Organic Growth
A pharmacy already has the hardest thing in healthcare to build: people who trust it.
HARP adds a cash-pay longevity and performance clinic inside an operating independent pharmacy. The patients are already yours. The prescriptions the care plan generates are filled by your own dispensary. This page explains exactly how the model works, what it costs, what it earns, and the controls that keep it above board.
01. Why this exists
Dispensing volume is up. Dispensing profit is not.
Independent pharmacy is a $103 billion marketplace. In 2024 it simultaneously reached a ten-year high in cost of goods, a ten-year high in average annual sales, and a ten-year low in gross profits. Filling more prescriptions no longer reliably produces more profit.
The accepted response is to diversify into clinical services. Immunizations, point-of-care testing and medication therapy management all move revenue outside PBM control, but they are transactional, low-ticket, and still capped by what a payer will reimburse. None of them create a recurring cash relationship, and none of them generate their own prescription demand.
HARP is built to do both.
Source: 2025 NCPA Digest, sponsored by Cardinal Health, released October 2025. Figures describe calendar 2024; store count as of July 2025.
02. How it works
Four stages, each one priced to make the next one easy
A patient collecting a refill is invited to a free consultation. That converts to a paid assessment. The assessment produces a care plan, and the plan is what a membership keeps alive. The therapies the plan calls for are dispensed by the pharmacy.
Free consultation
No charge · 20 min
A trained concierge explains the programme and answers questions. No clinical advice is given at this stage.
Assessment
$649 one-time
A comprehensive biomarker panel and symptom assessment, one hour with a medical provider, one hour with a registered dietitian, and a written personalised plan.
Membership
$149–$599 / month
Ongoing access to the clinical team, repeat lab panels at three, six and nine months, and a review of each with both the provider and the dietitian.
Therapies
Billed separately
Where a plan calls for them: hormone therapy, supplements, injectables, medication management. Prescribed independently by the clinician, dispensed by the pharmacy.
The assessment is an acquisition product, not a profit centre. At roughly 30–40% contribution margin it barely covers its own delivery cost. It earns its place by turning a one-time buyer into a member who stays for years. Anyone evaluating this model on the margin of its first sale will price it wrong and starve the funnel.
There is no lock-in. Members can cancel at any time. That removes the biggest objection at the point of sale and makes retention, not acquisition, the number the business is actually managed against.
03. The advantage
Two numbers decide whether a clinic like this works
This model has been proven at scale inside gyms, where a captive membership makes patients cheap to reach. A pharmacy has that same advantage, plus one the gym does not have. It owns the dispensary the care plan sends the patient to.
Cost to acquire one patient
US dollars · scale 0–1,200A standalone clinic buys patients from strangers. A pharmacy invites people who already walk in every month. Roughly a five- to tenfold advantage, and it is what makes a $649 assessment viable rather than promotional.
Gross margin on a dispensed prescription
Per cent · scale 0–60Paid at the counter. No adjudication lag, no reconciliation, no retroactive clawback, no network audit exposure. The clinical programme generates the demand and the pharmacy keeps the margin.
Members needed to break even
Active members · scale 0–400Converted space rather than new rent, internal outreach rather than paid media, and an existing front of house. A pharmacy filling 67,601 prescriptions a year serves several thousand distinct patients, so filling the panel means converting roughly four to eight per cent of people who already trust the business.
04. Pricing
Published, flat, and the same for everyone
HARP takes no insurance. Every price is set in advance and disclosed before a patient commits, which is only possible outside a payer relationship.
| Programme | Price | What it includes |
|---|---|---|
| Consultation | No charge | Twenty minutes with a concierge to understand the programme. No obligation. |
| Initial assessment | $649 | Biomarker panel, symptom assessment, one hour with a medical provider, one hour with a registered dietitian, written plan. One-time. |
| Performance & longevity | $149 / mo | Ongoing clinical access, repeat panels at three, six and nine months, provider and dietitian review at each. |
| Hormone optimisation | $179 / mo | The same scaffold, with monitoring and titration specific to hormone therapy. |
| Metabolic & weight | $199 / mo | The same scaffold, plus medication management, muscle-preservation protocol and structured taper planning. |
| Executive | $399–599 / mo | A named provider, expanded panel, priority access, body composition and cardiorespiratory testing included. |
| Annual prepay | 10 months for 12 | Available on any membership tier. |
Therapies, supplements and advanced testing are billed separately from membership and are never bundled into it. A patient is told the price of a therapy before it is prescribed, and is always free to fill the prescription elsewhere.
05. Unit economics
What one member is modelled to contribute
The figures below are a planning model, not observed results. They are what the business has to achieve for the thesis to hold, and they are the first thing a pilot site is designed to test.
