Telehealth pricing models: per visit, membership, medication included

Telehealth pricing models get argued about as if they were a matter of taste. A founder likes the simplicity of a single membership price; an advisor prefers per-visit fees because they feel fairer; someone on the team read that bundling medication raises lifetime value. The argument resolves quickly once one variable is put on the table: how often the patient needs a refill. Refill cadence decides the model, and the model decides where the consult fee shows up in the profit and loss statement.

This post walks through the three models, matches them to treatment types by refill cadence, and then runs two worked examples with labelled hypothetical inputs so the arithmetic is visible. The dollar figures are illustrations; what carries over to a real program is the position of each cost line relative to the price.

The three pricing models

Per visit charges the patient once for one clinical encounter. The price covers the clinician's review and, where appropriate, a prescription sent to a pharmacy. Whether the patient fills it, and where, is separate. Revenue is recognized on the day, there is no recurring obligation on either side, and the brand's cost of goods is the consult itself plus payment processing.

Membership charges a recurring fee, usually monthly, for access to the clinician and to prescription management, with medication billed separately or filled through the patient's insurance. The brand sells continuity. The cost of goods is still mostly consults, but now spread across months in which the patient may or may not have a visit, so the brand is carrying utilization risk in exchange for predictable revenue.

Medication included, sometimes called an all-in subscription, folds the drug into the recurring fee. The patient pays one price, and the consult, follow-ups, prescription and shipped medication are all inside it. The brand now owns the medication cost line, which is the largest one in most treatment categories, and the price has to clear it every month whether or not a consult happened. This is the model most direct-to-consumer telehealth uses, and it is the one where the difference between a pharmacy at wholesale and a pharmacy with a markup becomes visible in the price the brand can charge.

Which treatment types fit which model

Sort treatment types by how often the patient needs a new supply and the model picks itself. Weight loss on a GLP-1 medication involves a weekly injection, a titration protocol that changes the dose over the first months, and a supply that has to be reordered on a fixed cycle. Testosterone replacement is similar: ongoing supply, periodic labs, dose adjustments. Both have a refill cadence measured in weeks, and both fit medication-inclusive membership, because the patient is going to pay for the medication every month regardless and would rather pay one number than three.

Hair growth and skincare sit in the middle. The medications are daily and long-term, but the prescriptions can be written for several months at a time and the clinical review is light after the first visit. These categories work as a membership with medication included at a low monthly price, and they also work as per-visit asynchronous care where the patient pays for the review and a multi-month supply is shipped. The deciding factor is usually whether the brand wants recurring revenue badly enough to carry the fulfillment.

One-off categories fit per visit and nothing else. A single course of treatment, a sexual health prescription that does not require ongoing management, or an asynchronous review that ends in advice rather than a script: charging these as a membership annoys the patient and invites chargebacks. Mental health is its own case, since it is recurring but the recurring unit is the session rather than the medication, so it tends toward a membership priced on visit frequency.

• Weekly or monthly medication with dose changes (GLP-1, TRT, peptides): membership with medication included
• Daily medication with a stable dose and light review (hair, skin): membership at a low price, or per visit with a multi-month supply
• Single course or single review (many sexual health and asynchronous categories): per visit
• Recurring sessions without a medication line (much of mental health): membership priced on visit frequency

Worked example: a GLP-1 membership at three price points

Take a hypothetical GLP-1 program and hold every input fixed except the price. The medication lands at $140 a month at wholesale with 0 percent markup, an illustrative figure and not a benchmark. Consults run at Tessic Health's published $25 per completed consult, and the book averages four consults per ten patients per month once it is past launch, which puts the clinician line at $10 per patient per month. Card processing is assumed at 3 percent of the price. Nothing else is in cost of goods.

At $179 a month, the lines are $140 medication, $10 consults and about $5 processing, which leaves about $24 per patient per month before marketing and overhead. The consult fee is 5.6 percent of the price. The medication is 78 percent, and a dose escalation that raises the wholesale cost would take the program to zero.

At $229 a month, the same lines leave about $72 per patient per month. The consult fee has fallen to 4.4 percent of the price and the medication to 61 percent. This is the price point where a program can afford an acquisition cost in the low hundreds of dollars and still see it back inside a few months.

At $279 a month, contribution rises to about $121 per patient per month, the consult fee is 3.6 percent of the price, and the medication is 50 percent. Whether patients will pay $279 is a marketing question this post cannot answer, but the P&L answer is clear: the consult line barely moves as the price changes, because it is flat, and the medication line dominates at every point.

• $179: medication $140, consults $10, processing about $5, contribution about $24 (consults 5.6 percent of price)
• $229: medication $140, consults $10, processing about $7, contribution about $72 (consults 4.4 percent of price)
• $279: medication $140, consults $10, processing about $8, contribution about $121 (consults 3.6 percent of price)

Now change one assumption. Replace the 0 percent markup with a 30 percent markup on the medication, a figure within the range that appears in white-label agreements, and add a 10 percent revenue share in place of the flat consult fee. At $229 the medication becomes $182, the revenue share is $23, processing is still $7, and contribution falls from $72 to about $17. At $179 it goes negative. The brand's price did not change and its patient did not change; the vendor terms consumed the margin. The flat fee versus revenue share guide sets out how to read those terms before signing.

