GoodRx Holdings, Inc. (GDRX) Earnings Call Transcript & Summary

Good afternoon, everybody. I'm Nick Jones, an Internet analyst here at Citi. If you need my disclosures for this fireside chat, please e-mail me or corporate access and we can send them to you right away. We're really excited to have GoodRx here. We have Doug Hirsch, Co-Founder and CEO; and Karsten Voermann, CFO. Before we get into it though, I'm going to hand it to Whitney Notaro to go over the safe harbor.

Thank you for having us, Nick. Before we begin, I just want to remind the audience that this webcast may contain forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any forward-looking statements are based on management's current expectations and are subject to certain risks and uncertainties. Please review our SEC filings for risk factors that could impact our future performance. Thanks, and back to you, Nick.

Great. Thanks, Whitney. So it's been about a year since GoodRx IPO-ed. So I think there's likely some investors who are new to the story and here to learn about it. Maybe to kick things off for those who are not as familiar with GoodRx, can you give a quick overview of GoodRx and the opportunity ahead of it?

Sure. And Nick, thank you for having us today. We're very excited to be here and always excited to meet new potential investors. It's getting close to our tenth year anniversary, and we're really excited to talk about all the progress that we've made over the course of not just the last year but the last decade, honestly. Trevor and I started GoodRx to provide affordable and accessible health care. Our goal was to demystify an incredibly complex industry and just simply help people who have nowhere else to turn. It all started when, literally back in 2010, I was just a regular consumer who had a prescription in hand, and I walked into a nearby chain pharmacy and handed it over. Doctor hadn't talked to me about cost, and the pharmacist did the thing on the computer and came back and said, "It'd be $500." And I was just like, "That's insane." And because I'm also naturally thrifty, I took it back and I went to another pharmacy down the street, where it was half the cost. I took it to a third pharmacy where they said $400 but then they ran out to the parking lot and said, "Well, let's discuss this because there are ways for consumers to save." And I had no idea there are ways for consumers to save. I always assumed there was some set price list and that my insurance had like a fixed number of some capacity. It turned out that just like every industry, both pharmacy and all of health care is subject to all sorts of crazy price variations and also tremendous ways to save if only you know where to find them. So that's really the genesis of GoodRx. It's a very simple idea. You can find prescriptions at affordable prices at nearby locations. And if you go to GoodRx, you'll see just a big search box. You start typing the name of drug. We show you discounts. You present them at the pharmacy. You save a ton of money. Ten years later, we've saved Americans over $30 billion on prescriptions. And our business is just crushing it, right? Record revenue, record profit, record users in Q2. And this has really given us the fire to extend our platform from just focusing on prescriptions to subscription businesses, pharma manufacturer solutions and telehealth offerings. Today, almost 20 million Americans a month use GoodRx for a whole variety of reasons, including we actually launched a huge vaccine appointment finder when we played a major part in helping to get folks vaccines during COVID. Not just that but we also have health care professionals, a ton of health care professionals who use GoodRx. About 17% of the folks who come to GoodRx are actually health care professionals who are looking honestly to just help their patients. Our growing platform is the foundation to allow us to continually offer more valuable services to our health care providers and consumers, and we'll talk a lot about that today. Ultimately, we're really just empowering Americans with the knowledge, choice and care they need to stay healthy regardless of income or insurance status. I also just want to emphasize how positive and amazing the relationships that we have with the industry are. I know health care is really confusing and especially for folks who may be new to the space. You don't understand how strange and bizarre, honestly, the relationships are within health care. And one of the things I'm most proud of this is over the course of the last decade, we built incredible relationships with health care providers, with pharmacists, with pharmacies, with pharma manufacturers and, of course, first and foremost, these consumers who now trust us as a trusted advocate to use our platform to find a way to navigate our, unfortunately, very challenging health care system. So I'll pause there.

