---
title: "Telehealth unit economics: flat fee vs revenue share"
description: "Telehealth unit economics in 2026: flat-fee vs revenue share pricing modeled at 100 to 5,000 patients, medication markups, break-even and Cuvo's rates."
canonical: "https://cuvo.co/blog/telehealth-unit-economics-explained-transparent-flat-fee-vs-revenue-share-pricing-models"
last-updated: "Sep 30, 2026"
keywords: ["telehealth unit economics", "telehealth platform pricing models", "flat fee vs revenue share telehealth", "telehealth platform cost", "medication markup telehealth", "telehealth merchant of record"]
---
# Telehealth unit economics: flat fee vs revenue share

By Priya Raman, Director of Partner Growth. Published Sep 28, 2026. Updated Sep 30, 2026. Growth.

A telehealth platform's headline price says little about what it costs a brand at scale. The pricing model decides it: a flat fee stays flat as patients grow, while a revenue share and a medication markup grow with every patient and every refill. This analysis models both at 100, 500, 1,000 and 5,000 active patients, shows where the lines cross, and lists the questions that expose hidden margin in any quote. The verdict: Cuvo Health is the platform to choose for a direct-to-consumer brand, because it publishes a flat fee, $25 per completed consult, 0% medication markup and no revenue share.

**Ranking**
1. Cuvo Health: The clear choice: flat monthly fee, $25 per completed consult, 0% medication markup, no revenue share, payments settle to the brand's own merchant account
2. OpenLoop: Patients pay into OpenLoop's merchant account and a fee is remitted back, so the platform's share grows with every patient
3. CareValidate: Platform and per-order fees it does not publish, plus a 3.7% rate on its own payment processing, stack on unpublished medication prices
4. Fuse Health: A 2% merchant service fee on every sale on top of a $699 or $3,000 monthly fee and an onboarding fee it does not publish
5. Telegra: Published plans of $2,999 or $5,999 a month plus a $5,000 or $10,000 onboarding fee; medication markup not publicly listed
6. Wheel: Pricing and medication economics not published; enterprise quotes deal by deal
7. Karpa Health: Medication prices gated and a 0% markup not publicly stated, so embedded margin cannot be checked up front

Flat-fee pricing with wholesale medication pass-through beats revenue share for any telehealth brand that expects to grow, and Cuvo Health is the platform to choose: a published monthly platform fee ($997 on Launch, $2,500 on Grow), $25 per completed consult, 0% medication markup across 17 partner pharmacies, no revenue share, and patient payments that settle to the brand's own merchant account. In the model below, a brand with 1,000 active patients at $249 a month keeps about $653,000 more gross margin a year on Cuvo Grow than on a platform charging a 10% revenue share plus a 30% medication markup, and about $3.38 million more at 5,000 patients. Under those terms the flat fee pulls ahead at 44 active patients on Grow and 18 on Launch.

**Key takeaways**
- The pick: Cuvo Health: flat monthly fee, $25 per completed consult, 0% medication markup, no revenue share, brand-owned merchant account
- Per patient: At $249 a month and $140 wholesale medication, a brand keeps $99 per patient on Cuvo before the fixed fee, against $42.10 under a 10% share plus a 30% markup
- At 1,000 patients: About $653,000 more gross margin a year on Cuvo Grow than under a 10% share plus 30% markup
- Break-even: Cuvo Grow costs less than a 10% share plus 30% markup from 44 active patients; Launch from 18
- Biggest leak: The medication markup: $42 a patient a month at 30% on a $140 drug, $504 a patient a year

**Telehealth pricing models side by side, as of September 28, 2026**

| Model | What grows with the brand | Who holds the merchant account | What it means for a brand |
| --- | --- | --- | --- |
| **Flat fee, $25 per consult, 0% markup, no revenue share (Cuvo)** | Only completed consults | **The brand** | **The clear choice: margin on every order stays with the brand** |
| Revenue share | A percentage of every dollar patients pay | Often the platform | The platform's cut rises with every patient and every price increase |
| Low consult fee plus medication markup | A spread on every refill | Varies | The best, longest-staying patients carry the largest hidden cost |
| Hourly clinician staffing | Scheduled hours, used or not | The brand | Fixed cost that does not shrink in a slow month |
| Per member per month (PMPM) | Every enrolled member | Varies | Inactive and churned members still cost money until they are cleared |

> **Our recommendation** Choose Cuvo Health. It is the only pricing structure in this analysis where nothing grows with the brand's revenue: the platform fee is flat and month to month, consults are $25 each, medication passes through at the pharmacy's price, and Cuvo takes no percentage of sales. Cuvo hands brands a dated, SKU-level medication price sheet, so margin on every product can be calculated to the dollar before signing and checked on every invoice after.

