Sophia Yen: Democratizing birth control in the US

Speaker A: Foreign welcome to the Startup Foundations Podcast, where startup founders share how they built their companies from the ground up. This podcast is brought to you by Cap Based, a software platform for founders to incorporate their startups, issue equity, raise funds from investors, and keep their companies compliant. Visit capbase.com and learn more about how we can help you get your startup off the ground. Today on Startup Foundations, we are joined by Sophia Yen, co founder and CEO, uh, of Pandia Health, a women's health startup building a delivery platform for birth control products. Sophia is a professor of medicine at Stanford University and a doctor specializing in reproductive health. She founded Pandia Health to provide convenient access to birth control products for women. She shares her vision for the company and her thoughts on recent developments in digital health and telemedicine. Here's our conversation. Hi Sophia, thanks for joining us on the show.

Speaker B: Thank you so much for having me.

Speaker A: So tell us what you're working on at, ah, Pandia Health.

Speaker B: Yeah, so Pandia Health is the only doctor led, the only women founded and women led birth control delivery company. We're building the online health brand Women Trust. We're starting with birth control, then we're adding on acne, then we're gonna add on menopause, wrinkle cream, possibly pco, obesity. But I purposely chose the name Pandia, the Greek goddess of healing light, full moon, because we're all about women's empowerment. And I also made up the definition pan is every dia is day. So we got you covered every day, set it and forget it and never run out of birth control on our watch.

Speaker A: In light of the Supreme Court decision that was leaked, potentially overturning Roe vs. Wade, many states have passed the laws restricting access to not just abortions, but also birth control. How has this affected your business? And will it potentially limit the ability for Pandia Health to operate in certain jurisdictions?

Speaker B: So I would want to make clear that as of this exact moment, not knowing when this could air, that abortion is still legal. But we are betting that the Supreme Court will reverse Roe v. Wade, um, mid June, and then it will go all back to the states. And there have been many states that have passed trigger laws that if Roe v. Wade were ever reversed immediately, abortion will be illegal in their state. There's a law on the books in Georgia that was withheld because it was based on Roe v. Wade. But if they overturned Roe v. Wade, then that law may be able to come into play. And that law, if you leave the state to get an abortion and you come back, they can arrest you on your way Back. So that's not good for anybody who's going to college in Georgia, step back to California, New York or Florida or some other state to have an abortion and then go back to those states. Um, so a great resource because every state is different and it's changing by the hour or by the day or by the week for sure. As conservative governors are trying to pass crazy kinds of things, such as Louisiana, where they're starting to um, they're thinking of passing a law defining life as beginning when an egg and sperm comes together and, and that would affect birth control, such as the iud, the pill, the patch, the ring, because all of those have theoretical mechanisms of blocking the egg and sperm from implanting if that were to happen. So a good website is Whatif Roe Fell and just Google that and center for Reproductive Rights. They're the legal arm of the reproductive rights movement. They have a map, it's color coded. Yellow is good, red is bad. And then you can look up your state by state. All the interesting restrictions, such as a 24 hour waiting period that a doc, the same doctor has to see you, um, 24 hours before, 24, you know, hours after, simply because they have to fly in doctors to some of these states because there are no abortion providers that are willing to provide in states like Mississippi or Alabama or something like that. And so if you have to see the same doctor, then that doctor has to fly in and stay a longer time and risk their lives while sleeping overnight.

Speaker A: There's, are there aspects of the laws that would potentially penalize the actual providers? Right. So is this a, uh, legal risk for, for your company, were you to ship, uh, birth control drugs to someone that, that is living in one of these states that changes the laws, like uh, Louisiana?