Great. Thanks, Doug, and pharmaceutical pricing has kind of always been a hot topic for patients, politicians, doctors. Patients are leaning into telemedicine more and more, particularly during COVID. Digital solutions are becoming more popular as people are trying to solve problems from home. Can you maybe touch on how big the opportunity really is to kind of provide the type of pricing transparency within pharmaceuticals and then also the telemedicine offering you have, both the marketplace and the GoodRx offering?

Sure. Maybe I'll let Karsten handle that one. He's really good at TAM.

Thank you, Doug, and thank you, Nick. Yes. Pleased to speak about that one. The pharmaceutical market generally is extraordinarily large, one of the biggest markets in America. The prescription drugs market alone is over a $500 billion TAM. And the reason that's important is it's a huge market but so few people really realize that price divergence exists, as Doug discussed them in his last response, that even we, as the biggest player in prescription savings, even we only have a couple of percent of that TAM. We talked previously about our GMV that flows through GoodRx. Last time we disclosed the GMV number, it was 2019 at about $2.5 billion. And we've grown a little since then, but even with that growth, we're still in a very low single-digit percentage of penetrated into the market as the biggest player. So we feel like we have a ton of runway ahead of us. So 70% of consumers are not aware that prescription prices vary, and with the fact that the savings rate that we're able to provide to consumers goes up every year. As our scale grows and our product becomes more and more compelling, we're just really excited about penetrating deeper into it. And the way we monetize the prescriptions market is by taking amazing prices that we negotiate with PBMs and passing them to consumers. And in return for that, we're able to, at the marketplace, retain the take rate for ourselves and that take rate forms the subscription transactions revenue that you see in our financial statements. So huge TAM and really underpenetrated at this point. So we're excited about the runway ahead of us.

Can we touch on the pharma manufacturer solutions segment of your business? That's something you've been excited about. Appears to still be in the early innings. I think on the 2Q earnings call, you mentioned having relationships with only about 10% of manufacturers serving the U.S. How do you think about this opportunity and what it takes to maybe evangelize the 90% of manufacturers you're not serving today?

Sure. I'll take those in order. The first part of the question, we're really excited about the progress we've made to date. And we recognize that we're only at the early innings, as you put it, of penetrating into this market. We have relationships with a portion of the manufacturers, about 10% or so of the 550 manufacturers in the U.S. market today. But the reality is that the entire TAM of $30 billion is also concentrated, with about 50% of the spend being in the top 20. And the reason that's important is because we made a conscious effort to penetrate into the top 20 manufacturers first. And we were successful in that insofar as we represent and sell into 19 or 95% of those top 20 manufacturers, who represent, again, 50% of the spend in the $30 billion TAM. And the thing that makes us so excited about that is, number one, the top 20 are viewed by other manufacturers as indicative of the best ways to spend money. Number two, by having reference deals in all of the top 20, it means expanding horizontally into more medications in those same manufacturers becomes easier. And number three, we think we're really uniquely positioned because, as you think about it, we serve both, as Doug said, providers and consumer constituencies. Doug mentioned that 17% of our almost 20 million visitors are providers. And we also help on awareness, access and adherence solutions. So we cover the full gamut of what manufacturers are trying to accomplish and are able to capture both the HCP-targeted spend and the $10 billion of spend targeted at consumers, really leveraging that high NPS of 90 with consumers and 86 with providers to be able to offer yet another service to both sets of constituents.

Great. Great. And then let's just expound a little bit more on the telemedicine offering. You have the marketplace. You have the actual GoodRx offering. How do you feel GoodRx is positioned to compete with other telemedicine providers? And then maybe you could touch on, what kind of attach rate do you see to the telemedicine solutions and the pharmaceutical pricing?

