Let's be honest: every article promising to decode the "secrets" of scaling your D2C telehealth app probably triggers an immediate eye-roll—and rightfully so. You've already navigated product-market fit, nailed your UX, and begun dreaming about nationwide expansion, only to slam face-first into the brick wall of state-by-state compliance, controlled substances nightmares, and clunky clinical infrastructures.

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We get it: scaling isn't just about adding more users; it's wrestling with state medical boards, juggling synchronous versus asynchronous care, and praying your backend doesn't implode.

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This isn't another fluffy piece about "disrupting healthcare"—it's the cheat sheet you wish someone handed you months ago, breaking down exactly who can power your growth and why your tech stack could either catapult you or kill your momentum. Dive in; your future self will thank you.

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Key Takeaways

• Controlled Substances Are Your Biggest Bottleneck: Scaling nationally means navigating state-specific rules on controlled substances, including extra compliance layers like DEA registration and synchronous visit mandates. Platforms like OpenLoop are your best bet to navigate this compliance jungle efficiently.
• Your Clinical Partner Choice Shapes Your UX Freedom: Choosing the right clinical enablement provider directly impacts your frontend customization capabilities. Providers like Wheel offer robust backend support while letting you maintain complete UX control—critical if your user experience is your competitive edge.
• Integration Flexibility Drives Your Scaling Speed: API-driven, frontend-friendly platforms that allow seamless EHR and third-party pharmacy integration (think OpenLoop or MD Integrations) accelerate your growth far more than turnkey solutions that trap you into rigid tech ecosystems.

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The Rise of D2C Health Platforms

Remember when launching a healthcare startup meant leasing a clinic, filing a forest’s worth of paperwork, and praying your local licensing board returned your call? Yeah, that era’s gone.

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Today, the most exciting health brands are shipping nationwide from the cloud — with no physical footprint, no patient waiting rooms, and very real monthly recurring revenue. Companies like HIMS, HERS, and AgelessRx have pioneered a model where healthcare is just another productized service: onboard, get a script, receive meds at your door. Simple. Scalable. And for many startups, incredibly tempting.

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This direct-to-consumer (D2C) epharmacy model is taking off for a few reasons:

• Consumers expect convenience — if you can get dog food and dating advice delivered on demand, why not a GLP-1 prescription?
• Health niches are becoming brands — from men’s performance to hair loss to hormonal balance, startups are carving out micro-verticals with loyal user bases.
• Venture funding shifted — investors want to see revenue from day one, and D2C platforms offer a clear monetization path through subscriptions and refills.

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But here’s the thing: while the frontend looks smooth and shiny, the backend is a minefield. Every state has its own licensing rules. Synchronous visits (video calls) may be required in one state, while another allows asynchronous chat. Want to prescribe controlled substances like testosterone? You’d better plan for compliance gymnastics.

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That’s why most smart founders don’t try to do it all in-house. They turn to clinical enablement platforms — companies like OpenLoop, Wheel, SteadyMD, and Telemed2U — to provide the licensed providers and clinical coverage across all 50 states.

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These platforms are the invisible engine behind the modern healthtech boom. But here’s the rub: while they’re great at compliance, care delivery, and fulfillment… most of them weren’t built with your brand, UX, or roadmap in mind.

Which is where things get interesting — and where the right app infrastructure (hi, Specode 👋) becomes your leverage point.

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What’s Holding You Back from Scaling?

So, you’ve got the product-market fit. Your onboarding is slick, your UX sings, and patients are converting. But when it’s time to expand beyond your home state — suddenly, it feels like you’re dragging a boulder uphill.

Welcome to the messy reality of nationwide healthcare delivery.

Let’s break down the main culprits that keep most D2C health startups from going full throttle:

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50-State Licensing: The Tower of Babel Problem

Every state has its own medical board, rules, and red tape. You can’t just deploy one doctor across the country and call it a day.

• Some states require in-state licenses for telehealth consults.
• Others have restrictions on asynchronous care.
• And let’s not even talk about controlled substances — we’ll get there in a minute.

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Clinical enablement platforms promise to abstract this away with their provider networks — but each handles it differently. And if you’re building your own network? You’re going to need Advil.

