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Telehealth payment processing for GLP-1s, TRT, ED, and med spas –

We often get phone calls from practitioners who have the staff, the proper licensing, and a fully functional professional website that they have spent hours and thousands of dollars building.

Then they try to set up payment processing through the out-of-the-box payment processor that’s most common for their website builder, and they realize they can’t accept payments.

There is often a second surprise, too, because in telehealth a lot of payments happen through an invoice or a “click here to pay” link. When the practice tries to launch, it often finds out how hard it is to get set up to take payments that way.

Sound familiar? Since 2002, Tasker Payment Gateways LLC has helped high-risk businesses that the standard processors turned away, and we’re A+ rated and BBB accredited. If your practice can’t take payments, or can’t take them by invoice or pay link, we can probably help.

Contact us for free advice or a merchant account recommendation

Quick links to what's on this page: Show table of contents

Why is telehealth considered high-risk for payment processing?

Telehealth is considered high-risk because it sits in one of the most heavily regulated corners of the economy. Prescriptions, controlled substances, compounded medications, and state licensing rules all come into play, and the banks behind your payments have to be comfortable with every piece.

Prescriptions are the biggest factor, because once your practice takes payment online for medication, and not just for a visit, a lot more people want to see how that medication is prescribed and who fills it.

Recurring billing adds another layer. Many telehealth practices bill monthly for memberships or ongoing treatment, and underwriters want to know those charges are clear and accurate.

Chargebacks are occasionally a concern in the industry, too, but they are not usually the main reason a telehealth practice has trouble.

Payment gateway vs. merchant account for telehealth practices

This is important.

Authorize.Net and NMI are payment gateways. A payment gateway connects your software, like your website, intake platform, or billing system, to a merchant account.

The merchant account is the piece that underwrites your business and deposits the funds. In other words, the gateway moves the transaction, and the merchant account is what decides whether your practice is a fit and then pays you on the back end. You can learn more about how the two work together on our home page.

There are lots of different ways to connect payment processing to a telehealth practice. If you have any questions about your setup, reach out and ask, and we will be happy to help.

Appointment-only telehealth vs. practices that prescribe and ship

Not every telehealth practice works the same way, and the difference matters a lot to your payment setup.

Some online healthcare providers only have virtual appointments. Think of certain therapy appointments, counseling, or general medical appointments where any prescriptions are handled by the patient’s own pharmacy, so the practice is mostly charging for the visit itself.

Other providers are more vertically integrated. For example, a GLP-1 weight loss company or a testosterone replacement therapy (TRT) company may have consultants, providers, and doctors that refer business to an in-house or preferred pharmacy.

The difference in that scenario is that the checkout has to handle the prescription payments, not just the appointment.

When that is the case, storing cardholder data securely is essential, and setting up recurring billing that is accurate is essential, too.

So is an account updater service. If a patient is issued a new card, or the expiration date changes, account updater can update it automatically in the background. That helps the patient experience and cuts down on the practice’s workload for updating credit cards.

Why Stripe and Square often aren’t a fit for telehealth

The most common reason is simple: those processors have restricted-services policies that prohibit or limit these businesses.

As of November 2026, Stripe’s list of restricted businesses includes online pharmacies, card-not-present prescription products, and telemedicine and telehealth services. Square’s payment terms prohibit online, mail order, and phone order pharmacies and pharmacy referral services where medication is filled after an online or phone consultation with no physical visit.

Those types of processors generally don’t do full underwriting up front. They approve most things and then only look for problems after the fact, and because of that model, they’re more selective about which industries they handle, and they’re often hesitant to work with heavily regulated ones.

What about your own bank? Very often, the practice’s bank isn’t set up for this type of payment processing either. Banks do underwrite up front.

However, they often have much more limited allowed uses.

Their underwriting departments need enough business in each category to judge the risk. If they don’t have it, or if they’ve had a bad experience in the past, they’ll often decline a legitimate telehealth practice, even one that’s a current bank client.

Our solutions simply deposit funds into your practice’s existing checking account, regardless of your bank, as long as it’s a traditional US business checking account.

What to do if Stripe or Square puts your telehealth account on hold

Most of the time, a practice doesn’t get declined outright by Square or Stripe.

If you apply directly through your bank, you may go through a long underwriting process that ends in a decline.

With Square and Stripe, though, what usually happens is that you process for a short time, and then you get an email saying your account is being reviewed, or it’s on hold, or worse yet, it’s been shut down.

When that happens, reach out to us immediately and make a note in the contact form that it’s an ASAP request.

We’ll connect you with a dedicated independent agent who has deep experience in telehealth payment processing. We’ll prioritize getting you up and running as quickly as possible, so there’s very limited interruption to your practice.

If you bill on a recurring basis, our post on merchant accounts for free trial and recurring offers is worth a read, too.

How do DEA rules affect TRT and other controlled prescriptions?

They matter whenever your practice prescribes a controlled substance. The DEA lists testosterone and other anabolic steroids as Schedule III, so TRT practices fall into this group. GLP-1s like semaglutide and tirzepatide are not on the DEA’s schedules, but if you prescribe anything that is, expect your underwriter to ask how your prescribing model will hold up.

The Ryan Haight Act in plain English

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 says a controlled substance that’s a prescription drug can’t be dispensed over the internet without a valid prescription. In general, that means the prescriber has done at least one in-person medical evaluation of the patient, according to 21 U.S.C. 829(e).