Sure. Thanks for the question. I'm kind of proud of the fact that we identified early on, 1 thing we do at GoodRx is we listen carefully to what consumers are telling us, right? And they're telling us about the pain points that they have in health care, and there are many. And one of the things we found out early on in the GoodRx company history was that so many consumers were coming to GoodRx and they were looking for savings but they didn't actually have a prescription in hand. And that was the genesis of GoodRx Care. So we acquired a company a few years back, prior to COVID actually, and we knew that telehealth is going to play an important role in helping people not just get prescriptions but also to just find affordable cash pay doctor visits because there's so much that you can do with telehealth. And we really are excited about applying telehealth in the right way for prescription-associated conditions and other very specific categories where we think that, honestly, a telehealth visit is better than an in-person visit where you can just simply improve access and convenience for consumers at a really affordable cost. So we rebranded HeyDoctor, the company acquired, to GoodRx Care, and it continues to be a huge growth engine for us with an exceptional user experience. It's just so easy. And I think for so many Americans, once they can actually play with this product, they realize there is a better way for many conditions that they're dealing with. GoodRx Care focuses on low-cost prescription-associated conditions, and it's another entry point for consumers to experience GoodRx. And we always want to be there at a critical point in their health care journey. And of course, we want to drive incremental volume to our prescription, subscription and manufacturer solutions offerings. We've rebranded it and we've integrated it across the products. So if you've been watching GoodRx over the last few years, you've seen the GoodRx Care experience be integrated across GoodRx into a unified experience. And today, over 40% of our telehealth visits now convert into GoodRx Gold subscriptions, and maybe we'll talk about Gold a little later. More broadly, about 60% of care visits are driving incremental revenue through our other offerings, which is up from 30% just a year ago. We really do believe in these cross-platform integrated experiences because we think they're going to enhance our ability to cross-sell going forward to increase the stickiness and LTV of our users. They're also really just a great consumer experience. We're going to solve whatever those pain points are. And as you can imagine, many, many people have many, many pain points. And so whether it's a low-cost prescription or just needing to see a doctor or they don't have a prescription in hand, we're going to be there to provide and to fill those gaps for as many Americans as possible.

Great. I think that was really helpful to kind of paint the picture of the opportunity ahead and really what GoodRx is addressing. So maybe shifting gears to the pandemic and the impact it's had on the health care industry, which has been significant. Patients have not been seeing doctors in person, potentially impacting therapy starts. How are you thinking about the pandemic from here? We have variants emerging. We have vaccines also out there to combat the illness and variants. How do you think the pandemic impacts GoodRx from here in terms of therapy starts and kind of how nimble the ecosystem is now to react to kind of an ongoing pandemic potentially persisting longer than we think?

Sure. I can take that one, Nick. So we delivered strong performance and record numbers in the second quarter despite activity not being back to pre-COVID levels. And a large portion of our business, the Prescription Transactions portion of our business is correlated to prescription volume, but other parts of our business like manufacturer solutions that we're just speaking about earlier, of course, are not. We haven't seen a return to normal transaction levels yet in prescriptions, though we have seen nice sequential month-over-month growth. So that part of the month-over-month growth is very helpful. And we think the backlog of conditions that's been just increasing so much all the way through the second quarter has begun to level off, so at least it's not getting bigger anymore at this point. It's still kind of a coiled spring of conditions that will likely drive future growth as it begins to enroll. With the timing of going back to normal, that timing is still a little bit uncertain, like you said with the Delta variant. We believe that once things do go back to normal, that we'll be really well situated to capitalize on the recovery and the headwinds that we've seen become tailwinds and see these undiagnosed conditions -- those become diagnosed and people begin interacting with the health care system in a more regular way again. So we're looking forward to that with great anticipation at this point.

Nick, I also just want to emphasize what -- during COVID, what we managed to accomplish, which was we built this, I believe, it's the nation's largest COVID vaccine appointment finder, where we were tracking inventory of basically available appointments across the nation. And we had more than 2.5 million people sign up. And this was something we spun up in just a few weeks because we have that role as a trusted advocate with 20 million Americans. And it's sort of an honor actually to be able to play our part in helping connect Americans to vaccine appointments. We still do it today. And obviously, if COVID continues to rear its head in some capacity, we'll solve that gap for consumers along the way, making them GoodRx members and advocates for us. So we'll continue to adapt as if COVID throws any more curveballs our way.

