Back to the boards: Adam Pivko: Building a $900K/Day Telehealth Brand

Transcript

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  1. Choose a product you can stand behind

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    Adam Pivko How do I look? Is this my good side? My handsome as f*** or what?
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    John Casto Salud from España. Estamos, we are in Barcelona with Adam Pivko from Direct Meds who is averaging 900k a day right now.
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    Adam Pivko $900,
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    John Casto 000 per day with his telehealth brands. at. How did you get started doing this, man?
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    Adam Pivko It's explosive. What a crazy run we've been on. But yeah, about two years ago, this business was founded, which is crazy. But I got into this business through my personalized vitamin brand being acquired. So kind of an aqua hire of sorts. But at the time, there was a lot of pressure on personalization around the GLP-1 space. That's what it was back then. So the founding team of DirectMeds saw the brand that I was working on, Autumn DNA, as an awesome way to add a personalized element to the overall brand picture.
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    John Casto - But before that supplement brand, what actually brought you into the online marketing world?
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    Adam Pivko Yeah, I've been doing online marketing, digital marketing, affiliate marketing for like 18 years now. My first career ever in the space, even before entering the space, I was selling photocopiers door to door. And I realized right then and there, like after doing it for a year, which is great work experience. I would recommend it to anybody if you want to really become good at sales is doing something like that is so hard.
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    Adam Pivko um but i realized then and there that nobody's printing anymore and i should probably sell some on the internet so one thing led to another uh i got my first job in payment processing worked into anti-fraud ended up the business that i was with acquiring a very prominent performance marketing crm called limelight crm uh and i took over opera you know really the relationships and partnerships and client relationships that we had there and created a client success division working with like the best of the best in nutra um predominantly black hat free trial nutra back in the day so that was uh like 2015 to like 2019 kind of that range
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    Adam Pivko Um, like extremely high volume, neutral, the rise of CBD, acai, berry, Garcinia, skin creams, all of those things. Uh, the story goes that I went to go visit my mom. Uh, my parents retired and moved to Florida. I went to go visit them. We're going to go out to dinner. My mom's like, wait, wait, I need to like put on my face cream before we go. I go, Oh, I'm like, let me see it. Let me see this fucking cream. So I take a look at the cream. Sure enough, it's one of my client's face creams. It gets worse. I call the client. He's a good buddy of mine.
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    Adam Pivko I'm not going to drop his name out of respect, but I called him up and I put him on speakerphone in front of my mom. I said, hey, just one honest question for you, if you don't mind. He's like, whatever you need, Adam. I was like, would you give your ex product, your skin cream product to your mother? He goes, fuck no. I was like. Shit. It was literally a week later. I quit Limelight. I didn't want to do the black hat Nutra stuff anymore. I left and went to DFO, which is like a super awesome economy. I didn't know that. Yeah.
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    Adam Pivko I worked there for just over a year before launching my own direct-to-consumer brand, working on that and getting acquired. Here I am, direct meds, chief marketing officer.
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    John Casto There was a supplement company in between though. Yeah. That, that went great.
  14. Find the channel that fits the buying behavior

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    Adam Pivko and then it had its pros and cons you know like we were it required some education which is different than a lot of supplement offers so some opposite offers they just try to explain their ingredients really quick for us it was an at-home dna test combined with a lifestyle quiz so if you think health equals nature plus nurture nature genetics nurture like lifestyle choices put them together personalized vitamins but we could make 400 billion different combinations of personalized vitamins so it was like super hard to predict somebody's problems without getting the testing done first so we had to sell the test kit as well as do the personalization and uh it's it's an awesome business i was super thrilled to have worked
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    Adam Pivko on it but like Ultimately, you know, what that business kind of like its rise to fame was I had the idea. It's my brand. I can do whatever the fuck I want. We were a small team. So I ran ads on Grindr and I tested out Grindr with like a good buddy of mine. And the headline that smashed on Grindr for the personalized vitamin brand was put something healthy in your mouth for mice,
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    John Casto which.
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    Adam Pivko I think it was just fucking awesome marketing.
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    John Casto It's catchy and it works. That was pre-AI. That was pre like... Did you try that on Meta?
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    Adam Pivko Yeah, we tried it on a whole bunch of different places, but Grindr was by far... You know what's so interesting about Grindr for the personalized vitamin space was... I think we achieved like at a certain point, like 61% of orders were for two people.
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    Adam Pivko so like the couples would just like be like oh we're gonna do this together oh it was like incredible so like cpas were like 61 cheaper give or take um which is just incredible if you think about it so that was like a really fun time with the brand at the same time i was working on a performance marketing agency because i just like like to keep my brain fresh i love solving brand talking, marketing, working on landers, ads, strategy, those types of things. So I was like doing that alongside of Autumn and then Autumn got acquired and here I am just basically created an agency within direct meds for a brand.
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    John Casto What, what is your, what are your natural, like, or developed talents? Like, like when you run that self-help company, for example.
  23. Use AI to multiply an existing creative skill