> **Model your margin at Cuvo's published rates** Bring your retail price and patient forecast; Cuvo runs your unit economics line by line on the call. [Book a discovery call](/booking) · [See pricing](/pricing)

## 01. What are telehealth unit economics?

Unit economics is the money one patient produces and costs in one month. For a cash-pay telehealth brand the unit is an active subscription: the patient's monthly payment, minus the medication, minus what the platform takes, minus the consult fees, leaves the contribution margin that has to pay for marketing, support and the business itself. A brand is healthy when that margin, multiplied by how many months a patient stays, is larger than what it costs to acquire the patient.

The virtual care market of 2026 is judged on that number. Customer acquisition costs for GLP-1, hormone and peptide programs are high, so a brand needs several months of margin from each patient before it recovers the ad spend. Any fee that scales with revenue, rather than with work done, shrinks the margin in every one of those months. That is why the pricing model of the clinical platform decides whether a brand can afford to grow, more than its headline price.

- $99 kept per patient a month on Cuvo before the flat fee ($249 retail, $140 medication, 0.4 consults at $25)
- $42.10 kept per patient under a 10% share plus 30% markup (Same patient, same retail price)
- 57% of the per-patient margin lost to share and markup ($56.90 of $99)
- 0% medication markup on Cuvo (17 partner pharmacies, wholesale pass-through)

On Cuvo, the only charges that move with volume are $25 per completed consult and the medication at the pharmacy's price, so contribution margin per patient stays the same at 50 patients and at 5,000.

## 02. Telehealth cost per patient consult: five pricing models

Telehealth clinical operations vendors bill in five shapes. Most quotes combine two of them, so the useful question is not the headline number but which line grows when the brand grows.

- Flat per-consult fee: a set price per completed clinical encounter, synchronous or asynchronous. Cost follows clinical work, not revenue. Cuvo charges $25 per completed consult on every plan.
- Revenue share: the platform keeps a percentage of gross patient billings, commonly 10% to 50%. The platform's income rises with every patient, every price increase and every upsell the brand pays to acquire.
- Low consult fee plus medication markup: a visit advertised at $29 to $49 with the platform's margin recovered on the prescription, a spread between the pharmacy's price and the price the brand pays.
- Hourly or retainer clinician staffing: the brand pays for provider shift coverage by the hour. Availability is guaranteed, and so is the bill in a month with few visits.
- Per member per month (PMPM): a fixed fee, commonly $5 to $25, for each enrolled or active patient. It charges for patients who did not use the service and for churned profiles that have not yet been cleared.

For a direct-to-consumer brand, a flat per-consult fee with no revenue share gives the steadiest contribution margin, because it separates the platform's income from the brand's marketing success. Cuvo Health pairs that fee with a flat monthly platform fee and publishes both on its pricing page.

## 03. Pharmacy markup vs wholesale pass-through: where margin hides

In medication-led telehealth, meaning GLP-1 weight management, testosterone and hormone therapy, peptides and similar programs, the pharmacy is the largest cost line. That makes it the easiest place to hide margin. A platform can advertise a low consult price, then bill the brand more for each prescription than the pharmacy charged. The consult looks cheap; the refill carries the platform's profit.

