To start a telehealth company in 2026, you form a company and choose what to sell. Then you launch a brand (site, checkout, intake and patient portal) on a clinician network licensed in your patients' states and a pharmacy licensed to ship there. You also open your own payment processor account and get LegitScript certification before you run prescription ads. thimblehub sets up and runs the whole brand side, fully managed, and connects your clinician network and pharmacy or introduces you to ones we work with. You can be live as fast as 3 days after you sign. It takes longer if you still need clinicians or a pharmacy.
You don't need a medical license or an engineering team. Here are the eight steps, who owns each one, what every medicine category adds, and what sets your launch date.
The eight steps and who owns each
thimblehubCompany and attorney
You form the company and have a healthcare attorney check your structure, the states you'll serve and your marketing claims. Who may own a medical practice differs by state, so this comes first.
What you'll sell
You choose the medicines and how you sell them: one-time or subscription, a written intake or a video visit. Controlled substances such as testosterone add DEA telehealth rules. The table further down gives each category's main rule.
Clinician network
You choose a clinician network licensed in every state you'll serve, and thimblehub sets up any network you pick, such as SteadyMD or Wheel. We can also connect the clinicians you already work with, or introduce you to networks we work with, including MDI, OpenLoop, Beluga, Wizlo and Arora. You agree terms with the network directly, and its clinicians decide every prescription.
Pharmacy
You contract a pharmacy licensed in each state you ship to, use the one your network fills through, or thimblehub introduces one. Compounded medicines need a compounding pharmacy working under FDA's 503A or 503B rules.
Checkout, portals and site
thimblehub sets up and runs your checkout and intake (thimblecart), patient and admin portals (thimbleportal) and brand site (thimblesites), on your domain. Each order goes to your network for review, and approved prescriptions go to your pharmacy. We set up lab testing too, when your medicines need it.
Payment processor
You open your own payment processor account, such as Stripe, and patient payments land there. Processors review telehealth businesses first: Stripe lists telehealth and online prescription sales as restricted businesses that need its approval.
LegitScript certification
You apply for LegitScript certification, which Google requires for telemedicine ads and Meta requires for prescription drug ads. It costs $975 to apply and $2,150 a year per website. Your site is built to LegitScript's requirements, and thimblehub supports your application.
A test order, together
You and thimblehub place a test order through every step a patient takes: intake, payment, clinician review and pharmacy. Then you go live.
Go deeper on any step: founders without a medical license, DEA rules for controlled substances, clinician networks compared, interstate licensure compacts, brands run by compounding pharmacies and LegitScript certification.
Who does what
Seven parties make a telehealth company run. thimblehub sets up the brand side and connects the rest.
| Partner | What they do | How it's arranged |
|---|---|---|
| You | Own the company, brand, domain and payment processor account. Choose what to sell and approve every marketing claim. | Your company, structured with your attorney |
| thimblehub | Sets up and runs checkout and intake, patient and admin portals and your brand site. Connects your network, pharmacy and labs, sets up ad tracking with your site, and points you to people we trust for legal work and LegitScript prep. | With thimblehub, plus a signed BAA |
| Clinician network | Licensed clinicians review each intake, hold visits when needed and decide every prescription. Some networks we work with handle controlled-substance programs such as TRT. | With the network, directly |
| Pharmacy | Fills and ships prescriptions, with a license in each patient's state. | With the pharmacy, or through your network |
| Lab | At-home kits, walk-in draws or mobile phlebotomy, for medicines that need labs first. | Set up by thimblehub |
| Payment processor | Holds patient payments and pays out to you, after reviewing your business. | Your own account, such as Stripe |
| LegitScript | Certifies your website, which Google and Meta require for prescription ads. Each platform also runs its own approval. $975 to apply, $2,150 a year. | You apply, and the certification is yours |
Fees from LegitScript's Healthcare Certification page. Ad rules from Google's Healthcare and medicines policy and Meta's Drugs and pharmaceuticals standard. Processor rules from Stripe's restricted businesses list. Checked October 12, 2026.