Great. Great. So as you think about the shift to using digital solutions to solve health care needs, how are you thinking about the stickiness of telemedicine as we -- as things normalize? It sounds like there may be some early indications of therapy starts improving month-over-month. How are you thinking about it maybe more medium term? Are there indications that this is likely here to stay or do you think there'll be some kind of reversion?

Yes. I think there's been a lot of hype and buzz about telemedicine. And like many things in life, I think there's -- separating the smoke from the fire can be sometimes challenging. I think the reality is, yes, telemedicine is here to stay for certain conditions, and we are going to be there to meet consumers wherever telemedicine can provide a superior or better -- of just ultimately better experience than basically not having accessible health care, which is the other alternative for most Americans. Look, COVID has accelerated consumers' adoption of telehealth. We know that. We've seen the numbers. We think some of the aspects will be permanent, and some, honestly, we hear a lot from consumers who are like, "I can't wait to get back to seeing a doctor in person for certain things, right?" Before we acquired HeyDoctor back in 2019, 20% of the consumers on our platform didn't have a prescription. We saw the opportunity to use telehealth to fix that pain point. And as I discussed already, we knocked that down with low-cost prescription-associated visits. I think our visits start around $19 for a cash pay visit with a physician, which is a pretty great offering already for consumers. Again, it's another entry point and often at a very critical point in health care journey, which again drives incremental volume to our prescription, subscription and manufacturer businesses. Ultimately, we believe that telehealth will continue to be relevant for consumers, especially in certain categories, ones that we are really investing our time and effort into. And we're going to continue to make product investments to just have, honestly, the best telehealth experience that we can have in an easy, simple and, of course, most importantly, affordable user experience. So we're really excited to see different ways to apply telehealth. Again, I don't want to make it sound like telehealth is going to eat the world and consumers are never going to see doctors again. There's room for both. But we're excited to basically use our knowledge and our technical expertise to make telehealth a permanent part of most consumers' health care journeys.

Great. So I guess speaking of doctors, GoodRx has an in-office presence in over 400,000 physician's office today. Kind of unpaid word of mouth being a primary channel for customer acquisition, how do you look at growing your presence in doctors' offices around the country?

Sure. I can probably take that one, Nick. We're really proud of the deep relationships we've built with health care providers over the past decade. We've talked about it a little in the context of manufacturer solutions and being able to serve them that way. But you're right. Unpaid is the biggest single channel for user acquisition for us. And a huge piece of that is health care providers recommending GoodRx. Over 2 million prescribers in the U.S. have a patient that's used GoodRx, and 80% of physicians recommend us, which is just a powerful, powerful tool for us to grow. We've also done a lot of work to help become more useful to prescribers. And we're proud of the fact that Surescripts elected to partner with us on that opportunity, too, because Surescripts is an entity that integrates into physician EMRs and provides physicians with data. In our case, for uninsured patients specifically, Surescripts allows physicians to see what prescription pricing might be and to leverage the technology in order to have conversations with patients after the prescribing decision has been made about how the patient might best be able to afford their medication. Again, we are proud of the fact that they elected to work with us. We're proud of the fact that it helped us improve our offering both for health care providers and particularly for their uninsured patients for whom Surescripts shares the information on the pricing and on the accessibility of medications as well. And we believe that, that's going to help health care providers save some of the 14.6 hours a week. According to the American Medical Association, they spend trying to find ways to get their patients on to the medications they need. So it should save them a lot of time.

Another channel that's been interesting is the corporate opportunity with this kind of Gold subscriptions. You recently entered partnerships with DoorDash and USAA. Can you talk to us a bit about the nature of these partnerships and how you're looking to expanding to other kind of corporate opportunities and the value realized from some of these deals by those employees?

