When tiered SaaS breaks margin math — replace it with pass-through

A tiered SaaS model bundles platform access with fulfillment infrastructure. RxFul publishes Rx-GLP at $0/mo for GLP-only access, Bronze at $997/mo for the full SKU catalog, Silver at $1,497/mo for full white-label customization, and Gold at $1,997/mo with API and analytics — all plans include pharmacy integration and 3PL fulfillment per rxful.com. That structure can be the right fit when you are building a patient-facing brand and want predictable monthly platform cost. The trade-off on the prescriber side is visibility: drug landed cost and platform cost are not separated as pass-through per-vial lines you can quote during the consult, and full formulary access sits behind a monthly tier.

A pass-through model inverts that on the prescriber workflow. With Fizy Health, resolved 503A landed cost appears on each catalog and cart line before you check out, and the platform's margin is a disclosed facilitation fee at payment rather than a monthly catalog gate. The drug cost is what the pharmacy charges; the platform fee is stated separately. For a clinic whose clinicians place orders and quote cash-pay semaglutide or tirzepatide daily, that means margin math happens on visible per-vial numbers without paying $997/mo to unlock the formulary your team already prescribes.

Replace a tiered model when platform economics actively slow prescriber ops or margin clarity. Common signals: you delay quoting because you cannot separate drug cost from the monthly tier in your head; you pay Bronze or higher mainly to access SKUs while prescribers still batch orders outside the patient portal; you cannot confidently set cash-pay prices because per-vial landed cost is not visible at the point of sale on the prescriber side; or your team needs refill-day batch checkout but RxFul's workflow centers patient-facing checkout.

Another signal is operational: if paid orders get rejected after payment for SIG or licensure issues on the prescriber path, the pricing question compounds with a validation gap. Fizy Health pairs visible per-vial cost with pre-submit cart validation on the clinic dashboard. If none of these signals apply — your patient portal motion is the core product and tiered SaaS fits your P&L — RxFul may still be the right layer. Replace it when prescriber margin visibility and batch workflow, not patient storefront branding, are the constraint.