The short version
An ED telehealth brand in 2026 sells three generic molecules (sildenafil, tadalafil and vardenafil), none of which is a controlled substance, so the DEA telemedicine deadline on December 31, 2026 does not apply to you. The drugs are cheap. A study presented to urologists and covered by Urology Times on October 13, 2023 found introductory DTC prices of $4 to $6.50 per sildenafil pill against 33 cents at Mark Cuban Cost Plus Drug Company, and $6.25 to $9.75 per tadalafil pill against 33 cents. Those are 2023 prices and the gap has narrowed, but the shape has not changed.
So the business question is how you design the plan around a nearly free molecule. Patients pay for discretion, convenience and a refill they never have to think about.
The formulary, and what each product does to your subscription
| Product | How patients use it | Subscription shape | What to watch |
|---|---|---|---|
| Sildenafil (generic Viagra) | As needed, roughly an hour before sex | Packs of 4, 6, 8 doses a month; usage is lumpy | Patients over-order, then skip refills |
| Tadalafil, as needed (generic Cialis) | As needed, longer window | Same as sildenafil | Same stockpile risk |
| Tadalafil, once daily (2.5 or 5 mg) | Every day | One tablet a day, 30 a month, predictable | Also approved for BPH symptoms, so check the urinary history |
| Vardenafil (generic Levitra) | As needed | Packs, smaller demand | Label carries a QT-prolongation warning; screen cardiac history and meds |
Our opinion: lead with daily tadalafil where the clinician thinks it fits, and offer sildenafil packs for everyone else. Daily dosing is the only ED product whose refill rhythm looks like a subscription.
Combination products (Ro sells "Sparks," sildenafil plus tadalafil in one dissolvable, at $48 a month for 4 doses on its pricing page) are compounded. They work as a differentiator if your pharmacy partner makes them, and they bring 503A compounding questions with them, so decide that with your medical director, not your marketing lead.
Pricing reality: the drug is free, the plan is the product
Hims headlines generic daily Cialis on its blog as "spontaneous sex for less than $2/day." Ro's Sparks works out to $12 a dose. At those price points the consumer's anchor is set by two companies spending heavily on brand, and your pharmacy's ingredient cost is a rounding error next to the per-patient cost of the visit, the clinician and support.
Here is an illustrative month for one patient on a sildenafil pack. Every input is an assumption you should replace with your own quotes.
| Line (per patient per month) | Assumption | Amount |
|---|---|---|
| Plan price, 6 doses | Our illustration, below Ro's per-dose price | $39.00 |
| Pharmacy (ingredient, dispensing, shipping) | Assumed; get a written quote | $12.00 |
| Provider review, amortized | $25 async consult once a year plus a mid-year check, spread over 12 months | $4.00 |
| Card processing | 2.9% plus 30 cents | $1.43 |
| Support | Assumed at low volume | $3.00 |
| Contribution before platform and marketing | $18.57 |
Eighteen dollars a month is thin, and it is thinner when the patient churns in month three. That is why most ED brands sell quarterly packs, why the daily plan matters, and why your acquisition cost has to stay low. Our margin model uses $250 to replace a patient in weight loss. At $18 a month you cannot pay that in ED. You need organic search, partners, an existing audience, or a second program the patient also buys.
Three pricing rules we would follow. Price per dose and show the math, because every competitor does and patients compare. Make quarterly billing the default with the per-dose saving stated, and make monthly available without a penalty that feels like a trap. Charge after the provider approves, not at intake submission; that is one of the practices the FTC put at the center of its July 2026 complaint against Hims & Hers (Hims denies the allegations).
The intake has to screen like a pharmacist
The safety profile of PDE5 inhibitors is well understood, which is exactly why a regulator or a plaintiff's lawyer will expect your intake to catch the known problems every time. The screens below come from the FDA labels; your medical director signs off the final protocol.
Nitrates, in any form. Organic nitrates (nitroglycerin, isosorbide, and recreational "poppers") are a contraindication for all PDE5 inhibitors because the combination can drop blood pressure dangerously. The tadalafil label says nitrates should not be given within 48 hours of the last dose. Ask about poppers by name. Patients do not think of them as medication.
Riociguat and other guanylate cyclase stimulators. Contraindicated, same mechanism.
Alpha-blockers and blood pressure medication. A caution, not a contraindication; the labels tell clinicians to weigh the combination. Daily tadalafil patients with urinary symptoms are the ones most likely to be on tamsulosin or doxazosin.
Cardiac history where sexual activity is inadvisable. Recent heart attack or stroke, unstable angina, uncontrolled hypertension or hypotension, serious arrhythmia. Route these to decline or to an in-person referral.
