Cuvo vs OpenLoop

01Executive summary

OpenLoop and Cuvo both offer white-label telehealth infrastructure: clinicians, EHR, e-prescribing, pharmacy fulfillment, and compliance. The similarity ends there. The two operate on fundamentally opposite business models:

OpenLoop is a revenue-share landlord. Patients pay into OpenLoop's merchant account. OpenLoop owns the billing relationship, the credit card tokens, and the patient data pipeline, then remits a "Membership Services Fee" back to you weekly. On maintenance patients, OpenLoop retains 50–59% of every dollar your patient pays, indefinitely, on every patient, forever.

Cuvo is a flat-fee utility. Patients pay you first, into your merchant account. Cuvo passes medications through at $0 markup, charges a flat $25 per consultation, and takes no per-patient cut whatsoever. Your margin scales with you; Cuvo's revenue doesn't grow when yours does.

On identical retail pricing, a clinic nets roughly 35–90% more per maintenance patient per month on Cuvo, and that's before considering that on OpenLoop you never own your merchant account, card tokens, or billing relationship, which is precisely what makes leaving OpenLoop so difficult. Add a January 2026 data breach affecting ~716,000 downstream patients, sub-3-star employer ratings, and a review-generation practice that puts OpenLoop's brand in front of your patients, and the picture is clear.

02Business model and money flow

Why this matters more than any single fee: on OpenLoop, your entire revenue stream (every card token, every subscription billing record, every patient chart) lives inside OpenLoop's stack. Migrating away means re-acquiring payment authorization from every single patient and rebuilding billing from zero. That is functionally a customer-base reset, and it's the quiet mechanism that keeps clinics locked in regardless of how the relationship goes. On Cuvo, you could switch pharmacies, switch doctors, or leave entirely tomorrow and your business would be intact, because you already own everything that matters: records, tokens, merchant account, and cash flow.

03Fixed costs and contract terms

Year one on OpenLoop costs $30,000 in fixed fees, contractually locked for 12 months, versus $16,000 on Cuvo with zero commitment: a $14,000 (47%) saving before a single patient-level dollar is counted. The gap persists at steady state ($12,000/yr vs. $18,000/yr), and Cuvo's $1,000 covers everything needed to run the clinic, and anything beyond that is a genuinely optional add-on, not a required addendum with its own implementation fee. If your launch stalls, your funnel underperforms, or you simply want to change direction, OpenLoop holds you to the term; Cuvo lets you walk any month.

04Per-patient economics: where the real money is

OpenLoop's proposal is transparent about its mechanism: the middle column is what your patient pays, the right column is what you receive, and "the difference... is what is retained by OpenLoop." Below, we hold retail price constant (using OpenLoop's own price points) and compute what the same patient is worth on each platform. Cuvo figures = retail - medication cost (Cuvo's at-cost price list, lowest to highest dose level) - $25 consult in month 1 and quarterly thereafter (~$8/mo amortized at steady state). Shipping excluded from both sides.

Note what happens on OpenLoop's tirzepatide maintenance line: the patient pays $339 and you receive $138, and OpenLoop keeps $201, or 59% of your patient's payment, every month, forever. On Cuvo, even at the highest dose tier (Level 6, $145/vial), that same dollar goes 35% further to you; at typical mid-titration doses the gap approaches double.

The prepay penalty

OpenLoop's long-commitment tiers compound the problem. On the 52-week semaglutide injection plan, the patient pays $2,327 and you receive $1,076, and OpenLoop retains $1,251 (54%) of a patient who committed to you for a year. On Cuvo, a 52-week patient at even a discounted $179/mo retail nets you roughly $1,400–$1,700 after meds and consults, on a patient paying less.

The fixed-fee difference between the platforms is rounding error next to this. OpenLoop's model taxes your growth; Cuvo's doesn't.

05Flexibility and vendor independence

This is the structural point: because Cuvo makes no margin on medications or providers, it has no conflict of interest in letting you route around it. OpenLoop's economics depend on being the toll booth between you and your patients.

06Reputation, trust, and risk

The January 2026 data breach: 716,000 patients exposed

This is not a rumor; it is confirmed on the HHS Office for Civil Rights breach portal and reported to the California and Texas Attorneys General. On January 7, 2026, an unauthorized third party accessed OpenLoop's systems and exfiltrated files containing patient names, addresses, email addresses, dates of birth, and medical information, affecting up to 716,000 individuals across the telehealth brands running on OpenLoop's infrastructure. A threat actor ("Stuckin2019") publicly claimed 1.6 million records and posted samples as proof. The affected population "spans patients across multiple client organizations rather than direct OpenLoop consumers," meaning it was OpenLoop's clients' patients, under their clients' brand names, whose data was stolen.