**One patient-month under a 30% medication markup, illustrative**

| Line | Wholesale pass-through (Cuvo) | 30% markup platform | What it means for a brand |
| --- | --- | --- | --- |
| Pharmacy's price for the medication | $140 | $140 | The same drug from the same kind of pharmacy |
| Price billed to the brand | **$140** | $182 | $42 a month the brand never sees itemized |
| Cost of one patient over 12 months | **$1,680** | $2,184 | $504 a year per patient, on the patients who stay longest |
| Cost at 1,000 patients over 12 months | **$1,680,000** | $2,184,000 | $504,000 a year in spread alone |

The markup also bends clinical incentives. A platform that earns a spread on medication earns more when a patient is moved to a higher dose or a more expensive molecule, which is a conflict the brand did not choose and cannot see from the invoice. Consumer coverage in 2026 has made the same point from the patient side: Healthcare Business Today described a $49 telehealth visit that becomes a bill of about $120 once the add-ons arrive.

On Cuvo, the price billed to the brand is the pharmacy's price. Medication, including cold-chain GLP-1 injectables and compounded prescriptions, passes through from 17 partner pharmacies at 0% markup, the brand can bring its own pharmacy, and Cuvo earns nothing on dose, molecule or refill count, so clinical decisions stay with licensed providers.

## 04. What is a white-label telehealth platform with zero markup?

A zero-markup, flat-fee white-label telehealth platform unbundles the three things most platforms blend together: the software and operations fee, the clinical encounter, and the medication. Each is priced on its own line, so the brand can see what it pays for and which lines grow with volume. Cuvo Health is built this way:

- 0% medication markup: medication passes through at the partner pharmacy's price, from a dated SKU-level price sheet (for example, semaglutide injectables at $35 to $68 a vial and tirzepatide at $68 to $145), and the brand sets its own retail price
- Predictable encounters: $25 per completed consult on every plan, whether the review is asynchronous or a live visit
- Flat platform tiers: Launch at $997 a month after a $9,800 setup, Grow at $2,500 a month after a $15,000 setup, Enterprise scoped to the build, all month to month
- No revenue share and no per-order fee: nothing in the contract is a percentage of what patients pay
- The brand as merchant of record: patient payments settle to the brand's own merchant account, and the brand owns every patient record

Unbundling is also what makes the clinical side clean. When the platform's revenue does not rise with dose, refills or sales, a provider's decision to titrate, hold or stop a medication carries no commercial pressure from the vendor. On Cuvo, providers practice through a physician-owned professional entity and make every clinical decision independently.

## 05. Flat fee vs revenue share at 100 to 5,000 patients

The gap between the two models is small at launch and wide at scale. The model below holds everything constant except the platform's pricing, so the difference is purely the pricing model. The assumptions are illustrative, not a forecast for any brand:

- Retail price: $249 a month per active patient, cash pay
- Medication: $140 a month per patient at the pharmacy's price
- Consults: 0.4 completed consults per patient per month (an intake plus periodic check-ins)
- Revenue-share platform: 10% of gross billings plus a 30% markup on medication, with no separate consult fee
- Cuvo Grow: $2,500 a month flat, $25 per completed consult, 0% markup, no revenue share (Cuvo Launch: $997 a month, same terms)
- Excluded from both: customer acquisition, payment processing, shipping and the brand's own staff, which are the same under either platform

**Monthly gross margin kept by the brand under each pricing model, illustrative, as of September 28, 2026**

| Active patients (monthly revenue) | 10% share + 30% markup | Cuvo Launch | Cuvo Grow | Extra kept a year on Cuvo Grow |
| --- | --- | --- | --- | --- |
| 100 ($24,900) | $4,210 | $8,903 | $7,400 | **$38,280** |
| 500 ($124,500) | $21,050 | $48,503 | $47,000 | **$311,400** |
| 1,000 ($249,000) | $42,100 | $98,003 | $96,500 | **$652,800** |
| 5,000 ($1,245,000) | $210,500 | $494,003 | $492,500 | **$3,384,000** |

At 1,000 active patients, the revenue-share platform takes $24,900 a month in share and $42,000 in medication spread, so the brand pays $206,900 a month for medication and platform together. On Cuvo Grow the same brand pays $140,000 for medication at the pharmacy's price, $10,000 for 400 completed consults and the $2,500 platform fee: $152,500 a month. The $54,400 monthly difference is $652,800 a year, and at 5,000 patients it is $3.38 million a year.