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Async vs Sync: Choose Your Modality, Choose Your Battle

In some states, you can prescribe meds via asynchronous consults (text or chat-based). Others require a synchronous visit — meaning a video call with a licensed provider.

This creates friction at scale. You can’t promise a seamless national experience if state rules keep changing the game under your feet.

If your platform doesn’t support both out of the box — or if your clinical partner doesn’t — you’ll hit operational speed bumps that impact both your user experience and your bottom line.

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The Controlled Substances Bottleneck

This is the elephant in the virtual exam room. Testosterone, GLP-1s, and other meds often fall under controlled substance regulations.

• Prescribing these requires extra layers of compliance (e.g., DEA registration, I-STOP, PDMP lookups).
• You often need synchronous care (video calls), even in states that allow async for non-controlled meds.
• And the e-prescription network you use (like Surescripts) may not play nice with your stack — or your wallet.

This is where many promising D2C startups stall out. They build a great experience… and then discover they can’t legally fulfill the promise of their product.

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The EHR Elephant (Again)

Some founders come in with an existing EHR and want to keep using it. Others don’t want to touch EHRs at all — they just need light clinical documentation and SOAP notes.

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Most clinical providers (like SteadyMD or OpenLoop) offer their own internal systems. But they’re not built for custom UIs, and integration isn’t always trivial.

If your frontend is your differentiator — and for D2C brands, it always is — you can’t afford to be boxed into someone else’s tooling.

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Summary: The Scaling Problem Isn’t Just Clinical — It’s Infrastructural

To go national, you need:

• A compliant clinician network across all 50 states
• The ability to toggle between sync and async consults by state
• An eRx partner that handles controlled substances
• A backend infrastructure that supports your custom frontend

This is exactly why we wrote this blog — because the solution isn’t choosing one partner. It’s building the right stack.

In the next sections, we’ll compare the five main clinical platforms that claim to solve this. Spoiler: not all of them are startup-friendly.

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OpenLoop: Flexible Nationwide Powerhouse

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If you're a founder aiming to scale your D2C epharmacy quickly without drowning in multi-state regulatory quicksand, OpenLoop might just be your ace-in-the-hole. Think of it like "telehealth infrastructure as a service"—because who wants to build their own 50-state clinician network from scratch?

• Highlights: extensive nationwide coverage, controlled Rx, flexible backend integration.

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Who OpenLoop is Built For

OpenLoop plays well with:

• Weight loss programs scaling GLP-1s and labs
• Men’s health brands offering ED, hair loss, or TRT
• Women’s health startups expanding into hormone therapy
• Teams who want backend ops handled while retaining UX and brand control

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What You Get Out of the Box

OpenLoop’s network of over 20,000 licensed providers spans all 50 states, enabling true nationwide telehealth coverage. That said, watch out for niche state exceptions—like compounded GLP-1 medications in Mississippi.

• ✅Nationwide 50-state coverage (plus D.C.)
• ✅Synchronous (video) and asynchronous (chat) consults
• ✅Full prescriptive authority, including controlled substances (e.g., TRT meds)
• ✅Lab ordering + results integration (Quest/LabCorp by default)
• ✅Payment processing, including merchant account setup, chargebacks, and weekly payouts

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Notable Features

• White-label EHR with eRx, labs, and SOAP notes
• Private-label telehealth platform (but optional)
• Pre-built clinical protocols: From GLP-1 weight-loss programs to hormone therapy, leverage battle-tested clinical protocols out-of-the-box.
• RCM and insurance billing baked in — Medicare, Medicaid, and commercial
• 24/7/365 patient support — inbound channels handled by their team
• Multi-tier supply chain to avoid “dark states” where fulfillment falls through
• Continuity of care: Patients can consistently engage with the same provider, improving retention and satisfaction.

You also get a dedicated clinician network that’s credentialed, licensed, and ready to scale with you.

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Pharmacy Fulfillment

OpenLoop manages fulfillment and medication costs, tapping into a partner network with national reach. Their supply chain spans all states, and they foot the bill for medications — you just get the fulfillment status and peace of mind.

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Key detail: they control the logistics, so you’re not left chasing down delivery issues with a third-party mail-order pharmacy.