Sure. Thanks for the question. One of the fun things about being at GoodRx is you realize how badly this country and consumers need the offerings that we put out there, right? When we launched GoodRx way back when, over the course of those last 10 years, we've had all sorts of constituents come to us and basically say, "We just need help." And sometimes it's not consumers. Sometimes, it's other entities. I can remember back in 2013, we had a -- I think it was like a Fortune 100 company call us up and the Head of Benefits just said, "Hey, everyone -- all my employees keep coming to me and talking about GoodRx. And what is this thing? And can we work with you?" And those kind of experiences we've had, honestly, throughout our company's history, and we're generally responsive at all, honestly, to any constituency who basically is like, "We want to provide additional knowledge and additional savings to our membership base." And so as you mentioned, DoorDash and USAA are 2 partners we're really proud to offer the value and benefits of a Gold subscription program to them. The way it works is within Gold, so for Dashers and USAA's 13 million members, they can basically pay $10 or less for over 1,000 meds, which is pretty awesome. They can connect with a health care provider from home for a low cost and receive free delivery for certain prescriptions. These are just great examples of -- imagine if you're DoorDash and you're trying to keep your Dashers happy, what a great benefit, right? And these 2 agreements are just great examples of how we can reach more Americans going on sort of a B2B route versus direct-to-consumer. The gig economy is a great opportunity for us. And of course, active service or veterans with USAA is another great constituency who, again, any help we can provide is -- it's an honor for us to be able to do that. Historically, most subscribers came through direct-to-consumer marketing for us are upsells from our existing prescription user base. But we still think there's a huge opportunity to increase our reach and help out more consumers through these types of B2B relationships. And again, oftentimes, they're inbound to us and it's really just us trying to figure out, what is the best way that we can service those clients, right? So we're just getting started with business development efforts. I think you'll see lots of more really exciting partnerships coming out as we build more relationships with other constituents that really just want to integrate GoodRx Gold or any other GoodRx product into their offerings for their members.

Great. And then maybe as a last follow-up on maybe marketing or customer acquisition. And this is maybe for you, Karsten. GoodRx is delivering strong revenue growth and profit margins, which can be rare for a company growing at your pace. So what are the puts and takes as you think about incremental marketing spend and whether there's an opportunity to maybe deploy more cash to enhance brand awareness or acquire more customers?

Thanks, Nick. Great question. We have an incredible opportunity to increase awareness and continue to build our brand in the massive markets we operate in, especially given what we talked about at the very beginning, which is how underpenetrated this TAM really is in relation to its huge size. So we really seek to reach consumer and own the relationship with them when it comes to health care. 70% of consumers don't even know that prescription prices can vary significantly across pharmacies or that they can save and that the tools like ours to help them navigate the complex health care system. Our goal is to continue to drive awareness both at the top of the funnel and all the way through conversion through all of the channels we have available to us. Our most significant source of traffic has been and remains unpaid word-of-mouth referrals. We talked about health care providers a bunch already. And we're also doubling down on our research and content effort because we believe the right original content and insights further help consumers and educate them, empower them and drives our acquisition even faster. Health care professionals will continue to be important, like I said earlier, in a response to the question around how we're really driving continued partnership there. And we're also testing new channels like out-of-home and radio on top of that. We began to leverage our consumers by sharing and amplifying their stories, too, where it's appropriate and where they permit us to do so. So that, too, is an area of great expansion for us. So across all these dimensions, we have opportunities to grow further. Throughout the company's history, we've grown profitably. It's in our DNA to grow fast and to maintain margins that are attractive, and we intend to do that going forward as well.

Great. So maybe let's switch gears to the subscription models, right? Users can access GoodRx discounts for free through the app but also through GoodRx Gold or the Kroger Rx Savings Club. What are the types of users that choose to subscribe to GoodRx Gold? Is it generally families with more than 1 person? Or I guess what's the value proposition on the subscription versus just using the free application?

