Telehealth platform pricing in 2026: the four models and what they hide
Two vendors can quote the same headline number and cost three times apart at scale. The difference is in the pricing model, the exclusions, and the fees that show up after the contract is signed.
Lithos StaffTelehealth infrastructure is priced four ways: per-visit (pay per clinical encounter), platform fee plus usage (a monthly base plus per-visit and per-order fees), revenue share (a percentage of what patients pay), and per-member-per-month (a flat fee per active patient). Each is cheapest at a different scale: revenue share and pure per-visit at low volume, platform-plus-usage in the middle, PMPM at very high volume with frequent touches. The line items most often excluded from the headline — state expansion, controlled-substance visits, labs, pharmacy integration, identity verification, and data export — are where the real comparison happens. Model total cost at three volumes before comparing quotes.
The four pricing models
| Model | How you pay | Cheapest when | Trap |
|---|---|---|---|
| Per-visit | A fee for each clinical encounter (async, sync, follow-up) | Low or unpredictable volume | Follow-ups and refills multiply visits; check what counts as one |
| Platform + usage | Monthly base fee plus per-visit, per-order, per-state fees | Steady mid-volume programs | The base buys access, not inclusion; read the usage rate card |
| Revenue share | A percentage of patient revenue | Pre-launch and early validation | Scales with your success; hard to exit once volume is high |
| Per-member-per-month | Flat fee per active patient | High-touch programs with many encounters per patient | Definition of “active”; you pay for churned-but-not-cancelled patients |
Most vendors blend two of these, and the blend matters more than the headline. A low per-visit price on top of a high platform fee favors volume; a low platform fee with a wide usage rate card favors the vendor as you grow. The right question is not “what is your price?” but “what does my program cost at three volumes, all-in?”
The line items that are usually outside the headline
- Implementation and onboarding. One-time fees, and whether protocol setup for your products is included.
- State coverage. Some vendors price a base set of states and charge to add more; others bundle all 50. For a national program this is one of the biggest swings.
- Encounter types. Async vs. synchronous, first visit vs. follow-up, controlled-substance visits (which require more clinician time and specific licensure), and specialist consults.
- Prescriptions and pharmacy. eRx fees, EPCS for controlled substances, and pharmacy integration or routing fees.
- Labs. Ordering, result ingestion, and clinician review of results, which for hormone and metabolic programs can rival visit cost.
- Identity proofing and consent. Often a per-patient pass-through.
- Messaging. SMS and secure messaging, sometimes metered.
- Data export and API access. Whether you can pull every record via API at no charge, or pay for exports. This is the fee that determines your future switching cost; see how to switch infrastructure.
- Minimums and terms. Monthly minimums, annual commitments, and auto-renewal.
A worked comparison
Take a GLP-1 weight-care program with one async initial visit, monthly async follow-ups, baseline labs, and a compounded prescription each month. At 500 patients the program generates roughly 6,500 encounters a year; at 5,000 it is 65,000; at 50,000 it is 650,000. Under a revenue-share model the vendor cost tracks your revenue linearly, so at 50,000 patients the vendor is taking a percentage of a large number. Under platform-plus-usage the base fee is negligible at scale and per-visit fees dominate, so negotiate the follow-up visit rate, not the initial one. Under PMPM the cost is flat per patient regardless of how many encounters they use, which is excellent for high-touch programs and wasteful for a refill-heavy one.
The only way to see this is to lay all three volumes out with each vendor’s full rate card and look at cost per patient per year. The headline price will rarely be the line that decides it.
Questions for the vendor
- Can I have the complete rate card — every billable event — not just the pricing page?
- What does a follow-up cost, and what defines one?
- Are all 50 states included, and if not, what does each additional state cost and how long does it take?
- Is API data export free and unrestricted?
- What is the minimum commitment, and what happens at renewal?
Frequently asked questions
How much does a telehealth platform cost per visit?
Async visits with a licensed clinician are commonly quoted in the tens of dollars; synchronous video visits cost more, and controlled-substance or specialist visits more again. The per-visit number alone is rarely comparable across vendors because what it includes (intake, identity proofing, eRx, follow-ups) varies.
Is revenue share or per-visit pricing better?
Revenue share is cheapest when you have few patients and unproven pricing; it becomes the most expensive model once your average order value and volume rise, because the vendor’s take scales with your success. Per-visit and platform-plus-usage pricing decouple vendor cost from your pricing power.
What fees are usually not in the headline quote?
Implementation, adding states, controlled-substance encounters, lab orders and results, pharmacy integrations, identity verification, SMS and messaging, data export, and minimum monthly commitments. Ask for a rate card that lists every billable event.
How should we compare two telehealth vendor quotes?
Build a single spreadsheet with your expected visits, orders, states, and patient mix at three volumes (for example 500, 5,000, and 50,000 patients), apply each vendor’s full rate card, and compare total annual cost and cost per patient at each scale — not the headline price.
From first call to first patient, in weeks.
A 15-minute intro call, sandbox credentials the same day, go-live in 3–4 weeks — new launches and existing patient bases alike.