The Mandolin Thesis
Everyone talks about AI agents as the next big unlock. In specialty medicine they’re not “next”—they’re now. Biologics, gene therapies, and other infused treatments already total $250B a year in the U.S., and experts expect $1.5T in spend by 2033. Yet every prescription still limps through benefits checks, prior-auth ping-pong, and reimbursement wrestling. The clinics that treat patients purchase the drug, infuse it, then beg payers to pay; specialty pharmacies dispense, ship, and chase the same paperwork. The bottleneck in saving lives isn’t science; it’s endless copy-paste.
Mandolin exists to move treatments instead of paper. We drop AI teammates – software that can reason, click, call, and follow up – into the gap between a doctor’s signature and a patient’s first dose. Approvals that once took weeks compress into days, cash flow shows up on time, and patients start treatment while the window for clinical benefit is still open.
Why It Matters to Us
Breakthrough therapies for cancer, Alzheimer’s, HIV, and dozens of other conditions finally exist—but every one of them still has to run a gauntlet of forms, phone calls, and portal log-ins before it reaches the patient. Many of us at Mandolin have personally watched this delay steal days from patients who cannot afford to wait. Our mission is straightforward: strip the friction out of drug access, so that life-saving treatments move at the speed that science intended. This mission—not any single feature or metric—is at the core of everything we build.
What $40 Million Buys Us
Greylock just led our Series A, shortly after our seed co-led by SignalFire and Maverick alongside participation from Timeless, SV Angel, and the founders of Vercel, Decagon, and Yahoo. This capital isn’t fuel for vanity metrics; it gives us firepower to wire AI labor into several thousand infusion centers, specialty pharmacies, and health systems, to support roughly one million therapy journeys every year, and to let code—not clipboards—run the entire buy-and-bill relay.
The Market Wind at Our Back
Drug spend is soaring while workflows are stuck in 1998. Even our government has sounded the alarm: New federal rules require payers to answer prior authorization requests in days—not months—and to expose claims data through openly-accessible APIs. This is great for patients, but existential for any healthcare provider whose “API” is still a fax machine. Human head-count can’t stretch fast enough to support the onslaught of changes and new treatments—software has to close the gap, and agentic AI allows us to do so reliably.
Engineering on the Bleeding Edge
The best software should feel invisible; healthcare software has almost always felt like the opposite. Most attempts to clear the administrative sludge of American healthcare stall between “proof-of-concept” and “critical infrastructure.”
AI agents let us finally bridge that gap. Mandolin preserves a universal context and uses the latest advances in vision, language, and multimodal reasoning to weave structured records, clinical notes, imaging, and dense medical literature into a single workflow—making the decisions needed to put a patient on treatment.
Engineering rigor underpins every choice. Our agents talk to brittle EHRs, insurance portals, and telephony systems through carefully layered abstractions, staying resilient even when the outside world misbehaves. Each action is transparent, auditable, and guarded by strict safety checks with human oversight.
Our goal is straightforward: build stable, transparent, accountable agents that elevate clinical judgment. The result is practical, reliable AI that clinicians trust, patients benefit from, and engineers are proud to deploy.
Proof on the Ground
We’re still early, but the signal is clear. Across the hundreds of clinics, infusion suites, and specialty pharmacy locations running Mandolin, multi-week approval cycles are already dramatically shorter. Backlogs that once felt permanent are disappearing, and staff are being redeployed to higher-value work instead of paperwork triage. It’s like flipping on the lights in a warehouse and suddenly seeing wide-open floor space.
What’s Next
In our first year, we focused singularly on laying the foundation of our Agentic Operating System alongside a set of deeply committed early partners. Now, our priority is scaling that foundation—rapidly maturing it to support thousands of deployments across the U.S.
Come Build
If you’re excited about building boundary-pushing agentic systems – to solve urgent problems in one of the defining markets of our generation – we’d love to talk. We’re hiring across infra, ML, security, and product.
Move medicine at the speed of software. Read more in our Wall Street Journal coverage HERE.