Sure, sure. Thanks for the question. First of all, I just -- I'm really, really proud of GoodRx Gold and Kroger Rx Savings Clubs. I think, look, obviously, the membership base, which is now over 1 million users, which has almost doubled year-over-year, is evidence hopefully that we're providing great value to Americans, which is our first priority always. Our goal is always just to meet consumers wherever they need us, and it can be done through Prescription Transactions. We will continue to add benefits to the Gold program to, again, try to drive as much value as we can. There are a few ways that we can acquire subscribers. We can either upsell existing users or we can convert them without them ever really becoming MACs, right? Converting a MAC to a subscriber or visitor subscriber without even becoming a MAC is mutually beneficial because we offer consumers more value through the subscription offerings while they generate higher LTV for us and provide better revenue predictability for them -- for us as when we have subscribers. We'll continue to add more benefits to our subscription products. I mean, if you just look at GoodRx Gold for now, we have discounted telemedicine visits. We have home delivery options. And of course, we have discounts at retail pharmacies, too. It's, honestly, a great offering and it's quite inexpensive. And I think it's a wonderful offering, and again, now we have over 1 million users who are using it. We'll continue to create value for subscribers and put more value and more great products into the package to hope to see more MAC visitors converting into subscribers as a result. You'll continue to see lots of pushing and awareness across GoodRx Gold and Kroger Rx Savings because we just think they're great products and that more people could benefit from them.

Maybe as a quick follow-up. Are there other opportunities like the Kroger Rx Savings Club that could help accelerate user adoption via subscription?

Yes. I mean, one of the interesting things is, with all the recent noise, I'd say, in the pharmacy space, our pharmacy partners have got -- we've gotten even closer. I mean, I'm so proud of the fact that over the last decade, we've just built these incredible relationships with pharmacies, not just pharmacies, I mean manufacturers, obviously, consumers, providers. And that's one of the things that I'm most proud of over the course of the last decade is that we have positive growing relationships with really all of our pharmacy partners. So last quarter, for example, we strengthened the Gold network by adding Rite Aid's 2,000-plus locations into our offering with amazing prices, which grew the footprint of participating pharmacies and more savings for more consumers and more pharmacies on more prescriptions. So it's really just -- it's a flywheel of value that we're trying to really put in for consumers. The major pharmacies have all been developing programs to deepen consumer loyalty, to improve the availability and affordable and convenient ways to access prescriptions. As you may know, for pharmacies, they can't just like wake up 1 morning and say, "Oh, we're going to start discounting prescriptions. It's very complicated. There's very intricate relationships." And GoodRx can help them to do that. So in the case of Kroger Rx Savings Club, again, we are powering the official savings club for Kroger. We'll continue to work with Kroger, of course, and other retail partners as they innovate to improve their competitive offerings and ultimately drive more consumers into their pharmacies to fill their prescriptions. We're not at the point where we can speak of anything more specific than that, but we hope to share some news on the progression of these conversations in the future because, honestly, it's just a really, really exciting time to be working with these pharmacy partners who are keen to do more, and we want to do more with them.

Great. I'd love to kind of double-click into the pharma manufacturing solutions. I think many of the meds are curious to learn more about this. You mentioned that it's one of the fastest-growing area of your business with very attractive economics. Can you talk to us a bit about how does it work? And what is kind of the impact on both the top and bottom line? And how does it differ from kind of the core business today?