For a clinic evaluating OpenLoop, the lesson is architectural, not just reputational: OpenLoop's model requires concentrating 120+ brands' worth of patient data in one honeypot. When it was breached, every downstream clinic inherited the incident (the notification obligations, the patient trust damage, the churn) for a security failure they had zero control over. On Cuvo's model, you own and control your patient records.

The Google reviews illusion

OpenLoop shows 1,197 Google reviews averaging 4.5 stars, impressive until you read them. The reviews are overwhelmingly from patients of client clinics ("clinician was very attentive," "how fast my order was delivered by FedEx," "waiting on my prescription"), not from clinic operators evaluating OpenLoop as a B2B vendor. Per operator reports, OpenLoop generates these by emailing the client clinics' patients and soliciting reviews for OpenLoop, a practice with two problems:

1. It breaks the white label. The entire premise of the product is that your patients never know a third party is behind your brand. Soliciting your patients to publicly review OpenLoop puts OpenLoop's name directly in front of them.
2. It makes the rating unusable as a B2B signal. A patient's 5-star FedEx delivery experience tells you nothing about how OpenLoop treats the clinics that are its actual customers.

What people who actually deal with OpenLoop say

The B2B-relevant signals point the other way:

Employee reviews aren't client reviews, but they are a leading indicator of service quality: a company whose own staff rate job security at 1.9/5 and where barely a third would recommend working there is a company with turnover and morale problems, and turnover in credentialing, support, and account management lands directly on clients. Combined with operator reports of being "treated like a number on a take-it-or-leave-it basis" once signed, the 4.5-star Google facade and the 2.4–2.8 insider reality tell two very different stories.

07The fine print: fifteen red flags inside OpenLoop's own proposal

Cuvo's team obtained an actual OpenLoop proposal (a "Summary of Proposed Services" prepared for a prospective clinic, complete with pricing schedules, program terms, and contract structure) and went through it line by line. Everything below is drawn directly from that document; nothing is paraphrased from marketing or hearsay. Read individually, each item is a concession; read together, they describe a contract engineered so that risk flows to the client and margin flows to OpenLoop.

