Telehealth patient retention: refills, check-ins and subscriptions on MyOrbitHealth

Most attrition happens early

A real-world claims analysis published in the Journal of Managed Care and Specialty Pharmacy in 2024 (Gleason and colleagues) followed 4,066 commercially insured adults without diabetes who started a GLP-1 receptor agonist for obesity in 2021.

• It reported persistence of about 46 percent at 180 days and about 32 percent at one year.
• That cohort was insured and used brand-name products, so treat it as a direction rather than a forecast for your brand.
• The direction is clear: the first six months decide most of the outcome.

Why patients actually drop off

Support tickets show the same handful of causes.

• Side effects with no fast clinical answer.
• Dose titration that confuses the patient.
• A rebill that lands at a bad moment with no warning.
• A shipment that is late or arrives warm.
• No visible progress, because nothing was measured.
• A life event that makes the program feel optional.
• Only the last one is outside your control.
• The rest are workflow problems.

What holds patients in place

Four things do most of the work.

• A provider who responds quickly: the MyOrbitHealth network has 2,400+ board-certified providers across 38+ specialties and all 50 states, with an average response under six minutes during business hours.
• A written titration plan the patient can see in the portal.
• Labs that show the number moving.
• A refill that arrives without the patient having to chase it.

Step 1: the patient completes a check-in

Before each refill the patient answers a short check-in in the branded portal or app.

• The check-in covers how the current dose is going, side effects, weight or symptom changes and anything the provider asked to track.
• Red flags in the check-in escalate to the provider the same way red flags in the initial intake do.
• A concerning symptom routes to a provider conversation or a visit instead of a routine approval.

Step 2: a licensed provider reviews it

A provider in the network reviews the check-in and decides: continue the current dose, change it, order labs, request a visit, or hold the prescription.

• The provider signs the new prescription under their own NPI.
• This is the gate.
• There is no auto-ship on MyOrbitHealth, because a refill without a clinical review is a prescribing problem and a LegitScript problem.
• It is also the moment side effects get caught and doses get adjusted, which is when a patient who would otherwise quit stays.

Step 3: the storefront subscription rebills

The branded storefront includes checkout and subscriptions.

• Your brand is the merchant of record and the rebill settles to your own payment processor.
• MyOrbitHealth does not touch the cash.
• If a card declines, the order holds.
• Medication does not ship against a failed payment.
• Retry schedules, card updaters and dunning emails are features of your processor, not of MyOrbitHealth, so configure them there.

Step 4: OrbitRx routes to the pharmacy

Once the provider has signed and payment has cleared, OrbitRx sends the prescription through Surescripts to a pharmacy in the LegitScript-certified network, which includes 503A compounding and retail pharmacies.

• Cold-chain shipping covers all 50 states.
• Medication passes through at pharmacy cost with 0 percent markup.
• When the pharmacy dispenses, a prescription.dispensed webhook fires so your own systems can tell the patient a shipment is on the way.

What the portal and app provide

The branded patient portal and the native white-label iOS and Android app are the clinical channel.

• Patients use them for intake, visit history, secure messaging with their provider, prescriptions, refills and subscription management.
• The channel is authenticated, encrypted and covered by the BAA in every MyOrbitHealth contract, and every access is written to the OrbitOS HIPAA audit trail.
• Anything clinical, including dose questions, side-effect reports and lab results, belongs here.

What the brand runs in its own tools

MyOrbitHealth does not include an SMS or email journey builder.

Refill reminders, check-in nudges, win-back emails and shipment notifications are sent from your own email service provider and SMS vendor, triggered by webhooks or by your CRM. The platform tells those tools what happened, through signed webhooks and the REST API, and keeps the clinical conversation inside the portal.

Keep clinical content out of texts and marketing email

A reminder text should say that a check-in is due or that a message is waiting in the portal.

• It should not name the medication, the dose or the condition.
• Transactional emails should avoid tracking parameters that reveal the program.
• This keeps your SMS and email vendors out of the PHI path in most cases, which simplifies your BAA footprint.
• The MyOrbitHealth guide to HIPAA-compliant patient messaging at /blog/hipaa-compliant-patient-messaging goes deeper on channel rules and support scripts.

TCPA consent for texts and calls

The FCC's TCPA rules at 47 CFR 64.1200 restrict autodialed or prerecorded calls and texts to mobile numbers without the prior express consent of the called party, and require prior express written consent when the message includes advertising or telemarketing.

• The rule carves certain health care messages sent by or on behalf of a HIPAA covered entity or business associate out of the written-consent requirement, but that carve-out does not cover promotions, and a text about a discount or a new program is a promotion.
• Record informational consent and marketing consent as two separate fields, include a working opt-out, and honor STOP immediately.
• The health care context does not give you a marketing license.

HIPAA boundaries for marketing

Once a person enters intake they are a patient, and using their PHI for marketing generally requires authorization.

• Keep your marketing list and your clinical list separate, run your newsletter to the marketing list, and do not let a marketing tool read clinical fields unless it is under a BAA.
• Where the brand adds a helpdesk, email or SMS vendor that will see PHI, the brand signs the BAA with that vendor.
• MyOrbitHealth's BAA covers the platform, not tools you connect to it.