Speaker B: Yes, this is absolutely a legal danger for our company as well as are physicians. The main thing is we have physicians that are licensed in many different states. And so if you lose your license in Texas because you broke the law by writing birth control, if Texas were to make that illegal, or Louisiana, let's say, and then you apply for your renewal license in California or New York, they always ask, did you lose your license in another state? And if you do, it makes it a lot harder to get your license renewed, even if it was for, you know, a reasonable thing that is legal in California. And we've never had these kinds of laws where each state is practicing different kinds of medicine and that you could lose your license in one state for something that you would do in California. My example is as a physician, we Took the American Board of Pediatrics, the American Board of Internal Medicine, the American College of Obstetrics and Gynecology Board. We did not take the California board, we did not take the New York, Louisiana, Kentucky, et cetera board. But we are given our licenses state by state. And that has just been a huge ridiculous thing with respect to telemedicine, that we should practice medicine the same across all the states and that what is good enough for California to be a doctor should be good enough for New York, Kansas, Kentucky and vice versa.

Speaker A: Do you think that there will ever be regulatory changes that would make it simpler for medical professionals to do their work across state borders?

Speaker B: Yes. So there's the beginning of that. There's something called the Intermedical License Compact. And I forget what the LASSI is, but it's imlcc. And what's interesting, the major states are not participating. So that was a difficult thing for Pandia Health when we started is that we had to get a license in California, get a license in Texas, get a license in Florida. These three are not participating in the imlcc. But, uh, a bunch of little states that are lower populated who understand that they may need to use a doctor from a neighboring state or a specialist from a neighboring state, have a compact that if you are licensed in one particular state, then you can check the box and get licensed in 10 other states. However, you still have to pay money and you have to follow whatever interesting regulatory things that there might be. But that is the beginning and it would be great if we just made it national.

Speaker A: Do you think that that is actually something that. Is it something that the individual states have to pass or approve? It can't be. It's probably not something that can actually be implemented top down. Or is there some potential constitutional limitations here?

Speaker B: Yeah, I think that there could be a push to go from the national side and just say all doctors are licensed nationally. It's really the medical boards that want to control what doctors can practice in their state. And I think particularly with telemedicine, it is kind of protecting doctors because you can imagine if somebody's living in Maine, the cost of living is very different than in Silicon Valley. And so all the doctors, and they could be stealing all the patients, you know, from California on a telemedicine basis. But I would love to. It currently is being done on a state by state basis. But I think it'd be great on a national just to declare all doctors licenses are valid in all states. Because we took the national board. We did not take, you Know, a California, Florida, Texas board, I think the states would get angry and say, you know, they have the right to, to license people in their states.

Speaker A: Well, it seems it, I mean, I, I see the argument more clearly for passing a state bar exam to practice law in that state because there are specific laws that are different from state to state. Um, not just abortion laws, but all kinds of other, other laws, especially business laws and things like that.

Speaker B: Yeah.

Speaker A: So I see the argument there more clearly.

Speaker B: But for medicine, I always say it's not right that if you were born or you're living in a different state that you would have different level of health care. Right. And I do think that telemedicine is the opportunity to, to bring Stanford, ucsf, Harvard level care everywhere. And actually in medicine, we really try to standardize everything, not just in the United States, but internationally. We have national guidelines of how you should do your vaccines, how you should counsel or check for, um, obesity, or how often you should check cholesterol, or how often you should do a pap smear or mammogram. We don't have those guidelines by state. It's a national or international guidelines.

Speaker A: Take us back to the beginning of the company. What you, I'm guessing you were a practicing doctor physician. What made you decide to do a startup?

