Invest Like the Best · Nov 11, 2026 · 1h 16m · 66m saved
With Zach Reitano, Co-Founder and CEO of Ro
Ro's run rate has gone from about $250 million to over $3 billion in four years, with fewer employees than it had in 2021. Zach Reitano, co-founder and CEO of Ro, told Patrick O'Shaughnessy on the Invest Like the Best podcast that the growth came after he admitted the company had become a "zombie company."
Most critics of US healthcare start with how much the country spends. Zach thinks the spending is the wrong target, and that the real flaw is who holds the money.
"If I had to say what is the problem with our healthcare system, it is that the patient is not the customer. Whoever controls the flow of money at the point of purchase, that's the customer, that's the stakeholder that everyone builds around." — Zach Reitano
Zach built Ro into the leading GLP-1 provider in the US, on a stack it wrote itself: its own medical records system, lab, pharmacy software and provider network.
The full interview is covered here so you can skip it. 76 minutes of audio, 10 minutes of reading.
Here are the 9 lessons that matter.
Key Takeaways
The patient is not the customer, and Zach traces most of US healthcare's problems to that
More healthcare spending is not the problem if it buys more healthy years
The US spends 18% of GDP on healthcare, up from 9%
Selling GLP-1s direct to patients exposed the gap between list and net prices
Drugs listed at $1,300 were selling behind the scenes for $300 to $400
Ro grew 9% in 2021 and then about 100% a year for four years after cutting 20% of the company
Driverless cars are a jobs-versus-lives debate, with about 40,000 US car deaths a year
AI turns specialist advice into a prompt, one of three tailwinds Zach sees for patients
1. Patients Aren't the Customer
Zach opened with what he sees as the one flaw underneath US healthcare. Patients rarely control the money at the point of purchase, so the system is built around insurers, employers and pharmacy benefit managers (PBMs), the middlemen who negotiate drug prices for insurers.
Zach Reitano says whoever pays at the point of purchase is the real customer
That is why, in Zach's view, a fix has to start with putting patients in charge of the purchase. He answered the usual objection, that patients lack the information to choose well, with a one-liner.
"The patient's the worst person to make their own healthcare decisions, except for literally everyone else." — Zach Reitano
