699% ROAS in 80 Days: How Product Selection, Not Budget, Fixed This Medical Brand's Google Ads

699% ROAS in 80 Days: How Product Selection, Not Budget, Fixed This Medical Brand's Google Ads

When the owner of Mountainside Medical handed us his Google Ads account, it had 122 campaigns and a 25.57% ROAS. He wasn't doing anything wrong. He was doing everything without a system. No product selection logic, no campaign structure, no way to tell what was actually working.

A quick note on the timeline: the 80 days in this headline is the performance window for the winning campaign once it was validated and live. Getting there took 12 months of account rebuilding, product testing, and two major strategy pivots. What we found on day one explained why.

Who Is Mountainside Medical?

Mountainside Medical is a US-based online medical supplies and pharmaceutical distributor. Their Shopify store serves individual consumers, home care patients, doctors' offices, hospitals, EMS teams, and specialty clinics, stocking thousands of SKUs across needles and syringes, IV supplies, injectable medications, wound care, respiratory equipment, diabetes supplies, and emergency medications from brands including BD, Pfizer, Dynarex, and Fresenius Kabi.

Free US shipping over $100, wholesale pricing, a catalogue built for both everyday healthcare and complex clinical requirements.

Like most business owners running lean, he decided to manage Google Ads in-house. It made sense at the time. Over time, he built out 122 campaigns across the catalogue, kept them running, and watched conversions come in. On the surface, the account looked active.

The numbers told a different story. At 25.57% ROAS, the account was returning roughly $8,600 in revenue against $33,900 in ad spend. The 2,620 conversions were real, but the products behind them were low-AOV, which created a structural ceiling no amount of optimisation could fix. When revenue per order can't cover the cost of acquiring the customer, more volume makes the problem worse.

The 122 campaigns compounded it further. Without clear segmentation logic, budget spread thin, signals diluted, and there was no mechanism to identify what was working. The account was generating activity. It wasn't generating learning.

What We Found When We Took Over

The economics were broken at the product level, not the campaign level. That distinction matters.

The campaigns were built around low-AOV products. Even with decent conversion volume, revenue per conversion couldn't absorb advertising costs. You can't fix a 25% ROAS by tweaking bids. The problem's upstream, in what's being advertised.

Product titles weren't written for how buyers actually search. Medical buyers search with specificity: brand names, dosage terms, gauge sizes, application types. The existing titles were generic. A generic product title in Google Shopping means your ad appears in the wrong searches, attracts unqualified clicks, and burns budget on people who won't buy.

No product reviews on the listings. In a category where buyers are making decisions about health and body, reviews aren't optional. Without them, CTR drops and conversion rates follow.

No campaign segmentation logic. 122 campaigns sounds like structure. Without clear rules for how products are grouped and how budget flows, it's noise. Winning products can't be identified. Budget can't follow what works.

Phase 1: Merchant Center Cleanup Before Spend

The first thing we did wasn't campaign work.

We rewrote product titles to match buyer search intent. For medical products, that means including brand names, product specifications, and clinical descriptors. A syringe listing becomes far more discoverable when the title includes needle gauge, barrel size, and brand rather than just "syringe."

We added negative keywords to cut irrelevant search traffic that had been bleeding budget. Medical product searches attract informational queries, symptom lookups, non-commercial searches. None of those should be eating ad spend.

This phase produced no visible ROAS improvement. It wasn't supposed to. It was the groundwork that made everything after it possible.

Phase 2: Product Review Setup for Buyer Trust

In healthcare and medical supplies, trust is the conversion mechanism.

We set up product reviews on the listings, integrated the review feed correctly into Merchant Center, and ensured ratings appeared on Shopping ads. Reviews accumulate over time: the infrastructure had to be in place before scaling spend, not after.

Phase 3: Campaigns, Failures, and What the Data Actually Taught Us

This is the part most agencies leave out of their case studies.

In March 2026, we ran multiple campaign structures. Many of them didn't work.

The methodology across every campaign was consistent: start at $30/day with manual CPC at $0.50. Monitor for conversion signal. Campaigns showing genuine signal moved to $50/day with CPC raised to $1.00. Campaigns that failed got killed. Budget only moved where data supported it.