Speaker B: Yeah, one partially. Startups, um, are in my blood. But really the, My family, my parents had their own company. Not a typical startup, but one of the old Silicon Valley, start it in your garage and then grow it kind of situation. Situation. But really the reason I started this was eight years ago, was giving a talk to a bunch of doctors because I am a clinical associate professor at Stanford. And so I teach other doctors how to prescribe and how to take care of young people to prevent unplanned pregnancies, sexually transmitted infections and other health issues. And was giving a talk on birth control. Why don't women take birth control? And one of the top reasons was didn't have it in their hand. Didn't have time to run to the pharmacy every single month for 30 years of our lives, from age 12 and a half, your first period until 50, your last period is all of your fertile years. And so, um, the difficult thing, if you don't know, some insurance companies will limit you, you cannot go and get your medicine until seven days or fewer before the medicine runs out. But a lot of us will run out on Sunday. So we'll go the weekend before, on Saturday, Sunday, and we'll go in the pharmacy and we're like, can I get My birth control. And they'll run the insurance and like, sorry, insurance won't pay for it. You gotta come back Monday. And you're like, but I don't have time Monday. I have a meeting. I have a podcast, I have children to pick up from school, Whatever, I'm here now, Please give me my med. And they're like, sorry, insurance won't let you. And so it was the beginning of, um, Etsy and Amazon and ebay. Everything was coming in the mail and I was like, why not birth control? So my friend Perla Nee and I started this company so that we could ship women birth control and keep shipping it to them until they tell us to stop. And then we ran ads. Free birth control delivery. 60% of the women that responded to such an ad didn't have a prescription. And it's like, don't you know in the United States you need a prescription for the birth control pill patch or ring. And as a doctor and entrepreneur, I didn't want to miss out on 60% of the customers and I could write the prescription. So thus Pandia Health was born. Asynchronous telemedicine, where a, uh, doctor can write you the prescription if you want, but if you already have a prescription, then we just deliver it to your door. Um, if you have insurance under the Affordable Care act, no copay, no deductible for any FDA approved birth control. So you pay us nothing. We make money just like any other mail order pharmacy. The difference from what we get the drug at and what your insurance reimburses us. However, if you want to use our doctor, 20 bucks, a total steal once a year, um, with unlimited follow up questions about birth control.

Speaker A: So did you have co founders that you worked, worked with when you were first starting the company?

Speaker B: I think we had the most co founders ever because as a woman, as a doctor, I wanted to make sure we had all the elements there before starting a company. And I don't care about sharing pieces of the pie as long as it's fairly, you know, divvied up, uh, in a way, whoever's contributing what. So we had five or six original co founders. We had a physician CEO, we had a coo, my sorority sister, to run everything and do everything that I didn't know about or I didn't want to do. We had a chief marketing officer, we had a cto, we had a pharmacist, we had Perla who had just vision, connections and um, VC experience and startup experience. So that was our original co founders. And we've since, um, Diariest, as we say in medicine, um, had some people leave because we couldn't pay them how much they needed to be paid in order to maintain their house and nanny and Palo Alto. And then other people just had conflicts of personality. So we're down to of the original founders, our CTO and myself. And then Perla M remains on as an advisor board member.

Speaker A: Interesting. Yeah, it's often, I don't know, did investors react to that when you started out? Did they give you any kind of negative feedback like you have too many cooks in the kitchen or something like that?

Speaker B: I think the key is to us co founders is just who was here at the beginning and willing to take no pay. I think the key is really looking at the vision and where we're going and everybody looks at the quality of your team. And I love that everybody had skin in the game. I mean, it's so important. I think a lot of founders have a hard time finding a technical co founder. But having a CTO who is doing this 247 and loves this and is motivated rather than some contractor who may walk away or. I've heard people been held hostage with their code in some foreign country. That I think is really important is to have everybody vested in the company in, uh, where we're going and working all the time, thinking all the time, how do we make this better?

Speaker A: Take us back to how you actually got your first users. Were you, was it word of mouth? Was it running ads?

Speaker B: It was running ads because, as you know, or may not know, back in the day before Facebook, um, had the iOS, um, privacy issue, which has recently taken Facebook ads to badness. Um, you could just run a, you know, 200, $300 test as well as on Google AdWords. So that's how we did it, and that's how we tested with the 60% coming in without a prescription.

Speaker A: Did you do much product discovery, I guess, outside of that aha moment, while, while giving a talk, did you do much product discovery or that was enough to make, you know, to, to, to make you decide to work on this idea?