Subscription disclosure and cancellation

The FTC's Negative Option Rule, announced in October 2024 and often called click-to-cancel, has been the subject of federal court decisions and further rulemaking notices in 2026, so check its current status with counsel.

The safe posture does not depend on the rule's fate: disclose the recurring charge clearly before checkout, get affirmative consent to it, and make cancellation as easy as sign-up. Patients who can cancel easily are more likely to pause and return than to dispute the charge.

Three ways to draw

Orbit Labs offers a walk-in order slip for Quest Diagnostics or Labcorp, a Tasso at-home kit the patient returns by FedEx pickup, or mobile phlebotomy at the patient's home or office.

The provider picks the method that fits the panel and the patient picks the one that fits their week. Availability varies by state and panel, and a patient who can draw at home is a patient who will not skip the recheck because the lab was across town.

Results go back into the plan

Results are read by the provider into the treatment plan, not emailed as a PDF for the patient to interpret alone.

• On a TRT program that means the provider sees testosterone and hematocrit before approving the next cycle.
• On a GLP-1 program it might mean a metabolic panel at baseline and again after several months.
• On an HRT program it means the dose follows the labs.
• The recheck becomes part of the refill decision, which keeps the clinical loop honest and gives the patient a reason to log in.

Self-order from the storefront

Patients can order panels from a lab catalog on your branded storefront.

A licensed provider signs every order, so the catalog is a convenience layer on top of clinical oversight, not a way around it. Lab pricing is quoted per program and depends on panel and draw method, so we do not publish lab prices here.

Cadence is clinical, not promotional

The provider sets recheck timing based on the medication and the patient.

Your lifecycle messaging can remind patients that a provider-ordered recheck is due, and your storefront can make it one tap to schedule, but the order itself always comes from the clinician. Programs that treat labs as a clinical milestone rather than an upsell tend to keep patients who understand why they are still on treatment.

What OrbitOS reports

Operational reporting covers uptime, latency and queue health in real time, plus visits and provider response.

• Revenue and retention reporting is scoped to your brand, so you see your subscriptions, your refills and your cohort, and never another brand's.
• Role-based access decides who on your team sees patient-level detail and who sees aggregates.
• Every view and every change is written to the HIPAA audit trail.

Track the funnel by stage

Define stages in the order a patient moves through them: intake started, intake completed, provider approved, first prescription dispensed, first check-in completed, second refill dispensed, then third, sixth and twelfth.

• Retention at any stage is the share of the starting cohort still active there.
• The gaps between stages tell you where to work.
• A drop between intake completed and provider approved is a qualification or pricing problem.
• A drop between first shipment and second refill is usually side effects, titration or a surprise rebill.

Leading indicators worth a weekly look

Check-in completion rate before each refill.

• Time from check-in submitted to provider decision.
• Share of rebills that fail on first attempt, which lives in your processor but should sit next to the refill data.
• Lab recheck completion when a recheck was ordered.
• Portal message volume per hundred active patients, which rises before churn does.
• Support tickets tagged shipping or billing.
• They are counts you can pull from OrbitOS reporting and your own processor and join in a spreadsheet or your warehouse.

No benchmarks published, on purpose

MyOrbitHealth does not publish retention percentages, and you should be wary of any vendor that does.

Retention depends on vertical, price point, state mix, acquisition channel and how the brand runs support, so a single number is either a cherry-picked program or an average that applies to nobody. Build your own baseline from your first ninety days, cohort by start month and program, and measure yourself against yourself.

Webhooks for the moments that matter

Register a webhook endpoint and MyOrbitHealth sends signed events as they happen. appointment.completed and prescription.dispensed are the two most useful for lifecycle work: the first tells you a visit or check-in has been reviewed, the second tells you a shipment is coming.

Verify the signature, then use the event to trigger what you already do in your own tools: a shipment email from your ESP, a task in your CRM, a row in your warehouse.

The REST API for lookups and reconciliation

The product API at api.myorbithealth.com/v1 uses bearer-token auth with test and live keys, documented endpoints for patients, appointments, prescriptions and webhook registration, and a rate limit of 600 requests per minute per key with burst to 1,200.

• Use it to reconcile subscriptions against dispensed prescriptions or to pull cohort data on a schedule.
• A sandbox is provisioned within a day after a short partner review.
• Documentation lives at /api-docs.

No PHI in marketing payloads

Send your marketing and analytics tools an opaque patient identifier, an event name and a timestamp.

• Keep the mapping from that identifier to a person in a system that is under a BAA, whether that is OrbitOS, your warehouse or a CRM you have contracted properly.
• Do not forward medication names, diagnoses or dose changes to an email tool or ad platform.
• Design the payload so a leak would reveal that something happened, not what or to whom.
• An illustrative pattern: your webhook handler receives prescription.dispensed, looks up marketing consent in your own database, and only then enqueues a shipment-on-the-way email in your ESP.

You own the data, including on the way out

The brand owns its patients, records and data, with export at any time.

Contracts are month-to-month after onboarding with no exit or termination fee. Pick the CRM your team will use and connect it through events you control.