When aggregate pricing stops fitting — replace it with pass-through

Refill's public materials describe two medication-cost layers: pre-negotiated aggregate 503A pricing across its pharmacy network, and tiered software fees on transactions published at roughly 1.5–5% depending on platform plan, plus monthly platform tiers from free to about $299 and Refill Connect from about $399 per month when you add white-label patient tools. That bundle can produce competitive rates at volume — Refill advertises a meet-or-beat guarantee — but per-vial landed cost is usually confirmed through demo and onboarding, not on a fully public price list you can browse before signup.

Pass-through pricing inverts the visibility problem. On Fizy Health, resolved 503A landed cost appears on each catalog and cart line before checkout, and the platform's margin is a disclosed facilitation fee at payment rather than a percentage software fee folded into how you experience medication cost. Drug cost is what the pharmacy charges; the platform fee is named separately. For a clinic quoting cash-pay semaglutide or tirzepatide daily, the price you quote and the price you pay trace to the same visible number.

Replace aggregate-plus-software-fee pricing when lack of upfront visibility actively slows margin decisions. Common signals: you delay quoting a new patient because you are waiting on confirmed per-SKU rates from onboarding; you cannot separate drug cost from software fees when modeling cash-pay prices; your volume shifted and you are unsure aggregate leverage still wins without reopening a sales conversation; or you pay for Refill Connect or provider-network features you do not use while software fees still hit every transaction.

Operational signals compound the financial ones. If paid orders get rejected after payment for SIG or licensure issues, pricing opacity plus a validation gap costs you refund cycles and patient status calls. Fizy Health pairs visible per-vial cost with pre-submit cart validation. If none of these apply — aggregate rates plus fees still win on your top SKUs after an honest spreadsheet — Refill may remain the better fit. Replace the model when visibility and batch checkout matter more than bundled infrastructure you already pay for but do not use.

Do not switch on positioning alone. Export landed cost on your top five SKUs from Refill — medication rate, software fee impact, shipping — then open the Fizy Health catalog for the same strengths and supply durations. Compare per-vial pass-through cost including disclosed facilitation at checkout. Run one validated batch cart on a single refill day so coordinators experience validation and per-line tracking, not just catalog math.

If pass-through wins on the lines you order most, migrate volume per the switching guide. If Refill's aggregate pricing plus software fees still wins, keep Refill for those lines. Pass-through replacement is about daily margin clarity for in-house prescribers — not declaring Refill wrong for every clinic.