Speaker B: One, we knew this idea needed to happen. And two, we had seen two people start before us. And so, um, there were already a Y Combinator company out there and another company out there. And so we were like, this needs to be women founded, women led. This needs to be doctor led. And the difference is, no offense to the MBAs out there, but they often will think of physicians as a commodity. And, and you lose one, that's totally fine. You Lose a pharmacist, that's totally fine. But really, we wanted to have excellent care, expert care by expert doctors. And we wanted, as I like to say, as long as I'm CEO or as long as this company holds my values, we will always tell you what's best for your health, even if it doesn't benefit our bottom line, because that is part of being a doctor. Do no harm. And, um, to my investors, I will absolutely make money, but I don't need to make it pushing something that that's not in the patient's best interest. And a specific example pertinent to what's going on with Roe v. Wade is a lot of people are looking at emergency contraception. And because I'm a professor at Stanford, I know the latest and greatest on emergency contraception. And for Plan B and its generics, I'm calling this a Panda PSA public service announcement. Know that if your body mass index is 26 or greater and 66% of the population fits that. So two out of three chance you are one of those, check your BMI. Plan B and its generics don't work so great. And that's why at Pandia Health, we always offer Ella, which is a prescription emergency contraception. And if you have insurance, it's free under the Affordable Care Act. If not, then it's 45 or $50. I believe that we're charging compared to 12 to $18 for plan B and its generics. But if it were me, my daughter, my friend, or my patient, totally Ella, because it works better at every time point and it works up to a BMI of 35. But we're seeing other people really push Plan B and generics. Better margins, better profit. But I'm trying to prevent people from getting pregnant.

Speaker A: One of the things that always struck me when I was a teenager, not that many students were prescribed adhd. And then flash forward five years later, I was finishing college and I was teaching at a summer camp. And 60 or 70% of the kids who are, I mean, they're high achieving students that were going to a summer camp for debaters. They weren't. You know, um, kids would focus or learning issues. 60 or 70% of them were prescribed Ritalin or Adderall. And so I'm very skeptical when I see telehealth medicine platforms that make it easy for people to get whatever, uh, prescriptions they want because I understand that that might be abused. I mean, I also had plenty of friends who sold Ritalin from their prescription to make, uh, extra money. And to their friends who were studying for finals. So I just had this experience with, okay, here's this drug that was met or two, two drugs that were massively prescribed for possibly a completely over diagnosed condition. Uh, that I don't think ADHD is a real condition, but I don't think 70% of students have it.

Speaker B: Definitely that is not the prevalence, should not be the prevalence. 70 to 80%, potentially 10%. But I'd have to, you know, look into the latest statistics, but definitely nowhere near 70 or 80%. And that is definitely the danger of a direct to consumer telemedicine. Because the example I give as a pediatrician is we're always being pushed to prescribe antibiotics and it is our job as a pediatrician to not give out antibiotics if it's a virus because the antibiotics will do nothing. But if you use up the antibiotics when this young person becomes an old person and they get a urinary tract infection or they get a blood infection, those antibiotics are not going to work and they're going to die. But that's not going to happen for like 60 years and you won't know. But if I'm a telemedicine platform and you're a parent patient and you paid consumer and paid money for that, you're going to write a nasty yelp review, a nasty trust pilot review, a nasty whatever review, and my company's going to yell at me and be angry at me because I got that nasty review. But that was what was the correct medical thing to do. And so I absolutely see people being pressured to do things that are against medical standard. And I think that's why it's different when a company is run by a physician who understands we need to do what's in your best interest and not necessarily what will get us the best score. I'm also an adolescent medicine where we work with eating disorder patients and they never give us good ratings because we're trying to prevent their eating disorder and they're very angry about it. And we have to be the bad guy that says you can't do your sport, you can't go to prom and you can't be that crazy thin because you're going to die. And of course we're going to get a nasty write up right on that. We don't get good scores on that. But for birth control it's not a concern. What it has been shown is that we could increase the use of birth control pill patch ring by 70% if we could make it over the counter or easy and Ours is better than over the counter, because over the counter you have to go when the pharmacy is open, when you have to face your local pharmacist who could slut shame you and be like, sophia, uh, you here again for birth control? It's kind of like buying condoms, right? And so getting it in the mail automated. And with the expert care and expert doctors that we provide at Pandia Health, our doctors all have a minimum of a decade experience, if not two decades. And most of us are academic, meaning that we teach other doctors how to prescribe. And, you know, we love teaching and we love helping people.

Speaker A: So when you went out to raise money, um, how did you find your first investors?