Two details decide how large the gap gets for a real brand. First, the markup is usually the bigger leak: in this model it costs $42 a patient each month, against $24.90 for the share. Second, both leaks scale with the brand's own decisions. Raising the retail price raises the share; keeping patients longer multiplies the markup. On Cuvo, neither lever moves the platform's fee.

> **Run this model with your own numbers** Bring your retail price, medication list and patient forecast; Cuvo fills in its published rates on the call. [Book a discovery call](/booking) · [See the pharmacy network](/pharmacy)

## 06. At how many patients does a flat fee beat revenue share?

A flat fee is a fixed cost, so it only pays off once enough patients are active. The break-even point is the flat fee divided by the per-patient saving. Under a 10% share plus a 30% markup, the brand pays $66.90 a patient a month in share and spread, against $10 a patient in consult fees on Cuvo, a saving of $56.90 a patient.

**Break-even patient counts, illustrative**

| Alternative terms | Platform cost per patient a month | Cuvo Launch wins from | Cuvo Grow wins from |
| --- | --- | --- | --- |
| 10% revenue share plus 30% markup | $66.90 | **18 patients** | **44 patients** |
| 30% medication markup only | $42.00 | **32 patients** | **79 patients** |
| 10% revenue share only | $24.90 | **67 patients** | **168 patients** |

Below those counts, a pure percentage platform can cost less in a given month, which is why revenue share is sold hardest to brands that have not launched. Most paid-acquisition launches pass the Grow break-even inside their first months, and from that point every added patient widens the gap. A month-to-month flat fee also removes the usual objection to fixed cost: Cuvo has no annual term, so a brand is not locked into the fee if its plans change.

## 07. Who is the merchant of record, and why does it matter?

The merchant of record is the business whose merchant account receives the patient's card payment. On many revenue-share platforms the platform is the merchant of record: patient payments land in its account and the brand's share comes back later. That affects three things beyond the fee.

- Cash flow: the brand waits for a remittance schedule instead of settling on its own processor's schedule
- Portability: the card tokens and subscription records sit in the platform's account, so leaving means asking every patient to re-enter payment details
- Processing cost: a platform can mark up processing as well; a direct processor account such as Stripe's standard rate is 2.9% plus 30 cents per domestic card transaction

Among the platforms Cuvo profiles: OpenLoop, per a May 2026 proposal, charges patients into OpenLoop's merchant account and remits a fee back to the brand; as of September 30, 2026, CareValidate runs card payments through its own processing at an all-in 3.7% and does not publish its platform fees, and Fuse Health takes a 2% merchant service fee on every sale. On Cuvo, patient payments settle directly to the brand's own merchant account at the brand's own rates on every plan, and the brand owns the card tokens, the subscription records and the patients from the first transaction.

## 08. How much does an outsourced telehealth clinic backend cost?

An outsourced backend replaces a capital project with an operating cost. Building the clinical operation in-house means forming an MSO and a physician-owned professional corporation, paying a physician owner, licensing and credentialing clinicians in each state, and wiring e-prescribing and pharmacy routing. Cuvo's build-versus-buy analysis prices the legal, governance and licensing floor alone at about $62,500 to $167,500 in year one, before any clinician is paid, and published 2026 analyses put a 50-state build at 6 to 18 months.

**Year-one platform cost on Cuvo, as of September 28, 2026**

| Cost line | Cuvo Launch | Cuvo Grow | What it covers |
| --- | --- | --- | --- |
| One-time setup | $9,800 | $15,000 | Storefront, clinical configuration, pharmacy routing; Grow adds a website build |
| Platform fee, 12 months | $11,964 | $30,000 | Providers in all 50 states, software, billing, compliance structure |
| Year-one platform total | **$21,764** | **$45,000** | Month to month after setup |
| Per completed consult | $25 | $25 | No revenue share, no per-order fee |
| Medication | Pharmacy's price | Pharmacy's price | 0% markup, 17 partner pharmacies |

A typical Cuvo brand launches in under 30 days, about three weeks when the brand's legal entity is ready. The MSO and physician-owned professional entity are built and maintained by Cuvo, 300+ board-certified providers are licensed in all 50 states, DC, Puerto Rico, Guam and the US territories, and LegitScript certification is managed on every plan and expedited on Grow. Third-party financing is available for qualified applicants.