Sure. Thanks, Nick. I'll jump on that one. We're really excited about our pharma manufacturer solutions offering. It continues to grow really rapidly, about 3x in the last reporting we did and it helps reduce the cost of brand prescriptions for Americans and really provide access and awareness as well of adherence to those branded drugs. GoodRx has helped millions of Americans to be able to afford generic prescriptions, but branded prescriptions remain unattainable to consumers due to cost. Even with big discounts that we might be able to apply, they can cost thousands of dollars a month. And pharma manufacturers want to provide affordability options. And even with the $30 billion they spend annually to reach consumers and health care providers, they struggle to gain awareness and improve access and adherence to these medications and to their affordability solution. With our scale and reach across both consumers and providers, we help address this challenge. We deliver innovative solutions that connect doctors, patients and pharma manufacturers in a more efficient and effective way than it's been possible in the past. In less than a year, our pharma manufacturer solutions team has reimagined the way patients and providers learn about, afford, purchase and stay on brand name prescription treatments. We offer 8 solutions and continue to innovate more. These are data-driven and draw from a decade worth of insights and learnings about our consumer and health care provider audiences. And by leveraging our almost 20 million monthly visitors, GoodRx's audience has the attractive profile that manufacturers seek to reach. The value we provide to our pharma manufacturers is evidenced by offering strong year-to-date performance, as I said earlier, approximately 3x year-over-year growth and net revenue retention of over 150%. The margin on this business is also really remarkable, given that we already have the platforms in place, and we already have the audiences in place, both on the health care provider and on the consumer side. So there's very, very little incremental cost in terms of selling these solutions into manufacturers. And this portion of our other revenue becomes an ever bigger proportion of total revenue that has the potential for a positive impact on aggregate margin. While our manufacturer solutions has grown really fast, it's still early compared to a massive $30 billion manufacturer spend in this area. And so from that perspective, we're excited about the potential for future growth along the trajectory showcased so far.

Great. Maybe for those kind of less familiar with kind of how the segment works, what are the key components of monetization? Is it kind of cost per thousand impression, cost per click, cost per action? Can you kind of help explain how you monetize this business?

Yes. No, we monetize the business primarily off flat fee-based deals, which we price with manufacturers around targeting ROIs that we and they think are reasonable. And the reason we do that is because the majority of our business isn't focused on the traditional CPM model. We want to be aligned with making sure the right medications go to the right consumers and patients and a flat fee model that's congruent with ensuring that outcome happened. It results in sticky engagement with our pharma customers and has contributed significantly to 150%-plus net revenue retention rate because even though they're flat fees, those flat fees do go up as we deliver more value to the manufacturers. The agreements that leverage more of a CPM model are more typically deployed through agency partners. And those are more traditional kinds of relationships. But our fixing models include both setup fees and monthly fees that are paid ratably over the term of the agreement, and they can also include performance incentives. And we take into account a lot of variables, the expected engagement of our consumers and health care providers around the specific medication, the price of the medication, our reach through off-line channels and how we can leverage all of the constituencies in our ecosystem to support the outcome the manufacturer might be looking for. And we take all that into contemplation in terms of figuring out what a fair return on investment for the manufacturer is and, therefore, a fair price for us. And then the deal structures are typically implemented for a series of months. We really help address one of the biggest hurdles manufacturers have by helping reach the right audience at the right stage in the patient journey, often with a prescription in hand and often through providers who are writing that prescription. Whether it's a consumer search or a brand drug or a provider seeking to help their patient, we'll help all those different constituencies. And when we talk to our manufacturer clients, the top 10 manufacturer recently have said that we delivered them ROI in excess of 8x across 5 particular brands or medications we're working with, which is not super typical at all. Our net revenue retention with that customer is about 170% year-to-date as well. So clearly, they're very excited about working with us. And we're focused on growing volume and driving that -- this business even further as we penetrate deeper across the top 20. We're already in 19 of the top 20 pharma manufacturers in the U.S. and then well beyond that as well.

Great. I think we've got a few minutes left, and we have a question from one of the listeners on this topic. And the question is, can you talk about the sustainability of the revenue growth in this segment? And then also kind of what the medication penetration rate is among existing manufacturer revenue partners? So how many of the drugs of Pfizer are you penetrated on today?