Two major product pivots happened during this phase.

Pivot 1: RX to non-RX. The initial campaigns included prescription-adjacent products. These created persistent policy issues: approvals were inconsistent, products got flagged, campaigns stalled waiting on review. We made the call to move entirely to non-RX products that any consumer could buy without a prescription. It eliminated the compliance friction and opened inventory to a much broader buyer base.

Pivot 2: Bulk to single-unit. We assumed bulk-buying products would produce higher AOV and better returns. The data disagreed. Bulk medical supply buyers have longer consideration cycles, more price sensitivity, and different search behaviour. Single-unit products converted faster and at better margins for our campaign structure. We shifted focus there.

Neither pivot was obvious upfront. Both came from running campaigns, reading the results, and being willing to change direction rather than defend the original strategy.

Phase 4: Finding the Winning Campaign in Ointments and Injections

The "Webrex-shopping-Ointments and Injections" campaign was the breakthrough.

Non-RX ointments and injection supplies hit the right combination: high enough AOV, clear buyer intent, low policy risk, and review credibility now live on listings. Product titles matched how buyers were actually searching. The structure was clean and the signals were clear.

Once we had a proven formula, we used it as a blueprint, building additional campaigns around similar product categories showing the same signals. Same methodology, same budget discipline, applied to a small set of validated winners.

One structural decision worth understanding: 99% of products in the account are deliberately excluded from this campaign. That's not an oversight. It's the strategy. We identified which specific products drive profitable conversions and built the campaign around only those. Adding more products dilutes the signal. When scaling, new products go into separate controlled campaigns rather than mixed into the proven one.

The result is an account that today runs 4 active campaigns, all built on the same foundation.

Current ROAS and What Comes Next

The winning campaign is in active optimisation. Current focus: scaling spend while protecting ROAS, testing bid strategy adjustments, and identifying whether the product set can expand without diluting performance.

The account went from 122 loosely organised campaigns burning $33,900 to a focused structure where a single campaign generates 699% ROAS at under $800/month in spend. Volume was never the goal. Building something that compounds was.

Results: Before vs. After

View all Webrex Studio case studies.

Frequently Asked Questions

What is a good ROAS for Google Shopping in the medical supply category? Most medical ecommerce accounts target 400–600% ROAS to maintain profitability after product costs and ad spend. Mountainside Medical's winning campaign at 699% puts it above typical category performance. Our Google Ads service is built around reaching and sustaining this threshold.

Why only 48 conversions if the account used to generate thousands? The prior 2,620 conversions came from products with insufficient AOV to cover ad costs, hence the 25% ROAS. 48 conversions from high-AOV products at 699% ROAS generates significantly more actual profit. Volume isn't the goal. Margin is.

Can medical products be advertised on Google Shopping? Yes, with conditions. Non-prescription medical products can be advertised freely. Prescription-adjacent or regulated products face stricter review, policy restrictions, and potential disapprovals. Understanding which products qualify and how to structure a compliant feed is part of the job in this category. It's one reason the RX-to-non-RX pivot in Phase 3 mattered so much.

How long does it take to see ROAS improvement on Google Shopping? Feed optimisation and Merchant Center work starts showing impact within a few weeks. Identifying winning campaigns through structured testing typically takes two to six months. Full strategic alignment, including product selection pivots, can take longer. In this account, the full cycle from takeover to a stable winning campaign was approximately 12 months.

Why are 99% of products excluded from the winning campaign? Restricting the campaign to only the highest-converting products concentrates budget where conversion probability is highest. Adding more products dilutes that signal. When scaling, new products are tested in separate controlled campaigns rather than mixed into the winning one.

Work With Webrex Studio

Webrex Studio is a Shopify-focused ecommerce growth agency based in Ahmedabad, India, working with D2C and B2B brands across the US, UK, and Australia. Services include Google and Meta Ads, Shopify SEO, CRO, email marketing, and Shopify development.

If your Google Shopping account is spending without proportionate returns, the problem is likely not your bids. Get in touch with Webrex Studio.