process, which is very expensive for them and really convoluted in how it works. They pay a ton of fees to the existing infrastructure for very low value, despite how poorly it runs. Some of these insurance companies are paying literally $10 per form they’re receiving. You can imagine how much money that is.
They're seeing a ton of frustration from providers, patients, and employers, and in the media they're getting totally torched. The government is also on their case about this. They need to make change. And then fourth, we are getting big. That’s the most important piece for us specifically, that we are growing quickly. For us, it's always been this thing where we're constantly intermediating people, and you need to go from the point where you're small enough that people are like, "that's annoying, let's crush them," to "that's annoying, but they're probably too big for us to squash, so I guess we have to figure out how to play ball with them" as quickly as you can, and then you find ways you can actually help them.
So a lot of what we've worked through is just: hey, we're going to be here, there's going to be a new system. You need to make change. Let us help you. We're not asking for money, and they’re not taking money from us. It's just: we're both here, we're going to be here, and it'll be easier if we're partnered. We're not about press releases or anything. Just make sure everyone's your friend.
AUDIENCE MEMBER:
Quick question around your hiring from zero to 70. What do you think your key hires were, whether it be the first couple of people you convinced from Oscar to join you, or the 70th hire? And as you go forward, while trying to balance this goal of getting to 100% of providers in the US while also monetizing, how are you thinking about key hires going forward?
SAHIR:
Hiring is so hard. It's basically all I spend my time doing and thinking about, and constantly trying to figure out how to get better.
What's been interesting about this market is it's very inspiring. I'm not an apologist for any individuals, but things I find inspiring. The fact that OpenAI is getting people to stop being CEO of their own public company to go take a job there is kind of amazing. Similarly, that at Facebook, despite having all the talent in the world, they're like, "we need to go pay this much money to get these specific individuals so we don't fall behind" is also inspiring. That there's that much commitment to having the best people and to keep raising the bar for who we’re looking for is really compelling. Even the fact that xAI just picked up those two people from Cursor who had previously been at Notion, it's just like, even at the very top, people are being totally unforgiving and dissatisfied, like, “It's never enough, it's never good enough. You can always get better people. You need to be shooting as high as possible.” I've found that really inspiring, and I'm constantly feeling like we're not doing enough there.
For us, the people who were there at the beginning were super critical. They obviously, A, helped make the company happen. I was lucky the people who worked with me, partly because of my own personality and reputation, were only people who were going to be super committed and pour an unbelievable amount of time into the company. They've been really valuable, obviously, culturally. So they were all super important.
Of my first five hires, four were engineers and one was a data scientist — well, actually there were six, and one was a biz ops generalist. Another thing that set a lot of tone for our culture is that we've been basically hiring generalist engineers and generalist business people the entire time. We don't have a marketing team. We just started having a little bit of sales. We don't have account management, we don't have BD, we don't have ops — we just have one kind of generalist team for the most part that does everything. We like that profile because it's a projection of how I think about myself and how I work at the company.
As we're now shifting to a new level of growth, it's just super different to have a company past around 50 people. Up until 50, you can keep it pretty flat and flexible. After 50, it starts becoming tricky. Not everyone talks to everyone else. I don't even talk to everyone that much. Information starts becoming harder to pull together, and as a company becomes more successful or bigger, you as the founder or CEO end up spending a lot more time outside the company — recruiting, selling, fundraising, et cetera — so it's harder to keep everyone on the same page without structure.
The next big phase for us is: we just started hiring and promoting a bunch of leaders, and thinking about how to add the right amount of structure and leadership without undermining the existing culture, which is really powerful and valuable in its flatness and generalist nature. Then at this point, it's like: how do we move more quickly? If we had a blank check and we could get on the phone with anybody, who do we want to get? An exercise our head of recruiting has me do is: for a new role, who are the literal 50 best people in the country for this? Are we getting one of those people? If not, why? Who are they? Where are they? Could we get one of them? Could we get on the phone with 20 of them and convince one of them to come work here? That kind of approach is a lot of what we're thinking about.
AUDIENCE MEMBER:
Thank you so much for the time today. As you said, selling into pharma is really tough. The playbook that Forus took, aggregating providers for free with prior authorization services and selling that value to pharmaceuticals, has parallels to CoverMyMeds, which is this incumbent doing a services-heavy task. When it is a really tough market to sell into, how do you balance drawing those parallels so you can land a customer and help them understand your value prop, versus counter-positioning so that you are this much sexier AI-workflow, unprecedented-insights play that they can never get?
SAHIR:
Great question. So this company you're referring to, CoverMyMeds, is a very large company. It has something like 70% market share of medication prior authorizations in the country. Most doctor's offices use it. Big company, too. It does a couple billion in revenue and contributes like 15 to 20 billion in market cap to McKesson, which itself is a huge public company, so very successful business.
They actually had a smart strategy when they started growing initially. They grew through pharmacies. Pharmacies would get prescriptions they couldn't dispense because the patients couldn't afford them or they weren't covered, so they used pharmacies— whenever a prescription can't get filled, use our website to send the prior authorization back. They got really strong distribution that way. But it's basically an online form library, which is very successful. They make a bunch of money from insurance companies, they make a ton of money from pharma companies for banner ads and tooltips, and also some pub services — email reminders, calling people, going to people's offices in person to help with things like that. Very successful business, but to your point, they're also someone we're counter-positioning against. Doctors are like, "Oh, CoverMyMeds is just a website — we have to go do all the work." This is like, AI will do it all for you. With our pharma partners, we explain what value we can create that's differentiated.
The other challenge is that CoverMyMeds is not seen as a good vendor by a lot of clients. People feel like they are a tax collector or toll collector, where they’re extracting rent and people are not even sure what they're paying them for. There's actually a big challenge we have in fundraising where investors would do expert calls with clients who are like, "I'm paying $20 million." And they're like, "Wow, what are you getting?" And they're like, "You just have to pay them." Investors are like, "What are you talking about? What's in the contract?" And they're like, "I'm not really sure." Some of what people pay them for is literally not to show your competitors' banner ads on your page, silly things like that. So it was important not to align ourselves with them. We had to counter-position against them — not even to say "here's why we're better," but "here's why you're not going to hate us."
We really tried not to lean too much into using them as a parallel. What we ended up having to do — and this is why it took us a while to get the sales clicking — was figure out what language was going to resonate and who the right people were to talk to. The biggest thing that ended up clicking for us: most of our revenue has not come from us doing direct BD. Most of it has come from clients, either themselves or their field teams, going to doctors' offices, hearing about what we do, doing some diligence, and then calling us, like, "It looks like we could partner. Could we partner?" And going into that process with them.
So I don't know if I have an amazing answer to your question, but it was something we thought about a lot. The other big piece I mentioned was we did a lot of pilots early on — very rigorous pilots where we'd say: we're not just going to compare us to nothing; we're going to compare us with a partnership to us without a partnership, we’re going to do a controlled trial-level sample, and let you measure everything on your end. So people felt 100% certain they were getting real value by partnering with us. That was really important, because it also meant we could expand incrementally, since people worried: "Am I going to be double-paying for both these things?"
CIT:
I know we're a little over time, but thank you so much, Sahir, for talking today. We really appreciate the space. Thanks everyone.