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Integration Considerations

• API-driven: async/sync consults, RCM, and more via clean endpoints
• Frontend-friendly: you can keep your UX, brand, and product flow intact
• EHR options: use theirs or integrate your own (though you’ll want to confirm the effort required)
• No public API docs: you’ll need to get access post-demo

This setup gives you full stack flexibility, minus the lock-in.

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Pricing Model

Pricing isn’t public, but we’ve discovered that it’s cheaper than most of the other platforms. They’re open to startup-friendly terms. Founders building capital-efficient MVPs will appreciate that OpenLoop takes on merchant costs, lab fees, and reserves.

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Strengths / Watchouts

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Wheel: Backend Flexibility, Frontend Freedom

Wheel.com offers D2C epharmacy startups robust, nationwide clinician support through asynchronous and synchronous telehealth. With flexible, pay-per-consult pricing tailored for startups, it enables rapid scaling without upfront heavy lifting.

• Highlights: scalable clinician network, API-driven, frontend UX control, pharmacy-agnostic.

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Who Wheel is Built for

Wheel is designed for digital health players who aren’t just testing the waters — they’re gearing up for scale. It’s a fit for D2C epharmacy startups in weight loss, men’s and women’s health, and hormone therapy who either already have traction or want to go national fast — especially those needing a compliant clinician network without building one from scratch.

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What you get out of the box:

• ✅ Nationwide coverage across all 50 states, with licensed, board-certified clinicians
• ✅ Async and sync visits, with sub–2-minute avg. async response time and full support for scheduled video consults
• ⚠️ Controlled substance Rx — not out-of-the-box

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Notable Features

Wheel’s secret sauce is flexibility. You get a plug-and-play clinician network and backend, but you’re not forced to use their frontend or EMR. That’s huge for startups prioritizing brand experience and workflow control. Wheel also positions itself as “pharmacy and lab agnostic,” giving founders freedom to integrate with preferred fulfillment partners.

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Bonus: their upcoming partnership with Huma hints at a more vertically integrated platform-as-a-service coming in 2025.

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Pharmacy Fulfillment

Wheel doesn’t own a pharmacy — and that’s by design. They integrate with third-party pharmacy providers, allowing you to choose the best partner for your workflow or even switch as you scale. This keeps your stack lightweight, your fulfillment agile, and your patients happy with flexible Rx delivery options.

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Integration Considerations

Wheel gives you two solid options for plugging into their clinical infrastructure — and both are designed to keep you in control of the patient experience.

• Bring your own stack
  
  • Wheel clinicians are trained on your tools and workflows
  • Use Wheel’s Consult Routing API to trigger consults from your platform
  • Ideal if you already have a working app or custom frontend
• Use Wheel’s platform behind the scenes
  
  • Clinicians operate inside Wheel’s proprietary platform
  • You still own the patient-facing experience — connect via the Virtual Care Platform API
  • Great if you want backend done-for-you but still control UX and engagement

In both cases, you maintain control over how your users interact with care — Wheel stays behind the curtain. Think: backend-as-a-service for clinical ops.

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Pricing Model

Wheel’s pay-per-consult pricing means you don’t carry bloated fixed costs during early growth. You only pay for care delivered, making this model capital-efficient for startups with fluctuating volumes. One client cut 93% of their staffing cost per visit — not a typo. You scale your clinician usage with patient demand, not ahead of it.

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Strengths / Watchouts

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SteadyMD: Clinical Ops at Enterprise Scale

SteadyMD offers D2C epharmacy startups robust nationwide clinician coverage, fully customizable telehealth solutions, and regulatory expertise. Ideal for scaling weight loss and men’s health platforms, SteadyMD delivers comprehensive clinical infrastructure, letting startups focus on rapid growth.

• Highlights: full-stack ops, regulatory muscle, premium service for mature startups.

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Who SteadyMD is Built for

SteadyMD is a heavyweight clinical infrastructure partner best suited for D2C epharmacy startups that already have traction—think GLP-1 platforms with consistent patient demand or digital clinics scaling beyond a single state. They’re not courting the pre-seed crowd. Their model assumes you have a reliable forecast and the budget to back it up.