There is an exception for the “practice of telemedicine” as federal law defines it, and that is where the DEA’s temporary rules come in.

The temporary telemedicine rules, through December 31, 2026

As of November 2026, the DEA and HHS have extended the COVID-era telemedicine flexibilities through December 31, 2026. Under the Fourth Temporary Extension, published December 31, 2025, DEA-registered practitioners can prescribe Schedule II through V medications by telemedicine without an in-person exam, as long as every condition in the rule is met.

A final rule on special registration for telemedicine has been under White House review at OIRA (the Office of Information and Regulatory Affairs) since August 25, 2026. As of November 2026, it has not been published, so no one outside the government knows exactly what it will say.

If your TRT practice depends on prescribing without an in-person visit, plan ahead for 2027. Please get qualified legal advice before you prescribe controlled substances online.

Can you accept credit cards for GLP-1s and compounded medications?

Yes, many GLP-1 practices can. However, compounded GLP-1s get more scrutiny than almost anything else in telehealth right now, so it helps to know where things stand.

As of November 2026, FDA considers the tirzepatide shortage resolved (December 19, 2024) and the semaglutide shortage resolved (February 21, 2025). The grace periods FDA gave compounders after those decisions ended in 2025, and on August 27, 2026, the U.S. Court of Appeals for the Fifth Circuit upheld FDA’s removal of both drugs from the shortage list.

FDA has also proposed keeping semaglutide, tirzepatide, and liraglutide off the 503B bulks list, which is the list of ingredients outsourcing facilities can use to compound. FDA announced the proposal on April 30, 2026, and it was published on May 1, 2026. We didn’t find a final decision as of November 2026.

As of October 2026, FDA’s drug shortage database still lists liraglutide injection as currently in shortage, and we’re simply noting that here, not saying what it means for compounding.

Marketing is a big focus, too.

On February 6, 2026, FDA said it intends to act against non-FDA-approved GLP-1 drugs and misleading claims. On March 3, 2026, it announced 30 warning letters to telehealth companies over false or misleading claims about compounded GLP-1s, including claims implying they’re the same as FDA-approved products.

So can your GLP-1 practice get approved? It depends on underwriting.

Your products, your pharmacy, and how you describe them on your website all play a part.

GLP-1s, TRT, ED, med spas, and mental health compared

Every practice is different, so treat this table as a general guide, not a promise of how any bank will view your business.

Practice type Usual model Main rules that apply What underwriting tends to look at Common ways patients pay
GLP-1 / weight loss Often prescribe and ship FDA compounding rules and state licensing How prescribing works, the pharmacy, and marketing claims Online checkout and recurring billing
TRT Often prescribe and ship DEA rules (Schedule III) and state licensing Prescriber details and the consult model Online checkout and recurring billing
ED Often prescribe and ship State licensing and prescribing standards The consult model and the website Online checkout and recurring billing
Med spas Often in person, sometimes with telehealth consults State licensing Which services are online and which are in person In person, plus “click here to pay” links or an online billing portal
Mental health Often appointment-only State licensing, plus DEA rules if controlled medications are prescribed Provider licenses and how appointments are billed Invoices, payment links, and recurring billing

Med spas often take payments more than one way. Many accept payments in person, and many also let people pay after the fact through a “click here to pay” link or an online billing portal. If you are also selling or prescribing online, that changes what your setup needs.

Not sure where your practice fits? Contact us anytime – we are always happy to help.

What telehealth underwriting usually asks for

Underwriting is just the bank’s review of your business before it approves a merchant account. For telehealth, it usually looks at your provider licenses and prescriber details, how prescribing works in your consult model, and a review of your website and checkout.

There is no reason to gather all of this before you contact us. Reaching out early in the process can make things easier.

LegitScript and other recognized certifications

Many processors look for third-party certification when you sell or prescribe medication online. LegitScript is the best known, but the National Association of Boards of Pharmacy (NABP) runs programs that card brands also recognize, as of November 2026. Your processor will confirm which it accepts.

How to keep your telehealth merchant account stable

Getting approved is half the job, and keeping your account stable mostly comes down to clear communication with your patients and your processor.

Use a billing descriptor your patients will recognize on their statements.

Be honest and specific about your recurring billing terms, so patients know exactly what they’ll be charged and when. Send renewal reminders if you can, and use account updater, since fewer cards fail when they’re replaced or expire.

Keep your website and pricing matched to what was approved. If you add products, change prices, or start prescribing something new, tell your processor first.

Changes your underwriter didn’t approve are a common reason accounts get frozen.

Chargebacks are occasionally a concern, and clear billing does a lot to keep them down. For more ideas, see our high-risk payments resource guide, our take on the best high-risk payment gateways, and our ThriveCart page if you sell through a checkout tool. If you’re curious which online pharmacy and telehealth businesses Authorize.Net restricts, the online pharmacy and telehealth section of Authorize.Net’s list of prohibited categories covers it.

Need a telehealth payment gateway recommendation?

If you run a telehealth practice, med spa, or wellness clinic, reach out early. If you’re on hold or shut down, just write “ASAP” in the contact form below.

You can also call or text us at 207-772-8737.

Matthew Tasker, founder of Tasker Payment Gateways. I’ve been an industry expert and consultant since 2002. Over the decades, I’ve helped thousands of business owners set up reliable, easily integrated credit card processing that works for their business.

Note: We are not attorneys. You must sit with a qualified attorney and ensure compliance with all local, state or provincial, and federal laws, along with any card association rules.

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