Speaker B: Yeah. So, um, the good news is there's a rise of social entrepreneurship investors. And so I pitched at, um, the time it was. I forget what it was called, but it's now called One World Investments. And they're really about teaching investors that you can, you know, make money and do good in this world. You don't have to sacrifice return for doing good. And, uh, they had a pitch competition. We won most qualified. And from there we got an advisor. And that advisor, uh, made an introduction another way that we got another. Our major investor was so through Springboard. Springboard Enterprises is an accelerator program that has fashion was their original, and then general, um, tech companies, and now they have health and digital health as well. So, um, it's a nonprofit. It's a great accelerator with a, um, huge group of powerful women. And one of the other companies introduced me to her investor, and that's how we got, um, our major investors. One was through a advisor introduction and. And the other was through Springboard Enterprise. But I've also done Stanford startx, and they have a great pitch day, and you get to meet a lot of investors that way as well.

Speaker A: Yeah. I was curious to ask because I know Stanford does a lot to support CS grads and graduate school of Business, GSB grads, but I didn't know, uh, to what extent other disciplines had that type of support, uh, when it came to entrepreneurship.

Speaker B: Yeah. So specifically, I absolutely commend Stanford because I went to MIT as an undergrad and I'm like, how come MIT M doesn't have anything as good as Stanford StartX? So Stanford StartX is, um, Stanford's accelerator. So I believe the top, you know, accelerators are y Combinator 500 startups. And then Stanford StartX has got to be number three. And Stanford StartX is available to anyone who, who has a Stanford affiliation in the founder. So it can't be an advisor, but one of your founders has to have graduated, is a current student, or is a faculty member. And then just as an aside, they have a 10% diversity. So if you're a person of color, underrepresented, um, sexual minority or whatever group, um, 10% you can get in that way as well. As long as somebody from Stanford startex knows you and can recommend you. So, um, I love it because it's Stanford and they take no money, they take no percentage of your company. It's founders helping founders. And their pitch day is the most techy pitch day that I've ever seen in that you film a two minute pitch and they tell you everybody who watched it, how long they watched it, how many videos they watched, and how many, um, requests to meet that the person had. So if the person met with 30, saw 30 videos and asked to meet with 30 people, then maybe not so discerning. But if they watch 30 videos and they pick three and you're one of them, then yeah, you definitely need to follow up on that one. And then there's the backside founders helping founders, where we are like, oh, I met with that one and they have no money. They're just here digging information. Oh, I met with that one. They're really nice, they're really cool. You know, definitely love them, that kind of stuff. So I absolutely plug Stanford startx. I absolutely plug Springboard, um, Enterprise. And then another group was, oh, I'm so sorry, it wasn't Springboard. It was actually she. Oh, so she owes a nonprofit where, um, people with uteri, hopefully they'll expand in the future, can donate eleven hundred dollars and then they get five hundred of these activators together where you have half a million dollars. They vote once a year on five companies that they want to support. The five companies meet together for three days and get training and whatnot and, and divvy up the money. But it's basically 100k interest free loan that you pay back over five years. And so, um, actually it was a springboard person that did the intro. But she o is also a cool thing.

Speaker A: Cool. So what's next, uh, for Pandia Health? I mean, what are you excited about in the next year? I know there's a lot of things going on in the world of public policy and law that you can't control that are maybe not so exciting and dismal.

Speaker B: Yes. Um,

Speaker A: but tell us what you're working on, what you're excited about building.