$82
Monthly contribution from a $149 membership, after lab panels at three, six and nine months, provider and dietitian review time, nursing access, administration and payment processing.
$112
Monthly gross margin on roughly $225 of dispensed therapy at a blended fifty per cent, across supplements, hormone therapy and injectables.
$194
Per active member, per month. Against a modelled incremental operating cost of about $38,000 a month for a full clinical team, the site is expected to reach operating break-even between months ten and twelve.
<3.5%
Target monthly churn. At three per cent an average member stays about thirty-three months; at six per cent it is seventeen and lifetime value roughly halves. Retention, not acquisition, is the number this model lives on.
The honest weak point is therapy attachment. If fewer than half of members take up a prescribed therapy, the model does not work at these membership prices; the subscription alone barely covers clinical delivery. We would rather name that now than have it found later.
06. Projections
One dispensary, three sources of demand
A single pharmacy can support far more members than its own patient list will produce. Clinical staff, laboratory contracts, protocols and back office are all shared, so additional demand can be pointed at the same hub without building a second dispensary.
Every therapy prescribed at a satellite location is dispensed by the hub. A satellite adds members and prescription volume without adding inventory, a pharmacy licence, or a second back office, which is why its marginal economics are better than the hub’s own.
| Demand channel | Year 1 | Year 2 | Year 3 | Acquisition cost |
|---|---|---|---|---|
| Existing pharmacy patients | 135 | 225 | 315 | $40–120 · roughly 3%, then 5%, then 7% of about 4,500 active patients |
| Net-new local patients | 25 | 65 | 130 | $250–500 · these also become new dispensing customers beyond the programme |
| Satellite locations | — | 60 | 330 | $60–150 · one site in year two, three by year three. The host supplies the audience |
| Active members, end of year | 160 | 350 | 775 |
| Per hub | Year 1 | Year 2 | Year 3 |
|---|---|---|---|
| Membership and therapy revenue | $381,000 | $1,122,000 | $2,513,000 |
| Assessment revenue | $173,000 | $206,000 | $459,000 |
| Total revenue | $555,000 | $1,328,000 | $2,973,000 |
| of which cash-pay dispensing through the pharmacy | $230,000 | $675,000 | $1,512,000 |
| Operating cost, clinical and satellite | ($336,000) | ($522,000) | ($810,000) |
| Net profit | ($77,000) | $133,000 | $656,000 |
Read year one as the investment year. The hub carries a full clinical team before the panel is full, so it runs at a modest loss while the funnel is proven. The model is designed so that no satellite opens until the hub has held break-even; the satellites amplify a working system rather than rescuing a struggling one.
Satellites are also the channel most within our control. Existing-patient penetration is bounded by the size of the pharmacy’s list, and net-new local acquisition is bounded by marketing spend. A satellite adds a whole new captive audience at a known fixed cost, which is why year three growth is weighted towards it.
07. Controls
A pharmacy that owns a clinic is the highest-scrutiny version of this business
We treat that as a design constraint rather than a disclosure. Each control below is structural, built into the entity documents and the compensation plans, not written into a policy binder afterwards.
- 01. Separated entities
All clinical care is delivered by a physician-owned professional entity. The pharmacy-affiliated management company provides only non-clinical services (technology, premises, marketing, administration) under a written agreement at a fair market value fee.
Patient revenue is received by the clinical entity first. It is never swept directly to the management company. Patient records belong to the clinical entity.
- 02. Patient choice, in writing
Every patient receives written notice of the ownership relationship between the clinic and the pharmacy, and written notice of their right to have any prescription filled at the pharmacy of their choice.
There is no default routing and no steering. A patient who fills elsewhere is treated identically to one who does not.
- 03. Clinical independence
The management agreement expressly prohibits the management company from setting patient quotas, prescribing targets, or exercising any influence over diagnostic or therapeutic decisions. Formulary and protocol authority sits with the medical director.
The physician who owns the clinical entity holds no ownership interest in the pharmacy, which removes the self-referral question rather than managing it.
- 04. Compensation firewall
No clinician, employee or contractor is paid in any way that varies with prescription volume, dispensed revenue, the number of tests performed, the number of patients referred, or amounts billed. Compensation is salary, fixed fee, or hourly at fair market value.
This is deliberately stricter than general employment law requires. Federal law governing referrals to clinical laboratories applies to self-pay patients as well as insured ones, and a cash-only model does not sit outside it.
- 05. Real oversight, documented
A medical director with a defined monthly hour commitment authors and annually reviews every clinical protocol, credentials each clinician, and conducts chart review. Time is logged and reviews are dated and signed.
A medical director who holds a title without exercising genuine oversight is what makes a structure like this indefensible. The oversight has to be real, and it has to be evidenced.
