An overview of how fulfillment works across digital health brands
Telehealth brands operate with a wide range of pharmacy partners depending on the type of medications prescribed, the payment model, and the desired level of operational control.
The following outlines the primary pharmacy models used in direct-to-consumer (DTC) telehealth today and how they differ in structure and function.
Retail and mail-order pharmacies dispense FDA-approved branded and generic medications under state pharmacy licenses. They may be integrated into insurance networks or pharmacy benefit managers (PBMs) and typically fulfill prescriptions through standard pharmacy channels.
Some also support cash-pay telehealth models that operate outside of insurance billing. These pharmacies manage storage, dispensing, patient communication, and delivery using established fulfillment systems and nationwide distribution networks. Pharmacies that ship prescriptions across state lines generally hold nonresident pharmacy licenses in each destination state.
Direct-to-consumer (DTC) pharmacies are designed for cash-pay telehealth brands that do not bill insurance. They focus on technology integration, automation, and digital fulfillment workflows to support high-volume online operations. Unlike compounding pharmacies, they dispense only FDA-approved medications, not custom formulations. Many operate under nonresident pharmacy licenses that allow shipment across multiple states and may include custom inserts or packaging compliant with labeling requirements to align with a brand’s online experience.
Specialty pharmacies handle complex or temperature-sensitive therapies such as biologics, injectables, and hormone treatments. They maintain enhanced logistics systems for cold-chain shipping and provide additional patient services, including education, adherence monitoring, and adverse-event reporting. Some specialty pharmacies participate in manufacturer-limited distribution networks that govern access to specific high-cost or high-touch medications. While most dispense FDA-approved products, certain organizations may also maintain affiliated 503B facilities for sterile compounding.
Compounding pharmacies prepare customized medications that are not commercially available in a desired form, dose, or combination.
Under the Federal Food, Drug, and Cosmetic Act:
Compounded medications are typically used in dermatology, hormone therapy, and other therapeutic areas that require personalized or proprietary formulations. Compounding cannot be used to replace commercially available drugs unless a prescriber determines a specific clinical need for a different formulation.
Some telehealth companies combine multiple pharmacy relationships to meet diverse fulfillment needs. A hybrid model might include a 503B outsourcing facility for sterile compounds, a retail pharmacy for generic prescriptions, and a specialty pharmacy for injectables or biologics.
Other organizations establish separate, licensed pharmacy entities to maintain control of cost, consistency, and data while keeping prescribing and dispensing functions operationally distinct.
This model allows brands to manage multiple therapeutic categories within a unified, compliant care infrastructure.
MD Integrations provides a physician-led infrastructure that connects digital health brands with licensed pharmacies across all models. Our platform supports compliant prescription routing, technology integration, and operational visibility between providers, brands, and pharmacies. Each pharmacy operates independently, contracts directly with brands that work with MDI, and maintains full responsibility for its fulfillment, own licensure, quality, and compliance.
This material is provided for educational purposes only and does not constitute legal or regulatory advice. Pharmacies are responsible for their own compliance with state and federal regulations. Always consult qualified professionals before selecting or contracting with a pharmacy partner.