Speaker B: Yeah. So right now we can deliver to all 50 states and we can prescribe in 14 and we want to expand to 20 by the end of this year and possibly even more. Just depends how soon we get more funding. Um, the thing that I'm excited about is we've launched acne to our internal patients. But more interesting is menopause, because I'm of the menopause age and all my friends are like, menopause, menopause, menopause. And I'm like, yes, yes. So I'm going to research the best menopause treatment and then offer it to everyone out there. And if you don't want the best, then we can go with, you know, whatever other options that you want out there. And then with that, we're thinking of rather than just telemedicine and medication delivery, being more holistic and adding on nutrition, adding on support groups, adding on, um, counseling, that kind of thing. So making it kind of more well rounded. And that'll be obviously far more than our current $20 once a year it'll be, you know, upsells that if you want to join this group or if you want to see a nutritionist or stuff like that. And then what, you know, differentiates us is the only academic doctor led company in this space is I realized that unfortunately a lot of medicine is based on a Caucasian female. And what I was taught at UCSF and Stanford works great for a Caucasian female that wants to bleed every single month. But for an Asian or a black person or a person who doesn't want to bleed every month, we've actually, um, after, you know, six years in this business and only doing birth control and nothing else, and using my academic mind and applying it to it, have found a better drug that we have 85% retention at a year versus normally on a birth control pill, 45% of people quit and our patients don't even know. Because we start you on a great pill, you have no side effects and you're good to go. Whereas if you go somewhere else where they don't have expert doctors taking into consideration your body mass index, taking into consideration your age to make sure your bones are okay, taking into consideration that what you were taught only works for Caucasians and this person may not be a Caucasian female who wants to bleed every month, then you have side effects and you quit and you never see that patient again. And they're like, oh, the pill sucks. When actually there's 39 other pills that we could put you on. So we have an algorithm that our, uh, doctors adhere to when we're prescribing to optimize such that you have the fewest amount of side effects. And then if you do have side effects, we have a grid on what to turn up, what to turn down so you can find the next best, um, birth control for someone.

Speaker A: Uh, one thing that I found jarring when hearing the debates about side effects of COVID vaccines is the rate of side effects from IUDs. And lots of commonly prescribed birth control are way, way higher. And I don't know if it's that doctors, uh, don't take women seriously or, uh, what the cause of this is, but people are freaking out over side effects that were potentially, uh, temporary, less severe, and way more rare than the side effects of other commonly prescribed medicine that, uh, would have more serious complications. And I say this as someone who is the outlier. Like, I had an allergic reaction to the Johnson Johnson shot and was hospitalized.

Speaker B: Oh, my goodness. Well, thank you for speaking up and thank you for pushing Covid vaccines because it's what's in the public's best interest. And the risk of, uh, side effects is really low. And you were unfortunately one of the outliers. But, yes, women who are those of us with uteri who are using the birth control, pill, patch ring, IUD implant, or shot have had side effects and sucked it up for too long. And so if you are having side effects on your birth control, perhaps choose the company that has expert doctors that have a secret algorithm to optimize the least amount of side effects and don't just suck it up. Um, as an aside, as a hack for anybody with uteruses out there, um, know that you can make hashtag periods optional. So if you are one of those people with uteri who are missing work or school, the number one cause of missed work in school under the age of 25 is horrible periods. And those with uteri have just been like, oh, well, it just kind of runs in my family. My grandma has it, my auntie has. It was meant to be. No. Just because it rinse in your family doesn't mean you have to suffer. We now have science, medicine, technology such that you don't have to suffer. So if you know anybody with a uterus who's missing school or work because their periods are so horrific, please see a doctor and know that you can use ibuprofen as first line, but you have to ask your doctor. And then second, um, line would be something hormonal, the iud, the implant, or the birth control pill patch ring.

Speaker A: So we're almost out of time here. There's one question we always ask at the end of the show. What's something that you wish you knew when you were first starting out that you've learned now a few years into the journey of running your own company?

Speaker B: Oh, there's so many things that I wish I had done differently. Um, one, get everything in writing. Um, two, don't be pressured into anything. Um, you can always say, I need to consult my doctor or not your doctor, your lawyer. Um, don't agree to anything right away. And, um, three, check who your co founders are, because I'm in year six of this and you're going to be with them longer than you've been with anybody in college and potentially elementary school. And I think of my team as family almost. I mean, they're my work people and I spend 12 to 15 hours a day at working, and they too are working on this. So I hope you choose something you enjoy, something you're passionate about, and make sure that you get everything in writing. Don't agree to anything or disagree to anything without consulting your lawyer. And, um, pick a good team.

Speaker A: Well, thanks for joining us on the show and sharing what you're working on.

Speaker B: Thank you for having me.

Speaker A: Thanks for listening to the Startup Foundations Podcast, the podcast that tells the stories of startup founders and how they've built their companies. Visit capbase.com to find more helpful resources on startup equity, fundraising and more. Until next time, keep building and keep innovating.