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    Adam Pivko what were you focusing on what were you putting your energy and who'd you build around you always marketing so uh funnels landers copywriting ad creative styles researching um even product shots product imagery but that was again it was pre-ai so like it was a it was a So I was arranging like photo shoots and getting actresses and actors and all sorts of things that like you had to do. But that eventually evolved into like taking those skill sets and being able to apply them to like a massive AI infrastructure that we've built for ourselves now at Direct Mads, which is like crazy. Like we're doing, I think, 6,000, 6,500 new ads per month right now. Wow. Yeah, like stupid.
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    Adam Pivko no humans well there's there's humans involved of course yeah no i mean like in the creative is it all ai usually seeds i have like a mix i i would say maybe 15 real human wow yeah yeah a lot of times we'll take long form human cuts and chop them down into and splice that into creative yeah what's what's actually like internally what's actually working best for you is it a combination of these human elements in the creative it's so interesting about this telehealth space that i find really interesting is like you have to live in america to know this and like to really really feel it and experience it but even if you're there for like three days i think you can
  26. Match the message to what buyers already know

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    Adam Pivko you can get a taste of it but what most people don't understand who don't live in the u.s is that every third commercial on tv every fourth bus stop every fifth billboard is a big pharma ad it's a big form of ads yeah there's no way to freaking go buy that there's no like qr code there's no website to go buy it on any of these things because that's not how they advertise so when you're a telehealth direct-to-consumer brand like what's working is bottom of funnel Because everybody is aware and trust and know that these products work.
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    Adam Pivko Like I read a stat recently that like 18% of Americans have tried GLPs and one in two has a friend who's found success with it.
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    John Casto Like that's, that's insane.
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    Adam Pivko Like, I don't need to educate people on GLPs. I need to say, Hey, it's available here. And we're a great provider because we have all this care. We have 24 seven customer support with real agents. Like I think. I think that's what people don't understand. They think it's like this new vertical that you have to like explain to people and teach to people. But like, really, they're so inundated with this marketing nonstop that you can just play this bottom of funnel and still provide an excellent service.
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    John Casto Go super direct with exactly what it's going to do for them.
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    Adam Pivko Want to lose weight? Get started. See if you qualify for $147.
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    John Casto But what's separating you from every other telehealth brand that's out there? You're doing $900,000 per day, man. What the fuck?
  34. Treat a new vertical like a new business

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    Adam Pivko I think it's a combination of things. One, one thing that we've done like this year. like all of 2026 is like we've done serious product differentiation so and that means like just expanding into more verticals of telehealth it's a really hard thing to do people think that you can launch a telehealth brand and have like 10 flagship products you're going to, you're going to land on your face before you know it. Each one of these products is like a whole new business and it could be its whole new brand, but we want to keep it as, you know, one big direct meds. Um, that's, that was really, really, really hard.
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    Adam Pivko And every time, every new, every quarter we're launching one or two more, it's really, really hard to do. And I think, I think that's something we've been able to excel at, but like, again, we're We kind of got the timing super right in our favor that we're able to make these really sizable investments into killer talent on an explosively large team. We're 380 people. It's like crazy.
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    John Casto How do you divide that up of like worldwide?
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    Adam Pivko A lot of call center, a lot of telesales. So telesales, customer support, operations, analytics, dev, marketing, everybody else all kind of grouped together. Like my marketing team alone is 22 people. uh so yeah it's like it's mayhem plus like researching you have to like become an expert on all these new products and really understand the pain points the selling points and what people are truly desiring by each of these products it's really freaking hard and i think we just put our minds and our efforts and our focus down on let's do the hard things also what's different about us and other tall brands is like we built everything proprietary like we're not on those big platforms.
  39. Build the advantage after the purchase