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What You Get Out of the Box

• ✅ Nationwide coverage (licensed clinicians in all 50 states)
• ✅ Synchronous (video/phone) visits
• ✅ Asynchronous (chat/email) visits — but state availability may vary
• ✅ Lab ordering + review
• ✅ Custom clinical protocols
• ⚠️ No controlled substance Rx yet — working on it
• ⚠️ No startup-friendly onboarding (read: no low-cost pilot tiers)

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Notable Features

• Full-stack clinical ops: They handle clinician recruitment, training, scheduling, and regulatory compliance for you.
• White-label telehealth: Bring your own brand, SteadyMD handles the backend.
• Real-time analytics & reporting: Built-in visibility into your virtual care ops.
• Regulatory muscle: They navigate multi-state compliance so you don’t have to.
• Almost specialty-ready: Actively hiring for GLP-1 and TRT use cases—clearly invested in weight loss and men’s health verticals.

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Pharmacy Fulfillment

SteadyMD doesn’t operate its own pharmacy. Instead, they’ve partnered with AmerisourceBergen to plug into a national network of independent pharmacies. That’s a huge win if you’re trying to skip the nightmare of building a 50-state Rx logistics chain from scratch.

Bonus: They support “test-to-treat” models—e.g., a patient walks into a pharmacy, gets a test, sees a SteadyMD clinician virtually, and gets meds on the spot.

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Integration Considerations

• API support: SteadyMD offers a solid Partner API for managing visits, patients, labs, and Rx workflows. Ideal for building custom apps.
• External EHR support: Their “Limited API” lets you keep your own EHR and patient records.
• Full frontend flexibility: Use their white-label platform or build your own UX entirely.

In short: you’re not stuck in their walled garden.

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Pricing Model

SteadyMD positions itself as a premium clinical infrastructure provider—and the pricing reflects that. They charge a monthly operations fee for program management (think clinician hiring, training, scheduling, and oversight), plus a minimum monthly commitment tied to visit volume.

• Designed for scale, not small pilots
• No starter tiers or pay-as-you-go options
• You’ll need a solid forecast of patient volume to make this partnership viable

If you’re still counting MAUs in the hundreds, this will feel like overkill. But if you’re scaling up and want a clinic-in-a-box with high compliance, it makes sense.

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Strengths / Watchouts

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MD Integrations: Async-first, Lean Integration

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MD Integrations enables epharmacy startups to quickly scale nationwide via asynchronous-first telehealth. With robust API-driven white-label solutions, physician coverage across all 50 states, and startup-friendly pricing, MD Integrations helps brands rapidly launch and maintain full UX control without heavy upfront investments.

• Highlights: Shopify-ready, lean startup-friendly pricing, asynchronous care emphasis.

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Who MD Integrations is Built for

MD Integrations (MDI) is your go-to if you’re:

• A D2C epharmacy startup in weight loss, women’s health, dermatology, or HRT (minus testosterone)
• Scaling fast and want nationwide MD coverage without cobbling together your own network
• Selling on Shopify or WooCommerce and need plug-and-play clinical ops
• Favoring asynchronous care over live consults (think intake forms + fast Rx)

If you’re looking to prescribe controlled substances or want a one-stop-shop with fulfillment baked in—look elsewhere.

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What You Get Out of the Box

• ✅ Nationwide coverage: All 50 states + DC, Puerto Rico, Guam
• ✅ MD-only network (no PAs or NPs)
• ✅ Asynchronous care by default (video only in ~10 states)
• ✅ Personalized welcome videos from real doctors (not bots)
• ✅ Fast SLAs: ~52 min avg response, under 24h guaranteed
• ❌ No controlled substances (TRT, etc.)
• ✅ HIPAA & SOC2 compliance
• ✅ Slack access to real devs, not just account managers

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Notable Features

• White-labeled intake + portal — looks like your brand, not theirs
• Unlimited free patient messaging — only pay when an Rx is written
• Mobile apps — for both patients and docs
• Built-in patient verification — via Vouched or similar tools
• Custom provider training — doctors follow your clinical protocols

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Pharmacy Fulfillment

MDI is pharmacy-agnostic. You can route scripts to:

• Your preferred 3PL partner (e.g., Empower, Curexa, GoGoMeds)
• Patient’s local pharmacy
• Your own mail-order pharmacy (if you’ve got it set up)

They don’t fulfill Rx themselves, which means you’re free to optimize margins and logistics. But it also means you’re the one stitching together that piece.

