How We Vet Providers

Yes, with constraints. Some of the providers in our directory have an affiliate relationship with us, meaning we earn a per-click or per-qualified-consult fee when a reader clicks through and books a consultation. Inclusion in the directory is independent of whether a provider has an affiliate relationship with us; we list providers that meet our rubric whether they pay us or not. Affiliate relationship is disclosed on every listing card with a small "We earn a fee" pill so you know which is which.

Two reasons typically: (1) they didn't meet the licensure or accreditation bar, or (2) we haven't gotten to them yet. We verify and write up providers in batches. Email us if you think a provider belongs and we'll prioritize them in the next review cycle.

Because their weighted rubric score is higher. Each provider profile breaks down their score per dimension so you can see exactly which dimensions drove the ranking. If you disagree with a specific score, the rationale note next to it tells you what we considered; push back and we'll re-examine.

503A pharmacies compound for individual patients with a specific prescription. 503B pharmacies are FDA-registered outsourcing facilities that can compound at larger scale and ship to clinics without patient-specific prescriptions. For compounded GLP-1s, LegitScript and most major payment processors require sourcing from accredited compounders, and 503B status is the strongest signal. We note compounding-pharmacy type and accreditation when the provider discloses it.

Differently, because they measure different things. BBB ratings reflect how a business handles formal complaints over time; A+ accredited since 2018 is meaningfully stronger than F not accredited because it shows complaint-resolution behavior, not just complaint volume. Trustpilot averages reflect what individual customers post, where the most upset users dominate; we read the distribution (what percentage are 1-star) more than the average, and we weight Trustpilot's own suspected-fraudulent-review notice more heavily than the headline number when one is present. ConsumerAffairs is a useful third signal, especially on volume. The honest framing: read all three, weight the disagreements as informative rather than noise.

An FDA warning letter is a formal notice that the agency has identified violations of federal law and is requiring corrective action. It is more serious than a Form 483 (an inspection observation) but less serious than a recall or formal enforcement action. We treat a warning letter on the provider's GLP-1 line as a major flag that lowers the licensure score; we treat an industry-wide alert that names the category but not the specific provider (like the April 2025 compounded topical finasteride alert) as a softer counterweight that still applies if the provider markets the affected product line. Recency matters; we re-check the FDA warning-letter database quarterly.

Because civil litigation is not the same as regulatory enforcement, and most of the major manufacturer lawsuits in this category (Novo Nordisk and Eli Lilly against compounders) are about marketing claims rather than product safety. We surface the lawsuit prominently in the regulatory-history section, link the docket where possible, and note where the case stands (filed, partial dismissal, settlement). A live lawsuit lowers the licensure score but does not automatically disqualify a provider; what matters is the substance of the claim and whether the platform has continued the behavior post-filing.

LegitScript is a third-party verification organization that audits telehealth platforms and pharmacies for compliance with federal/state law and consumer-safety standards. Its certification is required by Google, Meta, TikTok, Microsoft, and most major credit-card processors before a healthcare merchant can advertise or accept payment. The catch is that LegitScript does not publish a public per-merchant directory we can verify against, so for some providers we mark certification as inferred (from the fact that they are advertising on Google or Meta, which gates on it) rather than verified. We err on the side of marking unverified when we cannot point to a public source.

Vertical integration (the platform owns the pharmacy that fills its prescriptions) is a transparency advantage we score in the Transparency dimension because it makes per-fill sourcing a non-question. Partner-pharmacy models (the platform routes prescriptions to one or more 503A or 503B partners) are not inherently worse, but they require additional disclosure: we look for whether the partner is named per fill, whether per-batch certificates of analysis are published, and whether the partner is itself accredited. Most cohort providers run partner models without per-fill disclosure, which lowers the Transparency score relative to vertically-integrated competitors.

Hard disqualifiers: no active state license in the states they claim to serve, an open FDA recall on a product line we'd be referring readers to, a pattern of unaddressed BBB complaints that suggests the company has stopped responding, or a revenue model that requires per-prescription compensation (which has Anti-Kickback Statute exposure). Soft disqualifiers that lower the score but don't automatically remove the listing: recent FDA warning letters, active manufacturer lawsuits, BBB ratings of D or F, Trustpilot suspected-fraudulent-review notices, and any opaque vendor management with downstream quality concerns.

Public-record checks (state license, accreditation status, FDA warning letters, manufacturer lawsuit dockets) every quarter. The full Tier-3 questionnaire annually for active providers, and immediately whenever a major event happens (recall, regulatory action, ownership change, settlement). The "last verified" date appears on each provider profile and on each comparison page; if you see a stale date, email us and we'll prioritize the re-check.

Every meaningful score change is logged in the provider's update history with a date and a one-sentence rationale, so you can see the rationale even after the fact. Material changes (a major flag added, a settlement closing a previously-open lawsuit, a new accreditation verified) trigger a re-publish with the date stamped at the top. We don't silently re-score; the diff is in the git history of data/providers.ts and in the update-history section of the profile.

Email us with the details. If it's a one-off we note it and watch for patterns. If it's representative of broader issues, the listing comes down or gets re-scored. We'd rather de-list a provider than defend one we shouldn't have listed.

This page explains the methodology: the rubric, the verification tiers, what we accept and refuse, and how we score across the cohort. Head-to-head comparison pages (at /providers/compare) take that methodology and apply it to a specific pair, picking a winner per use case so you get an opinionated answer for the decision in front of you. This page is the system; the comparison pages are the verdicts.