The consult line barely moves as the price changes, because it is flat, and the medication line dominates at every point.

Worked example: a per-visit hair or skin program

Now a hypothetical hair-growth program sold per visit. The patient pays $79 for an asynchronous review and, if prescribed, a three-month supply is shipped. Assume the medication costs $30 for three months at wholesale, an illustration; processing is 3 percent; the consult is $25. The lines are $25 consult, $30 medication and about $2 processing, leaving about $22 on the visit. The consult fee is 32 percent of the price: on a per-visit model at a low price, the consult is the biggest cost line, not the medication.

That changes the pricing decision. A per-visit program has to price the visit high enough to clear a fixed consult fee with room to spare, and it has to think hard about renewal, because the second and third visits are where the margin lives. If the same patient returns every three months for a refill review at $79, and the review is lighter the second time, the annual value is about $88 in contribution across four visits against one acquisition cost. Convert the same program to a $29 monthly membership with the three-month supply included and the annual revenue is $348, the consult line is $25 for the initial review plus $25 for one renewal review, medication is $120, processing is about $10, and contribution is about $168, nearly double, for the same patient with two clinical reviews instead of four.

The membership version wins on the P&L. It also carries risk the per-visit version does not: the brand is shipping product against a card that might fail, and it needs failed-payment recovery, often called dunning, to keep the book from leaking. Per visit avoids all of that at the cost of lower value per patient. Neither answer is wrong; the visits to recurring care post covers the operational shift a brand takes on when it moves from the first to the second.

Pricing against big consumer brands and manufacturer direct offers

A new brand does not price in a vacuum. The large consumer telehealth companies publish their membership prices on their own sites, and a patient comparing options will have seen them. This post does not quote those prices, because they change often and the comparison a patient makes is rarely price alone. What a brand should take from them is the structure: the large players almost all sell medication-inclusive memberships, they almost all show a monthly number, and they almost all discount the first month. A brand entering the same category with a per-visit price and separate medication billing is asking the patient to do arithmetic the incumbents have already done.

Manufacturer direct-to-patient pricing changed the ceiling in weight loss. As reported by CNBC in March 2025, Novo Nordisk began offering Wegovy through its own direct-to-consumer pharmacy at a $499 a month self-pay price, and press coverage since then has described lower self-pay prices for newer formulations and distribution deals between the manufacturers and large telehealth platforms. A brand pricing a branded-medication program has to price against those manufacturer offers directly; a brand pricing a compounded program has to price against them indirectly, because the patient's sense of what the category costs is set by them. In either case the manufacturer price is public and the brand's medication cost is not, which is one more reason the wholesale price, and whether anything is added to it, decides what price points are open.

Trials, pauses and cancellation

Introductory pricing is common in medication-inclusive memberships and it is worth modelling as a cost rather than a marketing line. A first month at $99 on a program that costs $150 in medication and consults is a $51 acquisition subsidy, in addition to whatever the ad spend was. The subsidy is only recovered if the patient stays past the point where the discount ends, which puts the retention question at the center of pricing rather than at the edge of it.

Retention in GLP-1 weight loss is measurably difficult. A study in JAMA Network Open, available through PubMed Central, found that 64.8 percent of patients without type 2 diabetes had discontinued GLP-1 treatment within a year, and 46.5 percent of those with diabetes. A Blue Health Intelligence issue brief reported that 58 percent of patients stopped before reaching a clinically meaningful benefit, with roughly 30 percent stopping in the first month. Those are study populations rather than any particular brand's book, but they set the expectation: a pricing model that only works if the average patient stays a year is a pricing model that will not work for most of the book.

Pauses are a retention tool with a P&L cost. Allowing a patient to pause for a month rather than cancel keeps the relationship open and stops a shipment the patient would otherwise have refused. Cancellation should be as easy as signup; the FTC's 2024 click-to-cancel amendments to the Negative Option Rule were vacated by the Eighth Circuit, and the FTC issued an advance notice of proposed rulemaking on March 11, 2026, so the federal rule is in motion rather than settled. A brand that builds one-click cancellation now is protecting itself against chargebacks today and against whatever the rule becomes.

Questions operators ask

"How should a telehealth brand price its services if the category could go either way?" Run both models through the unit economics calculator with the brand's own medication cost and consult cadence, and look at contribution per patient per year rather than per month or per visit. The membership version usually wins on that number, and the question becomes whether the brand can operate a subscription, which is a question about billing and retention, not about pricing.

"Should the consult be visible to the patient as a separate line?" Usually not in a membership, and usually yes per visit. In a membership the patient is buying an outcome and a package; itemizing the clinical review invites the patient to ask why they are paying for it in a month they did not use it. Per visit, the review is the product, and showing it is honest.

"What happens to the pricing math if the medication price changes?" On the worked example, every $10 move in the wholesale medication cost moves contribution by $10 at every price point, which is why the medication line deserves more scrutiny than the consult line in any vendor conversation. A flat consult fee is a known number; a medication price with a percentage on top is a number that changes when the wholesale price does, and in the same direction.

"Is membership versus per visit really a pricing decision, or an operations decision?" Both, in that order. Pricing picks the model by refill cadence. Operations then has to deliver it: subscription billing, failed-payment recovery, shipment scheduling, and the follow-up cadence that keeps the consult line where the model assumed.