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    Adam Pivko I'll leave them unmentioned, but you can probably know who they are just by being anywhere near the space. But we're not on those. We have our own pharmacy. We have our own doctors network. We have everything is proprietary. to us and it allows us to control costs a lot better, allows us to keep our margins way up high as well as deliver this excellent, above excellent level of customer support, which I think makes us different in a space where we secret shop our competitors and you get complete AI messaging that's not even right.
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    Adam Pivko it's like no your ltvs aren't as good you know what i mean it's an ltv game cpa to ltv game the sooner you realize that you make the investments into both sides of bringing down your cpa and improving ltv that's where you know you can really service a huge amount of customers with products that work when you went live you started with glp1 yeah was that okay yeah
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    John Casto What was it then? Was there the call center component? Was it just a funnel, like almost like you were testing like an offer just to see if it would hit? Like what did it look like when you first went live?
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    Adam Pivko It looked like Ecom quiz funnel offer. no sms like maybe i think before my time like again it started before me and when i joined i think we were doing like one million of one one to two million a month in revenue when i joined in march of 2025 it's only been a year a year and a half year and a half from one to over 20 yeah 22 24 yeah crazy
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    John Casto It's like they didn't have like high-level 24-hour support. They didn't have a call center. No,
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    Adam Pivko I think the original funnel was R&D of internet marketing, rob and duplicate. okay i honestly think that's how anybody should get started it sucks to say and i'm i've seen how much our funnels get ripped now but like it kind of like that's how you get started stop guessing you know i don't know it makes sense i don't get too frustrated by it anymore i think it's just part of the game your mode isn't the funnel.
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    John Casto It's everything else doesn't matter.
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    Adam Pivko Correct. Right.
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    John Casto You can't AI a call sign.
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    Adam Pivko Not yet at least. Correct. Our mode is everything post-purchase.
  50. Keep product plans conditional on approval

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    John Casto What's roughly what percentage of your business is GLP one now versus other product models?
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    Adam Pivko Now we're down to like 41 or trending down towards 30% by the end of the year will be GLP.
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    John Casto Are you nervous about something
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    Adam Pivko I'm excited about how like we embrace compliance like we want to be this long-term player let's be real it's over a billion dollar business like you think I want to take risks anymore no dude I'm I'm chill I'm like some guys that are getting famous for telehealth brands right it's just not necessary We've really locked down our compliance. I think we're doing a solid job. But above and beyond that, it's like we're just investing in what's to come. And who knows, July 24th, the FDA is ruling on seven more peptides.
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    John Casto We're ready. You're positioned. We're ready.
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    Adam Pivko Perfectly. We're ready. If they green light those, we want to do it compliantly. You're going to go nuts.
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    John Casto You'll be the first ones.
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    Adam Pivko We want real doctors on the phones for real peptides at work. That's what we want. We don't want to sell bullshit that doesn't work. It's not our model. It goes against everything we stand for at this point. Done that. Been there. Done that. Don't want to do it again.
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    John Casto but dude you're you're pretty young you got an eight-year-old well i'm not that young how old are you 40. oh you i thought you were like 32. huh i'll take it cheers to that what what keeps you motivated to keep pushing i've thought about this i've thought about this numerous times
  60. Bring customer feedback back to the team