- 06. Cleared state by state
Prescriber ownership limits, pharmacy referral prohibitions, fee-splitting rules and corporate practice of medicine doctrine all vary by jurisdiction. No site opens until healthcare counsel in that state has reviewed the structure.
Entity templates and agreements are drafted to satisfy the strictest state we expect to enter, not the most permissive one, so expansion does not require redesign.
08. Structure
Who owns what, and why it is built that way
In most states only licensed clinicians may own a medical practice. HARP is not owned by clinicians, so the clinical and commercial sides are held in separate entities joined by a written services agreement. This is the established structure for this kind of business, not a workaround.
The pharmacy owners hold the management company: the brand, the technology, the premises, the patient-facing operations and the dispensary. A licensed physician holds the clinical entity and retains full authority over care. Money flows in one direction only.
Patients pay → CLINICAL ENTITY (physician-owned)
│
├─→ clinician salaries (flat / FMV, never volume-based)
├─→ medical director stipend (defined hours, logged)
├─→ labs, malpractice, clinical supplies
│
└─→ fair market value services fee
│
▼
MANAGEMENT COMPANY (pharmacy-owned)
brand · technology · premises · marketing · adminTwo details that matter more than they look. The services fee is set on a fixed or cost-plus basis supported by an independent fair-market-value opinion; it is not a sweep of whatever profit remains. And where the management company funds the clinical entity during ramp-up, it does so as a documented loan with a rate and a repayment schedule that is actually repaid.
Foundation
Entities formed and agreements executed. Medical director appointed. Clinical framework authored, panel definition locked, technology configured. Counsel review complete.
Prove the funnel
One site, minimal clinical team. Every conversion step measured. The discipline in this phase is to add data rather than add services.
Prove the economics
Full clinical team. Therapy layer live and dispensing through the pharmacy. Retention programme and executive tier introduced.
Prove it repeats
A second site or a partner pharmacy. Protocols, training, compliance templates and reporting centralised so each new site inherits them.
On future regulation. No healthcare business is immune to rule changes, and we do not claim to be. What we can do is avoid depending on any single exemption or product. The membership sells ongoing clinical oversight, therapies are interchangeable inside that, and we cap any one therapy category at roughly a quarter of gross margin. If a category is restricted, we lose a product line rather than the business. The assets that cannot be regulated away are the ones the pharmacy already owns: a local patient base that trusts it, and the clinical relationship built on top.
09. Next
Two conversations, depending on why you are here
If you own a pharmacy
We will model your site on your own numbers rather than ours. Bring three things:
- Your active patient count
- Square footage you could convert to one or two consult rooms
- Your current cash-pay revenue mix
If you are an investor
Diligence materials available on request:
- The full site-level financial model and its assumptions
- Entity structure, services agreement and counsel opinions
- Conversion and retention data from the pilot as it accrues
10. Disclosures
Where these numbers come from
- Sourced
- Independent pharmacy market size, gross profit and prescription volume figures are from the 2025 NCPA Digest, sponsored by Cardinal Health and released October 2025, describing calendar 2024 with store counts as of July 2025.
- Modelled
- All HARP pricing, conversion rates, unit economics, cost structure, break-even points and ramp timings are planning assumptions rather than operating results. They are internally consistent but untested. Actual results will differ, and may differ materially.
- Projections
- The three-year figures are a single-hub model built from the per-member assumptions on this page, not a forecast and not a result. They assume a pharmacy with roughly 4,500 active patients, membership at published prices, therapy uptake by about half of members, and satellite locations opening only after the hub reaches break-even. Patient-base size, penetration, therapy uptake and satellite performance are all sensitive inputs; a change in any one moves the outcome materially.
- Contested
- Independent pharmacy store counts are disputed. NCPA reports a modest decline; PCMA, using NCPDP data analysed by Quest Analytics, reports a small increase into 2026. The case set out here rests on gross profit compression, which is not in dispute.
- Time-sensitive
- Federal policy on compounded medications used in weight management is actively changing. HARP's metabolic programme is built on clinical management value rather than low-cost compounded supply, and is not designed to depend on any compounding exemption remaining available.
- Forward-looking
- Statements about future performance, expansion, break-even timing and market conditions are forward-looking and subject to risks and uncertainties outside our control, including regulatory change, reimbursement policy, clinician availability and patient demand.
- Not an offer
- This page is provided for information only. It is not an offer to sell or a solicitation of an offer to buy any security, and it is not investment, legal, tax or medical advice. Any offering would be made only through formal documentation to eligible investors.
- Not medical advice
- HARP describes a business model. Clinical decisions are made solely by licensed clinicians in the context of an individual patient relationship. Nothing here describes treatment appropriate for any particular person.