The answer first
Take a $149 monthly membership, which is where Ro ($145) and Hims ($149) price branded GLP-1 access and roughly the middle of the $25 to $149 range Fortune tabulated on September 21, 2026. Fulfil the drug through the manufacturer's own channel so the patient pays NovoCare or LillyDirect directly. Pay for asynchronous provider review, a platform, card processing, and support. What is left per patient per month, before marketing, is about $115 on a flat-fee platform and about $75 on a 25% revenue-share platform, by our model below. Replace the churned patients each month and subtract the fixed overhead every program carries, and net operating income lands near $6,000 a month at 100 patients, $40,000 at 500, and $180,000 at 2,000 on the flat-fee path.
Those are our estimates, built from published prices and public filings, and the point of the post is the table you can rebuild with your own numbers, not the totals. The public benchmarks we checked it against are in the unit economics post; this one is the small-brand version.
The assumptions, stated so you can replace them
| Input | Value used | Where it comes from |
|---|---|---|
| Membership price | $149 per month | Ro $145, Hims $149; Fortune's September 21, 2026 comparison spans $25 to $149 |
| Drug | Manufacturer-direct; patient pays NovoCare or LillyDirect | Wegovy pill $149 to $299, Foundayo $149 to $349, Zepbound vials $299 to $449 |
| Provider cost | $20 per patient per month blended | $25 to $50 per async consult (Cuvo $25, Qualiphy $28.99, NP marketplace gigs at $40 to $50), one initial plus quarterly follow-ups plus dose changes |
| Card processing | 3.2% of revenue | 2.9% plus 30 cents on a $149 charge |
| Support | Founder-handled at 100; one coordinator at 500 ($4,500); three at 2,000 ($13,500) | Hims said on its August 10 call that AI now handles about 80% of support questions; assume less automation than Hims |
| Platform, flat model | $1,000 / $2,000 / $5,000 per month at the three volumes | Published tiers run from $200 (Remedora) and $297 to $1,997 (Karpa) to $997 and $2,000 plus $25 per consult (Cuvo) and $2,999 to $5,999 (Telegra) |
| Platform, revenue share | 25% of revenue | Mid-range of the share models we see quoted |
| Fixed overhead | $3,000 / $6,000 / $12,000 per month | Medical director from $799, insurance, legal, tooling, growing with states and volume |
| Churn | 8% per month, about a 12-month average lifetime | The figure Karpa uses; industry data says roughly half of GLP-1 patients stop within a year |
| Replacement CAC | $250 per new patient | Founders report $100 to $300 when it works and far worse when it does not ("Spent 7k in ad spend. 0 conversions.", r/EntrepreneurRideAlong, April 2026) |
Two things the model deliberately leaves out. It does not include the drug in revenue, because a brand that dispenses branded drugs itself adds revenue at a thin margin (more on Hims below). And it does not include the founder's salary at 100 patients, which is the honest way to say that 100 patients is a side business.
The three scenarios
| Line | 100 patients | 500 patients | 2,000 patients |
|---|---|---|---|
| Revenue at $149 | $14,900 | $74,500 | $298,000 |
| Provider review | $2,000 | $10,000 | $40,000 |
| Card processing | $477 | $2,384 | $9,536 |
| Support | $0 (founder) | $4,500 | $13,500 |
| Platform, flat fee | $1,000 | $2,000 | $5,000 |
| Contribution, flat fee | $11,423 (77%) | $55,616 (75%) | $229,964 (77%) |
| Platform, 25% share instead | $3,725 | $18,625 | $74,500 |
| Contribution, revenue share | $8,698 (58%) | $38,991 (52%) | $160,464 (54%) |
| Replacement marketing (8% churn x $250) | $2,000 | $10,000 | $40,000 |
| Fixed overhead | $3,000 | $6,000 | $12,000 |
| Net operating income, flat fee | $6,423 | $39,616 | $177,964 |
| Net operating income, revenue share | $3,698 | $22,991 | $108,464 |
Annualized on the flat-fee path: roughly $77,000, $475,000 and $2.1 million. Read the percentages, not only the totals. Contribution margin stays in the mid-70s across all three sizes on a flat fee, because provider and processing costs scale with patients and everything else scales slower. A revenue share compresses it to the low 50s, which is fine at 100 patients and expensive at 2,000, where the difference between the two platform lines is $69,500 a month.