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Integration Considerations

• ✅ API-friendly: Full API suite for teams who want full control
• ✅ White-label UI: Use theirs and just reskin—no code needed
• ✅ Shopify plug-in: For ultra-fast, dev-light setups
• ✅ External EHR support: Not locked into their system
• ❌ Some fuzziness on deeper EHR sync—ask questions if you’re picky about data flow

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Pricing Model

MD Integrations is built with early-stage growth in mind. Compared to other clinical infra providers (👀 SteadyMD), it’s noticeably lighter on overhead—especially if you’re starting out with a lean team and bootstrapped runway.

• Lower monthly commitment than many competitors
• Friendly to phased launches and MVP pilots
• Not exactly freemium, but you won’t need to remortgage your Lambo either
• Still requires some patient volume to make the math work (no hobby projects here)

If SteadyMD feels like hiring a full clinical pit crew, MDI is more like renting the fast lane with your own wheels. Ideal if you’re scaling thoughtfully and want to keep ops lean while still checking the compliance boxes.

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Strengths / Watchouts

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TeleMed2U: Specialist-Driven, Fully Integrated Care

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TeleMed2U offers epharmacy startups a nationwide network of specialists across endocrinology, mental health, and more, delivering seamless synchronous and asynchronous care. Their integrated telehealth model, including built-in pharmacy fulfillment, simplifies operational complexity—perfect for platforms targeting specialty verticals like weight loss, men’s and women’s health.

• Highlights: specialist clinicians, built-in pharmacy, multi-modal telehealth.

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Who TeleMed2U is Built for

TeleMed2U plays best with founders building D2C epharmacy apps in weight loss, men’s health, women’s health, and hormone therapy. Why? Because they’ve actually walked the walk—after acquiring Medzino, a D2C telehealth + mail pharmacy startup, they’ve been running their own subscription-based programs. That gives them battle-tested insights into your world: async consults, discreet med shipping, and scaling without sacrificing quality.

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Beyond D2C, they’ve supported Blue Shield, Medi-Cal, and employers like Virtual Blue—so whether you’re just launching or heading toward an enterprise deal, they’re built to flex.

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What You Get Out of the Box

• ✅ Nationwide coverage (all 50 states)
• ✅ Synchronous video visits
• ✅ Asynchronous consults (chat/questionnaire-based)
• ❌ no support for controlled substances Rx (e.g., testosterone)
• ✅ In-house mail-order pharmacy via Medzino
• ✅ Integration support for custom apps (APIs, EHR data feeds)
• ✅ Use your own EHR or go with theirs

No licensing headaches. No “Sorry, we don’t cover Idaho.” Just plug in and start seeing patients.

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Notable Features

• Specialist-driven care (not just GPs): endocrinologists, urologists, psychiatrists – a must for GLP-1s, TRT, or mental health add-ons
• Multi-modal platform: Async for easy refills, sync for clinical evals – your patient flows, your rules
• Regulatory muscle: They’re telehealth policy wonks with experience navigating DEA, FDA, and state quirks
• Insurance optionality: Accepts insurance and affordable for cash-pay users ($75–$149 range)

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Pharmacy Fulfillment

TeleMed2U gives founders real flexibility when it comes to fulfillment. You can use their integrated Medzino mail-order pharmacy, which ships FDA-approved medications quickly and discreetly—perfect for keeping the D2C experience smooth and frictionless.

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But if you already have a pharmacy partner (like Truepill or a local compounding pharmacy), or if your patients prefer using retail chains like CVS or Walgreens for insurance coverage, TeleMed2U can accommodate that too. Just note: while they do offer a form of white-labeling, some branding may still show up—prescription labels might say “Medzino,” for example.

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Integration Considerations

• Custom App Integrations: They’ll hook into your backend via APIs or HL7/FHIR feeds—though it’s more “partner handshake” than “Zapier-style plug-and-play”
• Bring Your Own EHR: Their docs can chart into your system—or you can lean fully on theirs
• No public dev docs: Expect a bit of lift upfront and coordination with their tech team

Bottom line: not as slick as a YC-backed API startup, but more flexible than most traditional telehealth groups.