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    Adam Pivko Honestly, like I love sharing our client testimonials into the broader team who doesn't get to see all of them. We're changing fucking lives. We're selling products at work. We're using like this marketing prowess and accumulation of like marketing skill and operational excellence to really, really help people.
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    Adam Pivko how is that not motivating enough i like to joke about it and say yeah we're turning mommies into milfs or helping helping dudes see their dicks again because it's like funny in a space like this but like but it's all the matter is we're really fucking doing it and it's an important job and like it really is changing lives like i i can dig into like in our arsenal of our favorite testimonials and we don't even like publicize all of them but like some of them are like i just want to thank the guys who who are keeping the lights on and even the guys down to sweeping the floors. You've changed my life as like the wholesome middle America.
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    Adam Pivko Guy's no longer, you know, on diabetic medication. Like he's just his whole life has changed. I don't know. There's something really frickin nice about like flexing like the skills we've accumulated to like do so good in the world. I don't know. It's good enough for me. Money is nice,
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    John Casto but of course it is.
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    Adam Pivko yeah what you know it's funny because like i was in the fitness industry before i came into the affiliate space and that's why you're so shredded look at you you're not right now this fat piece of shit well i'm not supposed to get high on my own supply i'm a drug dealer after all but what's interesting is a lot of people criticize glp ones but i'm i generally believe the net impact is far greater than some of the side effects that could come listen There's a lot. We see all the criticism. We see all sides of the spectrum, right? There's definitely something to be said about eating healthier and making better life choices. It's that simple.
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    Adam Pivko You know, you could say it's that simple, but some people really, really struggle. Their metabolism is feeding their brain misinformation about how hungry they are, how much they need to eat. Like there's real problems in the world. And it's partly due to like. You can point the finger at a lot of different things like the, what is it, like pesticides in our foods in the U.S. in particular, the prevalence of fast food. Did you know, I think I read a stat that was like there's 11 or sorry, maybe it's 18, 11 or 18 times as many fast food locations as there are grocery stores in America.
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    John Casto Not surprising. Dude, I was a fat kid. I grew up fat.
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    Adam Pivko I am a fat kid. I'm still a kid at heart. Listen. It's so easy to make bad choices on nutrition and lifestyle choices in America. And that is why, what, 40% of the population is considered obese. 100 million Americans are considered obese. We've had over 250,000 GLP-1 patients. Sounds like a lot. Such a small number compared to 100 million. So there's so many more people to help.
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    Adam Pivko these are i don't know i think like no matter which side of the coin you're on you can't say that and everybody can solve their solutions by just eating healthier and like you just can't say it it's very it's it's almost rude to the people who like really struggle with it i actually feel sorry for both sides because i see both sides we see those comments on our ads like yeah Yeah. I don't know. It's, it's weird to, especially if there's somebody coming from the fitness, but I respect your opinion. It's not, I don't look at it as cheating. I look at it as like, Hey, you've tried, you've tried the willpower, like try science. You know what I mean? There's just better.
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    Adam Pivko There's just better ways to do it.
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    John Casto Dude. Generally, if you, if you take the medication, the way it's prescribed,
  72. Separate a persuasive story from evidence

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    Adam Pivko like you're going to want less food whether whether you like it or not generally that's what's going to happen but even still there's like other you know other medications that we offer take for example nad plus nad plus is like this longevity energy mitochondrial health products that like listen, oh wow, do you have a birthday? Like, you're probably concerned with longevity. Like, are you alive right now? So like, when you think about that and you think about, hey, This is almost like a bio-identical additional service to your body. As you age, you produce less NAD and you need more of it. Otherwise, your skin starts to wrinkle and your memory starts to lose focus and you have less energy.
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    Adam Pivko If you fix that, how does that change the rest of your life? I don't know. People can get all hung up on the motivations behind why somebody does this or not. And you can pick a side and be on that side all you want. But don't insult the people that make the choices that this is what they really need to feel better and live a better life and live a longer life and be there more present for their kids or whatever the reason is.
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    Adam Pivko i don't know i just anybody's a naysayer publicly on the internet to these trolls you know what i mean it's like uh you don't get it you don't even know what's going on around you what what else are you guys rolling out max like yeah so as a as a fitness junkie you'd probably like uh So as a fitness junkie, you'd probably like Sermorlin or Tesamorlin. So if you think of some of Glutide and Trizepatide, some of Glutide is like the GLP-1. Trizepatide is like a GLP-2. It's like the better version. Same with muscle. So Sermorlin is like the HGH-1. Tesamorlin is like HGH-2. There's a lot of different ways to think about it, but it's way better.
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    Adam Pivko energy, way better sleep, way better muscle retention, muscle growth. Um, so thanks to Moreland. You know, I don't know if I can legally claim this, but like thanks to Moreland. I was like one workout feels like two and Tessa Moreland is one workout feels like four. So like if you work out three times a week on testimonial, I know, wow, you just worked out 12 times. It's like you're going to get more muscle gains if that's what you want in your life. Not to mention better sleep, better recovery, better focus. Yeah. Like those drugs are next.
  77. Solve the offer before asking affiliates to scale it