How long it takes
With thimblehub you can be live as fast as 3 days after you sign. It takes longer if you still need a pharmacy or clinicians, are waiting on LegitScript certification, want website design revisions, are planning marketing with us, or need custom builds. A recent brand went live the morning after its LegitScript certification and marketing were ready.
| Your situation | When you can go live | What sets the pace |
|---|---|---|
| Network, pharmacy and processor in place | As fast as 3 days after you sign | Our setup and a test order with you |
| Still need clinicians | Once you sign with a network | Agreeing terms. We introduce networks we work with. |
| Still need a pharmacy | Once a pharmacy is connected | Contracting one licensed in your states. We can introduce one. |
| Waiting on LegitScript | Once certification arrives | LegitScript's review. Its certification page gives no standard review time; expedited review costs $2,500 more and starts within 2 business days. |
| Want design revisions | After the rounds you ask for | How fast each round is agreed |
| Planning marketing with us | When your campaigns are ready | The campaign plan we agree with you |
| Need custom builds | When the custom work is done | The scope we agree with you |
LegitScript expedited review from its Healthcare Certification page, checked October 12, 2026.
Starting a company to sell a specific medicine
To start a company selling weight loss medication, hormone therapy or any other prescription, you follow the same eight steps. What changes is the rule each category brings, and that rule shapes your network, pharmacy and marketing.
| Category | What to plan for |
|---|---|
| Weight loss (GLP-1) | You can sell FDA-approved semaglutide and tirzepatide on prescription. FDA says both shortages are over. Under its April 1, 2026 notice, a version compounded under 503A that is essentially a copy of an approved drug needs the prescriber to document a significant difference for that patient. Neither drug is on the 503B bulks list or FDA's drug shortage list. On March 3, 2026 FDA warned 30 telehealth companies over claims implying compounded GLP-1s match approved drugs. How to start a GLP-1 telehealth business |
| Testosterone (TRT) | Testosterone is a Schedule III controlled substance. Prescribing it without an in-person visit relies on DEA telehealth flexibilities that run through December 31, 2026. How to start an online TRT clinic |
| Menopause and HRT | You can sell estradiol, progesterone and testosterone on prescription. Estradiol and progesterone are not controlled substances, and testosterone, including for women, is Schedule III. Compounded hormones usually come from a 503A pharmacy, which needs a patient-specific prescription. Launching a menopause or HRT brand |
| ED and hair loss | Sildenafil, tadalafil, finasteride and minoxidil are not controlled substances. FDA has approved no topical finasteride and flagged compounded versions sold through telemedicine in April 2025. Launching a men's health brand |
| Skin | Tretinoin is not a controlled substance. Isotretinoin requires FDA's iPLEDGE program, which enrolls prescribers, pharmacies and patients. Launching a prescription skincare brand |
| Longevity and peptides | Check each peptide's FDA status before you sell it. FDA lists some as compounding safety risks. In July 2026 its compounding advisory committee backed six of the seven peptides it reviewed, including BPC-157 and TB-500, for the 503A bulks list, and FDA has not added any of them yet. Launching a longevity prescriptions brand |
| Sleep and gut health | Zolpidem and suvorexant are Schedule IV, so DEA rules apply. Naltrexone, the drug in low-dose naltrexone (LDN) programs, is not controlled. Launching a sleep or low-dose naltrexone brand |
| Labs | Tests run at labs certified under CLIA, the federal lab program CMS runs. We set up at-home kits, walk-in draws and mobile phlebotomy. |
From FDA, DEA, Federal Register and CMS pages, plus DLA Piper's report of the July 2026 peptide votes, all listed under Sources. Checked October 12, 2026.
Do you need to be a doctor?
No. Licensed clinicians make every clinical decision, and you run the company. In states with strict rules, such as California, physicians must control medical decisions and medical records, so founders work through a clinician network or a physician-owned practice their company supports. Can you start a telehealth company without being a doctor? walks through the structures.
What it costs
LegitScript charges $975 to apply and $2,150 a year per website, and expedited review is $2,500 more. Your payment processor charges card fees, and your clinician network, pharmacy and lab each set their own prices. thimblehub charges setup, a monthly fee and a fee per order that drops as you grow, with no revenue share. You get exact pricing on the call.