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Pricing Model

• Cash-pay consults start at ~$75 (patients)
• B2B pricing is likely per consult (with volume discounts); no huge setup fees reported
• Friendly to early-stage startups: they’ve worked with clinics, FQHCs, and scrappy D2C brands

Cost scales linearly—great at the start, but founders should model margins carefully at volume

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Strengths / Watchouts

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Side-by-Side Comparison: Clinical Infrastructure Providers for D2C Epharmacy

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Choose Your Stack Based on Your DNA

Every startup has its own DNA, and choosing the right telehealth stack can make or break your nationwide ambitions. Here’s a quick-and-dirty guide tailored to your startup archetype:

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Bootstrapped startup with one provider, async-first

• MD Integrations or OpenLoop with Specode frontend

If you're scrappy, budget-conscious, and prefer asynchronous care, MD Integrations lets you plug quickly into Shopify or WooCommerce—perfect for early growth without breaking the bank. Alternatively, pairing Specode's flexible frontend framework with OpenLoop provides a scalable backend infrastructure, allowing you to grow without losing UX control.

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Mid-stage startup looking for sync visits and controlled Rx

• OpenLoop

OpenLoop offers robust nationwide coverage, async and synchronous visits, and solid controlled substance prescribing—ideal for startups scaling GLP-1, hormone therapy, or TRT.

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Specialty-heavy (e.g., endocrinology, psych)

• TeleMed2U

Specialty care demands more than just general practitioners—TeleMed2U’s endocrinologists, urologists, and psychiatrists ensure your specialized treatments are clinically sound and scalable.

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Wants full white-label turnkey solution

• SteadyMD

SteadyMD is your heavy hitter if you need clinical ops fully handled. Their partnership with AmerisourceBergen for Rx fulfillment, comprehensive white-labeling, and deep compliance management lets you scale fast—just make sure you’re ready for their higher baseline costs.

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Wants to control UX, EHR, and scale custom workflows

• Specode + OpenLoop or Wheel

When your brand’s frontend UX and tailored workflows are non-negotiable, Specode’s app development framework paired with OpenLoop's clinical infrastructure offers unmatched flexibility. Alternatively, Wheel’s "behind-the-scenes" integration via their APIs gives you backend power while leaving your UX pristine.

Remember: your stack choice isn’t just tech—it’s strategic. Choose wisely, scale swiftly, and keep your brand’s DNA intact.

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Where Specode Fits (and Why You’ll Want It)

If you’re betting your growth on rigid, generic solutions from clinical enablement providers—pause. White-labeled products might offer quick deployment, but they quickly hit their limits once you're scaling nationwide. Custom branding, unique user experiences, and specialized workflows suddenly become costly roadblocks or outright impossibilities.

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Enter Specode—your flexible digital health accelerator. Think of it as your app-building cheat code: a HIPAA-compliant development framework consisting of modular, compliant components that seamlessly integrate into your tech stack, providing both frontend ease-of-use and backend robustness. Need secure patient onboarding? Payments and subscription handling? Integrated telehealth visits (both synchronous and asynchronous)? Specode’s got you covered.

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Specode modules give your development team pre-built components covering:

• User Authentication and Registration: secure, seamless sign-ups.
• Appointment Scheduling & Management: sync calendars and reduce no-shows.
• Telehealth (sync & async): built-in video and chat infrastructure.
• Patient and Provider Profiles: easy management, robust functionality.
• Payments & Subscriptions: monetize without friction.
• Symptom Tracking & Basic EMR Functions: enhance patient engagement, streamline clinical workflows.
• Dashboards: real-time insights to optimize your platform.

The non-negotiables? Full code ownership, rapid deployment, and maximum flexibility—no vendor lock-ins. With Specode, your frontend UX stays pixel-perfect, your backend stays compliant, and your product roadmap stays firmly in your control.

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Plus, you'll continually benefit from new, cutting-edge features rolling out under Specode—like AI-powered assistants, advanced reporting tools, and more—keeping your platform ahead of the curve. 

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If scaling nationwide quickly and confidently matters—Specode is your edge.