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    John Casto When it comes to the marketing side, like what else differentiates you against all your competitors?
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    Adam Pivko I think we've built up a lot of trust in the affiliate game.
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    Adam Pivko i think we've done so because not only do we internally media buy and we solve our own problems i have a general affiliate marketing principle that i don't expect affiliates to solve my marketing problems i solve them first and then i ask affiliates to put a loudspeaker on what's working and we build our affiliate programs so that like our target and like we know what it costs we're buying alongside you not on every single platform that our affiliates can buy on but like we know generally speaking on every traffic source like how our offer is performing so we target margins for our affiliates in the 25 to 30 percent range we want our affiliates making 25 to 30 percent so that they can
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    Adam Pivko continue to grow they can continue to scale they can find success and i think that that's built up a lot of trust in our program uh as well as just like if you're new to new to the world like i think our onboarding guides are like really really really thorough and really helpful to help you understand like what's really happening in the funnel and what's happening in the space and what you need to get started so i think those things is also what makes us different from a marketing perspective just to answer your question like i think we're just more professional and more dialed in.
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    John Casto You get it, man. Like you come from it, right? Yeah.
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    Adam Pivko It's on my first rodeo. Yeah. So I think that, you know, it's interesting because like we have relationships with top partners of ours that we can just be like, Hey, you know, here's a new funnel. We've been testing it internally. Here's our metrics. Let's see if you can beat first 5,000, 10,000 bucks is guaranteed, let's go. Let's see what you got. And they would say, hell yeah, we'll get started in two days, I need two days. Show me some of your winning creatives so far. I say, here they are, go. And then we have like so much data.
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    Adam Pivko I think ultimately what makes us a better marketing engine is we have more at bats than most people have in a fucking lifetime. The amount of splits. that we're running the amount we're learning the amount of data we're accumulating on every single day just makes us infinitely better and we have like a data analytics team a data analytics analytics team that's like nine people deep right now it's crazy i'm like some of the best in the game like names you've heard of are on our team so i don't know i'm i'm just stoked about how much data we're accumulating how fast we're learning how fast we're iterating and just giving up
  85. Read the brief before spending

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    John Casto yeah we do share a lot so for the affiliates watching this that are like hey i want to get into telehealth as an affiliate that want to get started with you what should they expect like if they hit you up i'll say from personal experience you're going to immediately respond pretty not right away but pretty fast connect me with your team and then where do we go from there yeah i
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    Adam Pivko I think there's three rules for getting started with us. We share really, really thorough affiliate marketing briefs. They have everything about the offer, everything about performance marketing. They have everything about legit script. We have three rules for working with us or getting started working with us. Rule number one is read the brief. Rule number two is read the fucking brief. And rule number three is if you've read the brief, go ahead, sign up, ask for help. We're here to help you. Like, ultimately, our job and my affiliate team's job is to make our affiliates successful. I don't want to waste anybody's fucking time. I don't want to waste my own time. Yep.
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    Adam Pivko So, like, I try to be really clear on what product, what verticals you want to get into, what I expect testing budgets to look like for you. find optimizations and make sure that that's within your wheelhouse to get started. Because if you just get impatient or you cut short, you're just doing yourself a disservice. You're doing us a disservice. So it's really about just making sure it's the right commitment. You're well enough informed. You're set up for success. Go.
  89. Use quiz starts as an early diagnostic

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    John Casto And then we go live. What should we, as an affiliate, what should we expect? What are realistic expectations?
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    Adam Pivko I think early metrics, what you got to be looking at, in particular, there's a really easy one. And it's questionnaire started or quiz started. Basically, if they're coming to a pre-lander or direct to our lander, it's how many people are taking that action and saying, hey, I want to see if I qualify. If your ad number is not within the target thresholds for each product, generally speaking, 20 to 30% of people, generally speaking, if you're not within that range, you're driving shit quality traffic. Something's wrong with your ads. Something's wrong with targeting. Something's wrong. Something's wrong. So usually that's a really good indicator of if that channel, that partner is going to be successful.
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    Adam Pivko and we monitor that you monitor that we give full tracking of each of those every single events from you know as everything questionnaire started to lead to add to cart to initiate checkout to purchase we give you everything all events that you can fire and you can optimize pixels for but questionnaire started it's so early so quick you can know in 100 bucks if something's gonna
  93. Scale the angle you understand