Yes. No, I think I can hit both of those. I'm sure Doug may choose to jump in too. But I'll take them in a reverse order. Right now, our key focus is getting into the top 20. And again, we got -- we're successful in getting into 19 of the top 20. And the reason we did that first is because like -- we felt like having reference agreements in those deals, in those accounts where they could see how much value we delivered was important to then create the platform for horizontal spread. So right now, we're in about 4% of all the medications the top 20 have. So our big focus is, again, to get into all of them so we can then take that 4% and drive it upwards as we broaden our reach across more and more medications from these top manufacturers and then ultimately go beyond the top 20 and into the 500 or so [indiscernible] and then serve the U.S. market where we've only penetrated into about 35 of that remaining 500. And in terms of sustainability, the uniqueness of what we offer is really what makes the growth trajectories keep as it is and as sustainable as it is. Again, we serve both health care providers and consumers on 1 dimension, and we also serve them in terms of both awareness, access and adherence. And that combination is very, very rare. There are entities who maybe target providers and there are other entities who maybe target consumers. There are mechanisms or media that can create awareness like TV. But to be able to offer all of those services across both constituencies is something that we think that absolutely differentiates us.

I guess I just want to add real quick that I think what you've seen from us to date is sort of relatively straightforward in terms of experiences and, obviously, advertising and things you've seen on other platforms. But when you're sitting at that point of purchase and when you have 70% of the people coming to us are prescribers, you have an incredible opportunity to talk to folks right at that point where they're making the key purchase about whether they're going to be able to afford this drug or not. And so there's all sorts of really innovative new programs that we're talking about with pharma that I think are really, really exciting, ultimately benefiting the consumer, providing more education, but things that maybe you haven't seen in other platforms that we're looking forward to rolling out pretty soon.

Great. I think we could sneak in 1 last question. We just got 1 from the listeners and, I think, is important and maybe this is best for you, Doug, is how are you viewing future competition from Amazon after their announcement earlier in the year?

Yes. Sure. We -- I've been asked this question many, many times, and I think of our company's history. We've been asked this question many times as well. I want to first reiterate that when I think about competition, my competition is the old way of doing things. I think too many Americans simply just don't understand that there is price variation in health care. And so to be able to get out there and I mean, when you look at the marketing and the overall messaging that GoodRx tries to bring to the marketplace, it's become an active health care consumer. Because when you do so, you can find tremendous ways to save and honestly just find a way to afford something you otherwise can't. Too many people come to GoodRx and they literally -- it's rent or it's health care and those kinds of choices we don't ever want to see. In terms of Amazon, I mean, the reality is we are very much a marketplace. We have an incredible -- a robust group of retail partners. Our pricing is -- I don't like to think of them as an apples-to-apples thing. I think it more sort of -- we again offer a whole slew of both retail and mail order options for consumers, whereas Amazon is clearly focused on driving mail order prescriptions. The reality is, is that mail order is a very, very tough business. Even in a pandemic, mail order did not significantly grow, and I think you're seeing it actually somewhat recede post -- as COVID starts to wind down. If you want to look at it on an apples-to-apples basis, GoodRx is tremendously lower priced, both at retail and mail. And you'll find like crazy numbers like 90%-plus where you'll see GoodRx pricing is lower than Amazon. But again, I don't really view it that way. It's not an either/or to us. It's -- GoodRx is squarely focused on delivering an answer to 20 million consumers. Amazon is trying to do mail but mail's a really, really hard game. We've reached record revenue, record profit and record users, and we continue to see incredible momentum here. And so it's -- look, I'm an entrepreneur, so I'm worried about everything, and I'll constantly be focusing on growing our business and making sure nobody eats our lunch. But I'm really more focused on getting more consumers to understand and become active health care consumers. And that's not a threat that I worry too much about today.

Great. Well, this is great. Thank you, Doug and Karsten, for joining us today, and this will conclude our fireside chat.

Thank you.

Thank you, Nick.