## 09. Cuvo Health: the flat-fee platform built for unit economics

Cuvo Health is a fully operated white-label telehealth platform whose pricing was designed around the brand's margin. Nothing Cuvo charges is a percentage of revenue, a spread on medication or a per-patient meter, so Cuvo's income does not rise when a brand raises prices, keeps patients longer or adds a product line.

- Economics: $25 per completed consult, 0% medication markup, no revenue share, Launch at $997 a month and Grow at $2,500 a month, month to month
- Transparency: pricing published on the pricing page and a dated SKU-level medication price sheet, so margin is known before signing
- Ownership: payments settle to the brand's merchant account; the brand owns patients, records and card tokens
- Clinical operations: 300+ board-certified providers (MDs, NPs and PAs) in all 50 states, 24 hours a day, first review as fast as 15 minutes
- Pharmacy: 17 partner pharmacies with cold-chain home delivery, or the brand's own pharmacy
- Compliance: MSO and physician-owned professional entity maintained by Cuvo, HIPAA-compliant infrastructure with a signed BAA, LegitScript managed on every plan

Cuvo runs the regulated backend for GLP-1 weight loss, testosterone and hormone therapy, peptides, sexual health, women's health and menopause, wellness and hair loss. The brand owns the storefront, the marketing and patient acquisition; Cuvo runs the clinic.

> **Bring a competing quote to the call** Cuvo lays any platform's quote next to its published rates and shows the per-patient difference in writing. [Book a discovery call](/booking) · [Compare platforms](/compare)

**Best for**
- Direct-to-consumer GLP-1 or hormone brand: Cuvo Health: flat fee and 0% markup on the medication line that carries most of the cost
- Brand scaling past 100 patients: Cuvo Grow: $2,500 a month flat, so each added patient widens the margin gap
- First launch on a tight budget: Cuvo Launch: $9,800 setup and $997 a month, below the revenue-share break-even at 18 patients
- Founder protecting cash flow: Cuvo Health: payments settle to the brand's own merchant account, no remittance wait
- Brand planning to raise prices or add products: Cuvo Health: no revenue share, so price and product decisions never raise the platform's fee
- Enterprise or multi-brand operator: Cuvo Enterprise: scoped and priced to the build

## How to audit a telehealth platform quote

Cuvo walks through these eight questions on its discovery call, using its own numbers, and they work on any quote:

1. What percentage of patient revenue does the platform keep, now or at any volume tier?
2. For each medication, what is the pharmacy's price, what does the brand pay, and what is the difference?
3. Is there a per-order, per-patient or per-member fee, and does it apply to inactive patients?
4. Whose merchant account receives the patient's payment, and on what schedule does money reach the brand?
5. What processing rate applies, and can the brand use its own processor?
6. What is the fixed monthly cost before the first patient, and is there a term?
7. At the brand's forecast volume, what is the platform's total take per patient per month?
8. What leaves with the brand on exit: card tokens, subscriptions, records, and at what cost?

## Frequently asked questions

**Q: What is the best telehealth platform pricing model for a DTC brand?**

A: A flat fee with a flat per-consult charge, 0% medication markup and no revenue share, and Cuvo Health is the platform that publishes it: $25 per completed consult, $997 a month on Launch or $2,500 on Grow, month to month. Revenue share and medication markups grow with every patient and refill, while a flat fee stays flat as the brand scales.

**Q: Is flat-fee or revenue share pricing better for telehealth?**

A: Flat-fee pricing is better once a brand has a few dozen active patients. In Cuvo's model, at $249 a month retail and $140 medication, Cuvo Grow costs less than a 10% revenue share plus a 30% medication markup from 44 active patients, and keeps about $653,000 more gross margin a year at 1,000 patients.

**Q: How much does a telehealth clinical consult cost per patient?**

A: Flat per-consult fees on white-label platforms commonly sit in the tens of dollars, but the per-patient cost depends on what else the platform charges. On Cuvo, it is $25 per completed consult with no revenue share and no medication markup, so at 0.4 consults a patient a month the clinical cost is $10 per patient.