What one call to thimblehub gets you
One call covers the whole launch. We set you up and point you to people we trust for anything we don't do in house.
- Your checkout and intake, patient and admin portals and brand site, set up and run for you on your domain.
- Your clinician network and pharmacy connected, or introductions to ones we work with.
- Lab testing set up: at-home kits, walk-in draws or mobile phlebotomy.
- Ad tracking set up with your site. We can also run or manage your campaigns as an added engagement. How Meta ads work for telehealth.
- A signed BAA, a site built to LegitScript's requirements, and help with your application.
- Introductions to people we trust for healthcare law and LegitScript prep.
- A named owner on our team for every request, from setup through launch and after.
You own your brand, domain and payment processor account, and you can export your patient and order records any time.
Frequently asked questions
- How long does it take to start a telehealth company?
- With thimblehub, as fast as 3 days after you sign. It takes longer if you still need a pharmacy or clinicians, are waiting on LegitScript certification, want website design revisions, are planning marketing with us, or need custom builds.
- Do I need to be a doctor to start a telehealth company?
- No. Licensed clinicians make every clinical decision, through a clinician network or a physician-owned practice. Some states, including California, require physicians to control medical decisions and records, so have a healthcare attorney check your structure.
- How much does it cost to start a telehealth company?
- Third-party costs include LegitScript certification ($975 to apply and $2,150 a year per website), card processing, and the fees your clinician network, pharmacy and lab set. thimblehub charges setup, a monthly fee and a fee per order that drops as you grow, with no revenue share. You get exact pricing on the call.
- Do I need my own pharmacy?
- No. Use your network's pharmacy, your own, or any other you pick, and we set it up for you. No pharmacy yet? We can introduce you.
- Do I need LegitScript certification?
- You need it to run ads on Google and Meta. Google requires it for telemedicine ads, and Meta requires it for prescription drug ads. Each platform also runs its own approval. Your site is built to LegitScript's requirements and we support your application. The certification is yours.
- Can I sell testosterone or other controlled substances?
- Yes, through clinicians registered with the DEA. Testosterone is Schedule III, and prescribing it without an in-person visit relies on DEA telehealth flexibilities that run through December 31, 2026. Some networks we work with handle controlled-substance programs such as TRT.
- What does thimblehub do?
- thimblehub sets up and runs your telehealth brand, fully managed: checkout and intake, patient and admin portals and your brand site, on any clinician network and pharmacy you choose or ones we introduce. We sign a BAA, support your LegitScript application, and point you to people we trust for anything we don't do in house.
Questions, or a topic you'd like us to cover? Book a call or email hello@thimblehub.com.
Sources
- LegitScript: Healthcare Certification fees and expedited review
- Google Ads policy: Healthcare and medicines
- Meta: Drugs and pharmaceuticals ad standard
- Stripe: Prohibited and restricted businesses (updated Sep 22, 2026)
- FDA: How to buy medicines safely from an online pharmacy
- Medical Board of California: Corporate practice of medicine
- Medical Board of California: Telehealth
- Interstate Medical Licensure Compact: A faster pathway to physician licensure
- Federal Register: Fourth temporary extension of telemedicine flexibilities, 90 FR 61301 (Dec 31, 2025)
- Reginfo.gov: DEA special registration final rule under review (RIN 1117-AB40)
- DEA: Controlled substances, alphabetical order
- FDA: Policies for compounders as GLP-1 supply stabilizes (Apr 1, 2026)
- FDA: Warning letters to 30 telehealth companies over compounded GLP-1s (Mar 3, 2026)
- FDA: Human drug compounding laws (sections 503A and 503B)
- FDA: Risks of compounded topical finasteride (Apr 2025)
- FDA: iPLEDGE REMS
- FDA: Bulk drug substances that may present significant safety risks (category 2)
- FDA: Pharmacy Compounding Advisory Committee, July 23-24, 2026
- DLA Piper: FDA advisory committee recommends adding six peptides to the bulks list (Jul 31, 2026)
- CMS: Clinical Laboratory Improvement Amendments (CLIA)