How to Start an ED Telehealth Brand in 2026

Checked October 18, 2026. Prices are entry prices from the Telehealth Match database (our sister comparison site) unless noted.

The medications

• FDA-approved PDE5 inhibitors: sildenafil (Viagra), tadalafil (Cialis, as-needed and daily), vardenafil and avanafil, with sildenafil and tadalafil widely available as generics.
• Compounded products: chewables, troches, sublingual mixes and "3-in-1" or "4-in-1" combinations, plus Trimix injections. These aren't FDA-approved.
• None are controlled. The key screen is nitrate use, a contraindication on the labels.

Visits

A 2023 study of 15 DTC ED platforms found 93% prescribed from online intake forms only, and two-thirds promised review within two business days (Sexual Medicine, 2023). Some states bar prescribing from a static questionnaire alone, so use an adaptive intake and real clinician review (our structure guide).

What brands charge, and what it costs

Several brands price per dose instead, from about $2 to $7. The 2023 study found the lowest sildenafil prices across platforms averaged $5.16 a pill (median $2.65). At Cost Plus Drugs, 30 tablets of sildenafil 100 mg cost $1.69 and tadalafil 5 mg $0.98, before a $5 fee and shipping. As in hair loss, dispensing and shipping fees, not the drug, set your real cost.

Retention

About half of men stop PDE5 inhibitors within a year, around 4% a month, more often younger men, with partner issues and lack of effect the main reasons (Andrology, 2016). Good follow-up, dose and drug switching, and adjacent care keep patients: hair, testosterone, or the patient's partner via a women's sexual health line.

The rules that matter

• FDA's BlueChew letter (September 9, 2025) called compounded sildenafil and tadalafil chewables misbranded over claims like "SIL: Same active as Viagra" and that they "contain the same active ingredients… used in FDA-approved drugs like Viagra, Cialis" (FDA). Never write "same active as [brand]" for a compounded product.
• Subscriptions: the FTC's July 2026 case against Hims alleges charges before a provider consult, unclear refill timing and a hard-to-find cancel flow (FTC). Show refill terms before payment and make cancelling easy.
• Unapproved "male enhancement" products are a long-running FDA target (FDA). Keep your brand clearly on the prescription side.
• Ads: prescription ED ads need LegitScript plus Meta or Google authorization, targeting adults only (our LegitScript guide).

Launch checklist

1. Choose a clinician network with fast async review and a pharmacy with good per-dose pricing (partners compared).
2. Pick a position the giants don't own: an audience, a format, or care for both partners.
3. Price per dose or per month with honest auto-refill terms.
4. Write compounded-product copy to the BlueChew lesson.
5. Plan adjacent products early, with hair loss the obvious first one.