Revenue share vs flat fee in telehealth
The two models look similar on a proposal and diverge permanently in practice. Here is the arithmetic at 300, 1,000 and 3,000 patients, and the structural argument underneath it.
Key takeaways
- A flat fee prices software as software. A revenue share indexes the fee to your success instead.
- The crossover comes early, and after it the gap widens every month your marketing works.
- At 1,000 patients the difference between models runs to roughly half a million dollars a year.
- Percentage models also cap your pricing power, because every price increase hands over a share.
- The test: what does your platform bill become if you double ad spend and it works?
The structural argument
The cost of running telehealth infrastructure does not increase because your ad account performed well. Servers, provider network, pharmacy integrations and compliance operations cost roughly the same whether you bill $50,000 or $500,000 in a month.
A flat fee reflects that. A revenue share does not: it charges more for the same service on the basis of an outcome the platform did not produce. You bought the traffic, built the brand and paid for the creative.
There is a coherent version of a revenue share, and it is worth stating fairly. When a platform genuinely funds your medication and lab costs, absorbs merchant reserves and chargebacks, and runs clinical operations end to end, it is carrying real risk and working capital. A percentage is a reasonable price for that transfer. It stops being reasonable when the platform is only providing software.
The arithmetic
Take a brand billing $249 per patient per month. Compare a published flat fee with a 20% revenue share, which sits in the middle of the range operators report.
| Active patients | Annual billings | Flat fee + transaction fee | 20% revenue share | Annual difference |
|---|---|---|---|---|
| 300 | $896,400 | $44,892 | $179,280 | $134,388 |
| 1,000 | $2,988,000 | $95,760 | $597,600 | $501,840 |
| 3,000 | $8,964,000 | $194,460 | $1,792,800 | $1,598,340 |
Where the crossover actually is
At genuinely low volume, a percentage of almost nothing is less than a fixed monthly fee. That is the honest case for a revenue share, and it is real for a brand with a handful of patients.
The crossover arrives quickly. At $249 a month, a 20% share equals a $1,500 monthly flat fee at around 30 active patients. Beyond that the flat fee wins by a widening margin, and the margin widens fastest exactly when the business starts working.
So model it at the volume you expect in month six, not the volume you have in week one.
The second cost nobody models
A percentage model does not only cost you money directly. It constrains what you can do with price.
Raising your retail price from $249 to $299 under a 20% share hands the platform an extra $10 per patient per month for doing nothing different. Every pricing experiment you run is partly funding your vendor.
In the worst version, the platform's schedule sets the retail price outright. Then you cannot test a higher price, run a premium tier, discount to win a channel, or price by cohort. Your margin is assigned rather than built, and pricing stops being a lever you own.
How to compare an actual proposal
Percentages are quoted in different ways, so normalise before comparing.
- Ask whether the percentage is on gross patient billings or on some net figure, and what is deducted first.
- Ask whether payment processing sits inside or on top of the percentage.
- Ask whether medication cost is carried by the platform out of its share or billed to you separately.
- Ask whether the percentage falls at volume, and at what thresholds, in writing.
- Then rebuild both models on gross billings so the numbers are actually comparable.
Flat, published, and falling as you grow
PharmaBro charges a published flat platform fee from $1,500 to $5,000 a month, plus a transaction fee that falls from 3% to 1.5% by tier. Stripe's own published rate is 2.9% plus 30 cents, so from Grow onward the transaction fee is below what the processor charges.
Zero revenue share and zero medication markup. You set your retail price and keep the entire spread between it and your fulfillment cost.
Conclusion
The two models are not different prices for the same thing. They are different relationships.
Under one you buy software and pay for it. Under the other you acquire customers and share the proceeds. Both can be defensible, but only one of them gets cheaper per patient as you grow, and only one leaves your pricing entirely in your own hands.
Frequently asked questions
Is a revenue share ever cheaper?
At very low volume, yes. At $249 per patient per month, a 20% share costs less than a $1,500 flat fee below roughly 30 active patients. Above that the flat fee wins, and the gap widens with every patient you add.
What percentage do telehealth platforms typically take?
It varies widely and most do not publish it. Operators report figures from the high teens to roughly half of patient revenue once medication, labs and processing are accounted for inside the platform's share. Ask for the number in writing and ask exactly what base it is calculated on.
Does PharmaBro take a percentage of revenue?
No, at any tier. The commercial relationship is a published flat platform fee plus a transaction fee that falls from 3% to 1.5%. There is no revenue share and no medication markup.
References
Marcus ElleryHead of Payments and Billing
Works on the rebill engine, merchant routing and recovery logic. Spends most of his time on the unglamorous half of subscription telehealth: why a card failed, and whether it had to.