Potent CYP3A4 inhibitors, such as certain antifungals, HIV protease inhibitors and some antibiotics, which change dosing.
Red-flag symptoms to put in post-approval messaging: an erection lasting more than four hours, sudden vision loss, sudden hearing loss. These belong in the onboarding message and the portal, in plain words, with "seek emergency care."
Also ask when the patient last had blood pressure and blood sugar checked; ED can be an early sign of cardiovascular disease and diabetes. Design the flow for privacy and speed too; the sexual health patient journey post covers that half.
The retention problem
ED is the easiest telehealth category to acquire into and one of the hardest to keep. Three mechanics cause it.
On-demand use is irregular. A patient who orders 8 doses and uses 3 has no reason to refill next month, and an auto-ship that arrives anyway produces a refund request or a chargeback. Quarterly packs make this worse in one way (bigger stockpile) and better in another (fewer billing events to dispute).
The refill gap is invisible. When a monthly patient skips, it looks like churn on day 31 and like a reactivation on day 75, and most dashboards count both wrong.
The condition is private. Patients do not answer check-in emails about it, so engagement metrics borrowed from weight loss look terrible even for satisfied patients.
What helps, in rough order of impact:
- Let patients pause and skip from the portal instead of cancelling. A skipped month is recoverable; a cancellation is not. The subscription design post has the mechanics.
- Ship on usage, not on calendar, where your pharmacy and billing allow it: a "send my next pack" button and a reminder when the patient is probably running low.
- Offer the daily option at the first renewal for patients the clinician thinks are suitable, framed as convenience, not as an upsell.
- Run win-back at day 60 to 90, with one message, not a sequence. The reactivation post has the workflow.
- Keep the annual re-authorization short. Re-ask the medication and cardiac questions; do not make a returning patient fill out the whole intake.
We do not have a reliable public benchmark for ED subscription retention, and we would distrust anyone who quotes one without a source. Measure yours by cohort from the first month.
Positioning against Hims and Ro
You will not outspend them. Hims reported $753.2 million of revenue in Q2 2026 across all its categories, and ED was the business that built its brand. Where a small brand can win:
- A specific patient. Men over 50 with blood pressure medication, men with diabetes, couples-oriented sexual health, or a men's health clinic that already sees the patient in person. The niche economics post has more.
- An existing audience. A fitness brand, a podcast, a supplement company or a TRT clinic that already has the trust. ED is a strong second program because the acquisition is already paid for. If you are deciding whether ED should be your first program or your second, the specialty expansion post walks through it. Our view: as a first program it works only if you have a cheap acquisition channel. As a second program next to weight loss, hair or testosterone, it is one of the best additions available.
What Turbopills ships for an ED program
Our Sexual Health solution is the ED version of the platform: an intake template built for PDE5 screening that covers cardiovascular history, nitrates and current medications with conditional logic, inline ID verification, an async review queue with a structured contraindication summary for your clinicians, on-demand packs and daily plans in the same cart, billing that starts after approval, refill reminders with re-authorization when your protocol requires it, and a private branded portal and app. We do not employ clinicians or dispense medication; your providers and pharmacy partner do that, and the platform keeps information moving between them and the patient.
What stays with you: the medical director and protocol, the pharmacy relationship, LegitScript if you advertise, and the brand. We are in private beta, quote per program, and launch in weeks, not months. Ask us to walk through the ED intake in a demo, and push on the contraindication logic.
FAQ
Do you need a DEA registration to run an online ED clinic? No. Sildenafil, tadalafil, vardenafil and avanafil are not controlled substances, so the DEA telemedicine rules and the December 31, 2026 expiry of the flexibilities do not apply. Your prescribers still need state licenses where patients are located.
How much does generic sildenafil cost a telehealth brand? The ingredient is very cheap: a 2023 Journal of Urology study found Cost Plus Drugs charging 33 cents per sildenafil pill. Your real cost is the pharmacy's dispensing and shipping fee, so get a written per-fill quote; the margin comes from the plan, not the pill.
What should an ED telehealth intake ask? At minimum: nitrate use (including poppers), riociguat, alpha-blockers and blood pressure drugs, recent cardiac events, potent CYP3A4 inhibitors, prior reactions to PDE5 inhibitors, and the symptoms that would need emergency care. Your medical director owns the final protocol.
Is an ED telehealth business profitable? It can be, at low acquisition cost. In our illustration a 6-dose plan at $39 contributes about $18 a month before platform and marketing, so the model works with organic or existing-audience acquisition and struggles on paid social alone.