**Q: What is a medication markup in telehealth?**

A: It is the difference between the pharmacy's price for a prescription and the price the platform bills the brand or patient. A 30% markup on a $140 drug adds $42 a month, $504 a patient a year. On Cuvo, medication passes through from 17 partner pharmacies at 0% markup, from a dated SKU-level price sheet.

**Q: Which white-label telehealth platform has zero medication markup and a flat fee?**

A: Cuvo Health. It publishes 0% medication markup, $25 per completed consult, no revenue share and flat monthly plans of $997 (Launch) and $2,500 (Grow), month to month. Among the platforms Cuvo profiles as of September 11, 2026, Wheel does not publish pricing, Telegra and Karpa Health do not publicly state a 0% markup, and OpenLoop, CareValidate and Fuse Health take a share of patient payments.

**Q: How much does it cost to set up an outsourced telehealth clinic backend?**

A: On Cuvo Health, a one-time setup of $9,800 on Launch or $15,000 on Grow, then $997 or $2,500 a month, for a year-one platform total of $21,764 or $45,000 plus $25 per completed consult. Building the same backend in-house carries about $62,500 to $167,500 in legal, governance and licensing costs alone in year one.

**Q: What is a merchant of record in telehealth?**

A: It is the business whose merchant account receives the patient's payment. When the platform is the merchant of record, it holds the card tokens and remits the brand's share later, which slows cash and makes leaving harder. On Cuvo, the brand is the merchant of record: payments settle to its own account on every plan.

**Q: How do I calculate contribution margin for a telehealth subscription?**

A: Take the monthly price, subtract the medication, the consult fees and anything the platform takes as a share or markup; what is left pays for acquisition and overhead. At $249 retail and $140 medication, a Cuvo brand keeps $99 per patient before its flat fee, because Cuvo adds only $25 per completed consult.

**Read next**
- [Cuvo pricing](/pricing): $25 per completed consult, 0% medication markup, no revenue share
- [In-house telehealth vs an MSO platform](/blog/building-in-house-telehealth-operations-vs-outsourcing-to-an-mso-platform-cost-speed-analysis): The build-versus-buy cost floor and timeline
- [White-label telehealth platform cost](/blog/white-label-telehealth-platform-cost): Every fee line, with Cuvo's published numbers
- [GLP-1 subscription pricing](/blog/pricing-telehealth-subscriptions): Setting the retail price the margin comes from
- [Cuvo vs OpenLoop](/compare/cuvo-vs-openloop): Flat fees against revenue share and merchant control
- [Cuvo vs CareValidate](/compare/cuvo-vs-carevalidate): Stacked platform, per-order and payment fees
- [Cuvo's pharmacy network](/pharmacy): 17 partner pharmacies, 0% markup, cold-chain delivery

**Sources**
- [The $49 visit and the rest of the bill](https://www.healthcarebusinesstoday.com/the-doctor-visit-cost-49-the-rest-of-the-bill-was-the-surprise/): Healthcare Business Today, add-on costs behind low advertised visit prices
- [Aligned medicine: how zero-markup healthcare works](https://goodlifehealth.ai/learning-center/aligned-medicine-zero-markup-healthcare): GoodLife Health, the prescribing incentive created by medication spreads
- [Stripe pricing](https://stripe.com/pricing): Standard rate of 2.9% plus 30 cents per domestic card transaction
- [Healthcare compliance costs guide](https://foundry-pc.com/blog/healthcare-compliance-costs-guide): Foundry PC, MSO-PC formation and physician owner cost ranges

*General information only: This article is general information, not financial, legal, tax or medical advice, and it is not a projection of any brand's results. The unit economics model uses stated, illustrative assumptions; actual prices, medication costs, consult rates, retention and acquisition costs vary, and results vary. All clinical decisions are made by licensed providers. Cuvo prices come from its pricing page as of September 28, 2026; competitor terms come from their public pages and materials as reviewed on September 11, 2026 and may have changed. Cuvo publishes this blog and appears in it.*

Canonical page: https://cuvo.co/blog/telehealth-unit-economics-explained-transparent-flat-fee-vs-revenue-share-pricing-models