1. The maturity penalty: OpenLoop's cut grows the longer you keep a patient. On tirzepatide, the patient pays the same $339 every month, but your remittance falls from $196 in month 1 to $138 at month 5+, while OpenLoop's take climbs from $143 (42%) to $201 (59%). That's a 41% increase in OpenLoop's cut and a 30% drop in your revenue on the identical patient paying the identical price. Retention is the hardest thing to earn in telehealth; this schedule is built so that the fruits of your retention accrue to OpenLoop.
2. You fund the patient discounts on long-term plans. On the 52-week semaglutide plan, the patient's price drops 28% (from $249 to $179/cycle), but your remittance drops 33% (from $124 to ~$83/cycle). OpenLoop offers your patients a discount and makes you absorb a disproportionate share of it.
3. OpenLoop holds the float on annual prepayments. A 52-week tirzepatide patient pays $3,497 on day one, into OpenLoop's merchant account. Your $1,572 share arrives dripped out weekly, contingent on OpenLoop's own determination that the patient is "active." OpenLoop banks a year of your patients' cash up front; you get yours on layaway.
4. OpenLoop counts, OpenLoop calculates, you get what they say. Your weekly payment is "based on count of net active patients for the week by Month Cohort," with active status "determined by successful credit card charge," all measured inside systems only OpenLoop can see. The proposal grants no audit rights, no reporting standard, and no recourse if their count and yours disagree. "Net" active also implies refunds and chargebacks are clawed back from your remittance.
5. OpenLoop sets the refund policy for your customers. The proposal dictates that patients "may request refund for any reason at any time." A generous refund policy is defensible, but it's imposed unilaterally, on revenue that flows through OpenLoop's account, with the resulting losses netted against your share. You carry refund exposure on a policy you didn't write and can't change.
6. Reserves and hold-backs on your revenue. OpenLoop explicitly manages "reserves/hold-backs" on the merchant account. Standard merchant practice, except it's your patients' payments being reserved, at a percentage and duration you don't control, by a counterparty you can't audit. Structurally, you are an unsecured creditor of OpenLoop for every dollar in transit.
7. Your product can vanish overnight, and that's in writing. "Availability of any given GLP-1 option may change at any time, with no notice." If a patient's medication disappears, OpenLoop will "attempt" to find an alternative, but "not all patients will qualify." Your core offering (the thing your marketing spend acquired patients for) exists at OpenLoop's pleasure, and they've pre-disclaimed any obligation when it doesn't.
8. Pricing is a moving target with a signature deadline. The proposal expires in 30 days and states pricing "will change immediately upon changes in FDA and state regulations." Combined with flag #7, you're asked to sign a 12-month commitment against pricing and product availability that OpenLoop reserves the right to change at any moment.
9. You're asked to sign against blanks. An upfront implementation fee is normal, and what's not normal is what's behind it. In OpenLoop's proposal, the provider quantities in Schedule A are literally "TBD," the staff start date is "tbd," and holiday coverage is explicitly excluded, yet $4,500 is due at signature and the 12-month clock starts anyway. You're committing to a year against a staffing plan that hasn't been written. And the scope you're buying is deliberately narrow: every future business line triggers "an addendum to the MSA and a separate implementation fee": expansion is a tollbooth, not a feature. (Contrast: Cuvo's $6,000 setup buys a fully defined offering: the complete 05/01/2026 price list, the 17-pharmacy network, the consult rate, and the LegitScript certification, with no term, no per-line addendums, and no re-implementation fees to grow.)
10. The margins on commodity products are indefensible. On the sexual-health single-dose 10-pack, the patient pays $119 and you receive $50, and OpenLoop keeps 58% on generic sildenafil/tadalafil that costs roughly a dollar a dose at compounding cost. The best example: the biotin supplement: patient pays $35/month, you receive $11, and OpenLoop keeps $24 (69%) on an over-the-counter vitamin. These aren't clinical-services margins; they're what a captive channel looks like.
11. Coverage and eligibility carve-outs hide behind the "50-state" headline. TRT with scheduled medications is available in only ~35 listed states ("subject to change at any time"). Weight loss is capped at ages 18–74, TRT at 25+, sexual health at 21+ with 75+ restricted to single-ingredient products. Staffing "does not include holiday coverage." OpenLoop defines your addressable market, and reserves the right to redefine it without notice.
12. The proposal can't even keep its own numbers straight. The microdosing table lists the 24-week option as "$159/mo (charged as $507)" and the 52-week option as "$149/mo (charged as $507)": the same $507 for both, when the stated monthly rates imply roughly $954 and $1,937 respectively. A pricing document with internally contradictory numbers is either careless or convenient; either way, it's what the contract will incorporate by reference, and you'd be the one discovering which figure OpenLoop honors after signing. (Note also: TRT care coaching is "$5 per patient per month (waived)," waived, not removed. The right to start charging is retained.)
13. "Paid by OpenLoop" means deducted from you. The tables tout "(labs paid by OpenLoop)" in Month 2, and in exactly that month your remittance drops $12 on semaglutide and $30 on tirzepatide. The "optional" Care Coaching works identically: the care-coaching-included tables carry a footnote confirming a "$10 per 4-week reduction in Admin Fee," and every figure in your column falls by precisely $10 while OpenLoop's retained share is untouched. Across the entire proposal, not one cost is ever absorbed on OpenLoop's side of the ledger.
14. The termination clause is a loaded gun pointed one way. "12-month initial term, 30 day notice to terminate for any reason." Read it from both sides. If you terminate, you leave behind your merchant account, card tokens, billing relationships, and patient records (all resident in OpenLoop's stack) and effectively restart from zero. If OpenLoop terminates, they lose one revenue-share client and keep everything. A mutual 30-day clause between parties with wildly asymmetric switching costs isn't mutual at all: it's a kill switch on your business that only one side can afford to pull.
15. Even your legitimacy credential may be a tether. Before considering the $3,000 "LegitScript Through OpenLoop Integration," ask in writing: if certification is obtained through OpenLoop's integration, does it survive your departure from the platform? The proposal is silent. (Cuvo's included expedited LegitScript certification is yours outright, a $5,625 standalone value, free.)

The pattern across all fifteen: OpenLoop holds the cash, the count, the policy, the product availability, the pricing, and the exit. The client holds the brand risk, the marketing cost, the refund exposure, and a 12-month obligation. Cuvo's flat-fee model doesn't just price better, it structurally can't do most of the above, because Cuvo never touches your money, your tokens, or your patient relationships in the first place.

08Side-by-side scorecard

09Bottom line

OpenLoop's proposal reads well until you follow the money. You pay twice the setup cost, sign for twelve months against pricing OpenLoop can change at any moment and product availability it can pull "with no notice," surrender your merchant account, your card tokens, and your patient data pipeline, and then hand over half or more of every maintenance patient's payment (a cut that grows as your patients stay longer) to a vendor with an HHS-confirmed 716,000-patient breach, bottom-quartile employee sentiment, a 69% margin on a drugstore vitamin, and a review practice that markets itself to your patients.

Cuvo charges $6,000 once, includes the $5,625 LegitScript expedited certification free, waives its flat $1,000 monthly fee for your first 90 days live, binds you to nothing, marks up nothing, and leaves you owning every asset that makes a telehealth clinic a business: the patients, the records, the tokens, the merchant account, and the margin. Year one you spend $16,000 on Cuvo versus $30,000 locked in on OpenLoop, and at 500 maintenance patients, the per-patient model difference alone is worth roughly $300K–$480K a year on top of that.

One platform is built to make money when you do. The other is built to make money from you. That's the choice.