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    John Casto and that's where i would recommend day zero getting started keeping a really close eye whichever funnel you're on and questioner started what's share with me a story of an affiliate that was maybe a little bit newer but got started with you and now they're hitting big numbers oh it's funny we had this like um i forget what we called it but we hosted this event in
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    Adam Pivko uh november of last year in san diego and it's for all of our affiliate partners we took care of all the meals we took care of everything that we could all they had to book was like the flight and i think maybe a hotel but we had a discounted rate at the hotel we were at and we did a full training I really love this event, but there was one person in the room who's known me a long time and seen us come up and coming. And he said like the nicest thing I think somebody said to me in a long time. He came up to me after that event and he just like shook my hand.
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    Adam Pivko He said, you guys did an excellent job. I think you're going to make a lot of new millionaires from everybody who sat in that room. And I was like, fuck, wouldn't that be great? I'm like, wouldn't that be great? Because I like love the people who came long time partners of ours. Many I think like I want to say upwards of 75% of the people who came to that event are still running with us. That's cool. But yeah, like literally we have partners doing 200 sales a day of like at $400 CPAs like clockwork.
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    John Casto What separates that guy from the guy that's struggling to get any kind of traction or make money?
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    Adam Pivko Patience, data, data understanding. Like there's levels to this shit, right? So like as you accumulate more data and your pixels optimize and then... you truly understand what angle is working for how you like to sell and how you can produce content more around that angle and translating that to other channels that you also have expertise in it's that blend of everything i think like our number one number two number three guys are probably mult or they're all multi-platform not just meta they're all multi-platform um and uh
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    Adam Pivko like they're just deeply rooted with us and no like special treatment we treat everybody the same like no special treatment um they're just like deeply they ask the good questions they understand their metrics and they're they're just cruise control now Same with our internal team. I find like a lot of our some of our creatives are like really long lasting. It's been cruise control for a while. There's like weird days. July 4th weekend. What a bloodbath. But like and like July in general is like the worst health and wellness month of the year. But right now, even still, it's like it just feels comfy. It feels consistent. It feels predictable.
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    Adam Pivko And I, I really like that as being like an, just an e-comm operator.
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    John Casto Especially being in this space, man. Yeah. It's not very common.
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    Adam Pivko It feels, it feels consistent. And every new product is just additional as opposed to, you know, moving the volume. awesome. Yeah, that's the most fun part is like, and again, if they if they approve those peptides July 24,
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    John Casto game on baby,
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    Adam Pivko keep a lookout. Keep a lookout. I'll be I'll be flying a private jet to this event next year. GLP Air Force One. Let's go.
  105. Make sharing useful before asking for a return

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    John Casto What else should people know about you? How can they connect with you?
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    Adam Pivko Yeah, I'm like, I think Telegram is the best way to reach me. Just A-P-I-V-K-O, Adam Pivko, A-P-I-V-K-O on Telegram. Or see me in the chats and comment away, reach out. Happy to chat anytime.
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    John Casto I can be a personal testament to that. I met him at this event last year. And I've seen, we've connected a few times since, and we're back.
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    Adam Pivko I try to add value. You know, there's another community that I think we're both in. I don't want to like name drop, but, um, there's a belief that I, I, I strongly resonate with. Um, it's like if one candle touches another candle, it doesn't lose its flame. Um, so like sharing, I don't know.
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    Adam Pivko it's such a big market and i don't need to gatekeep information i know what what trajectory we are on i'm not trying to like bash competitors or keep people down or spread misinformation i'm an open book and i'm happy to help people i always have throughout my whole career so never lining my pockets with commissions always just doing intros to good people for good karma i think that that's a really great way to operate in this space Yeah,
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    John Casto man. I've seen you do that firsthand in my group, my telegram chat. You drop sauce, long form sauce multiple times with asking for nothing in return and not even pushing your brand once. Nothing. So thank you, man. I appreciate you. Thanks for having me. Oh, of course. And so we'll link back to your telegram here. Anything else you want to share? Any last words of motivation doing $900,000 a day on average?
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    Adam Pivko I'd say, well, like, I'll do the colloquial joke. If you want to sell skinny shots and make fat checks, hit me up. But alternatively, like, I think the more you give, the more you get in the internet marketing community. And I would encourage you to ask for help or try to share knowledge as best as you can. And you'll see how much it returns dividends for you. That's like.
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    John Casto my number one word of wisdom i'm such a believer in that man yeah with the right people 100 yeah well thank you so much brother thanks great having you yeah delicious sangria by the way
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