Breakeven is easier to think about in patients than months. On the flat-fee path, fixed costs of $4,000 (overhead plus platform) divided by a per-patient contribution of about $114 means around 35 paying patients. On the revenue-share path it is closer to 50. Either way, the platform bill is rarely the gate. Replacement marketing staying near $250 per patient is, and that is the number founders most often get wrong in both directions.
What the public companies say, and why their margins differ
Hims & Hers reported second-quarter 2026 revenue of $753 million with a gross margin of 64%, down from 76% a year earlier, because it now sells branded Wegovy and Ozempic through its own channel after the March 9 settlement with Novo Nordisk and books the drug at a thin margin. LifeMD, which runs its own pharmacy, reported a gross margin near 89% and said 95% of its new weight-management patients start on branded drugs. WeightWatchers' clinical subscribers grew 56% year over year. Same category, three different margin structures, and the difference is who touches the drug.
The lesson for a small brand is not to copy Hims. Selling the drug adds revenue per patient and subtracts margin, adds inventory and pharmacy operations, and makes you a target for the pricing pressure that manufacturers and retail have already applied (CVS sells a $29 visit with Lilly cash pricing in the app). Selling care, access, follow-up and retention at $99 to $149 while the manufacturer ships the drug is the structure our model assumes, and it is the one most of the founder-lane platforms are built for.
The cost that moves the answer more than price
Look at the 100-patient column again and ask where a self-assembled stack would sit. The launch budget post prices the self-assembly pile: intake tooling, EHR seats, CRM and support-desk stitching, subscription billing engineering, integration glue, plus a storefront build, which together run $60,000 to $250,000 before the first patient and $1,000 to $3,000 a month in tools afterward. Drop $3,000 of monthly tooling into the 100-patient column and net income falls from $6,400 to about $3,400; amortize the build over two years and it goes negative. The same stack at 2,000 patients is a rounding error.
That asymmetry is the argument for the platform category, and it is our argument too. Turbopills ships the storefront, conditional intake, state-aware provider routing, billing that starts only after the provider approves, pharmacy routing and the branded patient portal as one configured system, so the 100-patient brand runs on the same infrastructure as the 2,000-patient brand and pays a platform fee instead of an engineering team. We are in private beta and quote per program, so you should force our quote into the table above at your projected volume before believing the previous sentence, and compare it with the published flat fees in the pricing breakdown.
Three ways the model breaks in real life
Churn is not a constant. The 8% monthly assumption hides the shape: most drop-off lands in months two and three, which is why the month-two churn post exists. A program that gets a patient through month three keeps most of them past month twelve, and the model's biggest lever is the retention infrastructure, not the price.
CAC is a distribution, not a number. Paid social in this category has been hostile since 2025, LegitScript certification gates the ad platforms, and the founders who report $250 tend to have an audience, a referral loop or an employer channel. Model $400 as the downside case and see whether the 500-patient column still clears.
Support scales in steps. One coordinator handles 500 patients only if the platform absorbs the "where is my prescription" tickets with live order status in the portal. Without that, the support line doubles, and the pharmacy-status post shows why.
FAQ
Is a telehealth business profitable? A cash-pay telehealth brand can be profitable at a few hundred patients: by our model, a $149 membership program keeps roughly 75% contribution margin on a flat-fee platform and nets about $40,000 a month at 500 patients after replacement marketing and overhead. Profitability depends on replacement acquisition cost and month-two retention more than on price.
How much does a telehealth business make per month? Using published prices and public filings, our estimate is about $6,000 net at 100 patients, $40,000 at 500 and $180,000 at 2,000 for a $149-per-month program on a flat-fee platform, before founder salary and taxes. A revenue-share platform lowers those to roughly $3,700, $23,000 and $108,000.
What profit margin does a telehealth business have? Contribution margin before marketing runs in the mid-70s on a flat-fee platform and the low-to-mid 50s on a 25% revenue share, when the manufacturer ships the drug. Brands that dispense branded drugs themselves report lower gross margins (Hims 64% in Q2 2026); brands with their own pharmacy report higher ones (LifeMD about 89%).
How many patients do you need to break even? Roughly 35 paying patients on a flat-fee platform and about 50 on a revenue share, with $3,000 of monthly overhead, a $1,000 platform fee and about $114 of contribution per patient. Your number moves with the medical director fee, the states you cover and your platform terms.