Key takeaways
- Benchmark everything against the processor's own published rate, which for Stripe is 2.9% plus 30 cents.
- A platform charging 3.9% through its own account is adding roughly a full point of markup.
- At $3,000,000 of annual billings, one percentage point is about $30,000 a year for an identical transaction.
- Prescription telehealth is frequently coded high risk, which brings reserves and closer scrutiny.
- Chargeback ratio is a business-continuity metric in this category, not a customer service one.
Start from the processor's published rate
Every comparison in this area should begin from what the card networks and the processor actually charge, because that is the floor. Stripe publishes 2.9% plus 30 cents for standard online card payments.
A platform fee at or slightly above that is a pass-through with a small margin for orchestration. A platform fee substantially above it is a markup, and you are entitled to ask what you are buying for the difference.
What a point costs
Percentages feel small and compound relentlessly. Here is the same billing volume at three rates.
| Annual billings | 1.5% | 2.9% + 30c (Stripe direct) | 3.9% | 3.9% vs 1.5% |
|---|---|---|---|---|
| $896,400 | $13,446 | $27,076 | $34,960 | $21,514 |
| $2,988,000 | $44,820 | $90,252 | $116,532 | $71,712 |
| $8,964,000 | $134,460 | $270,756 | $349,596 | $215,136 |
Who holds the account changes what the rate means
If the platform processes through its own merchant account, the rate you are quoted is a resale price and the underlying relationship is theirs. You cannot negotiate with the processor, cannot see the true cost, and cannot move volume elsewhere.
If your brand holds the account, the rate you pay the processor is between you and them, and the platform's transaction fee is a separate, visible line. That transparency is itself worth something, independent of the number.
It also determines who bears reserves and chargeback liability, and who controls the statement descriptor.
High-risk classification and reserves
Prescription telehealth is frequently coded as high risk because of chargeback exposure, regulatory complexity and the subscription model. The practical consequences are elevated rates, rolling reserves holding back a percentage of settlements, and periodic risk reviews that can freeze payouts.
If the platform is merchant of record, those reserves sit against their balance and their relationship, which means decisions about your cash flow are made in a conversation you are not part of.
Chargeback ratio is a continuity metric
Above certain thresholds, processors place merchants into monitoring programmes, and persistent breaches can end in termination. In a high-risk-coded category the margin for error is thinner.
The controls are mostly operational rather than financial: a recognisable descriptor, genuinely easy cancellation, proactive shipping communication, and screening before charging so a declined patient never becomes a refund dispute.
Below the processor's own rate, into your own account
PharmaBro's transaction fee is 3% on Launch, 2% on Grow and 1.5% on Scale. Against Stripe's published 2.9% plus 30 cents, that means from Grow onward you are paying less to PharmaBro than the processor itself charges.
And it settles into your own Stripe account, on every tier, so the processing relationship, the reserves, the descriptor and the dispute handling are all yours.
Conclusion
Payment processing is the easiest line in a telehealth proposal to evaluate objectively, because there is a published public benchmark to compare against.
Ask what the rate is, ask whose merchant account it settles into, and compare both against the processor's own pricing. A platform charging a point above the network for an identical transaction should be able to say what the point buys.
Frequently asked questions
What is a normal payment processing rate for telehealth?
Benchmark against the processor's published pricing, which for Stripe is 2.9% plus 30 cents. Platform fees in this category range from below that to around a full point above it. Anything materially above the published rate is a markup rather than a pass-through.
Why is telehealth considered high risk?
Chargeback exposure, regulatory complexity and the subscription model. The consequences are elevated rates, rolling reserves and periodic risk reviews. The mitigations are operational: clear descriptors, easy cancellation, responsive support and substantiated claims.
Can I negotiate processing rates?
Only if the merchant account is yours. If the platform is merchant of record, the processing relationship is theirs and the rate you see is a resale price you cannot negotiate or move.
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.