How we think about pricing.

A family should understand how we think about pricing before they understand any specific number. Specialty pharmacy is a field in which the headline cost of a therapy is often less meaningful than the structure of the transaction behind it. We have seen families pay three times more than they should have because the structure was opaque, and we have seen coordinators collect a good margin on the drug while hiding the fact behind a single bundled figure. Our approach is intentionally different, and this page explains why.

Cash-pay only

Reserve Meds is cash-pay. We do not bill US insurance, we do not process Medicare or Medicaid claims, and we do not accept payment from a payer network on the patient's behalf. That is not a workaround; it is a deliberate scope decision. The patients we serve are paying privately, typically because their local insurance does not cover the therapy, because the therapy is not yet available in their country of residence, or because they want to work outside the timelines their insurer would impose. Cash-pay lets us quote honestly and deliver quickly, and it keeps our incentives aligned with the patient rather than with a payer's reimbursement grid.

No rebate kickbacks

We do not accept volume rebates, referral fees, or undisclosed payments from manufacturers, wholesalers, destination-country distributors, or prescriber networks. That is a structural commitment, documented in our vendor agreements, and it is one we are prepared to evidence on request for institutional partners that perform a compliance diligence on us. The reason matters: a rebate-driven coordinator has a financial interest in which therapy gets prescribed, and that interest sits in conflict with the prescriber's independent judgment. We refuse that conflict on principle and on compliance grounds.

The coordination fee is disclosed up front

Every quote we issue contains a line item for our coordination fee, shown as a stated US-dollar figure, not as a percentage of drug cost. Families see that figure before they commit anything. The fee reflects the work of the specific case: the clinical and regulatory review, the pharmacist review, the documentation preparation, the wholesaler and pharmacy coordination, the cold-chain logistics management, and the case coordination through delivery and the first follow-up cycle. Where a case is simpler than average, the fee is lower. Where the case requires exceptional handling, we say so and explain why. What we do not do is bury the fee inside a marked-up drug price or obscure it as a handling charge.

Costs flow through, not around

The drug itself, the import duty, the freight, and the cold-chain packaging each pass through our invoice as documented line items. For the drug, we show the manufacturer cost basis we obtained through our specialty wholesaler; for duty and freight, we show the destination-country figures as documented by the customs broker we are using on the case; for cold-chain, we show the validated-shipper and monitoring-device cost. That is the transparent flow-through model, and it is the only one we operate. We do not mark up the drug beyond our stated coordination fee, and we do not inflate logistics lines to hide margin.

No referral-volume discounts

A prescriber, clinic, or hospital that refers ten cases to us does not receive a better quote than one that refers a single case. The patient is the customer, not the referrer, and every case is priced on its own facts. This is not only ethically cleaner; it also keeps our compliance posture simple under the US federal Anti-Kickback Statute and analogous rules in destination jurisdictions. Enterprise arrangements, where a hospital system or specialty clinic commits to a master services agreement with us, operate on a different basis entirely and are structured to stay inside the relevant safe harbors; see enterprise and institutional partnerships for that context.

Where our margin comes from

We are a business, not a charity, and we are explicit about that. Our margin comes from the coordination fee, period. It does not come from a spread on the drug, it does not come from rebates, and it does not come from payment terms that trap float. That structure produces a service that is fully disclosable, fully auditable, and fully comparable against any other coordinator a family might also speak to. We think the families we serve should be making that comparison, and we believe we will usually win it. For indicative cost bands by therapy modality, see what to expect on cost.

Refunds and changes

Prepaid cases sometimes change. A prescriber revises the regimen; a destination authority moves a timeline; a patient's clinical picture shifts. Our refund posture tracks the honest cost of the work completed to date: anything we have not yet committed as a prepayment to a wholesaler, a broker, or a freight provider is refundable; anything we have already committed is refundable only to the extent we can recover it downstream. We write that into the engagement letter rather than rely on a posted policy, because the honest number depends on the stage of the case. What we commit to is that a change in plan never results in us earning more than the coordination fee on the original case.

Reviewed 2026-04-22 by Reserve Meds’s AI clinical and regulatory review agents. Human pharmacist-in-charge: Altima Care. Next scheduled review: 2026-10-22.