Payment Processing and Compliance in Telehealth: What 2026 Will Demand

Telehealth and digitally enabled pharmacy models have moved decisively from the margins of health care delivery into the mainstream. What began as a pandemic-era necessity has evolved into a durable, nationwide care channel supported by licensed clinicians, fulfillment pharmacies, and increasingly sophisticated technology platforms. Industry analysts estimate that telehealth now represents a quarter-trillion-dollar segment of the US health care economy, with sustained growth projected through the remainder of the decade.¹^,²

Yet as telehealth and medication-based virtual care scale, many operators are discovering that payment processing infrastructure has become one of the most consequential—and least understood—risk variables in their businesses. From pharmacy owners navigating health savings account (HSA) and flexible spending account (FSA) acceptance, to telemedicine platforms managing subscriptions, refills, and higher-ticket treatment plans, payment decisions now directly affect compliance posture, cash flow, and long-term enterprise stability.

The Hidden Risk of Aggregated Payment Models

Many telehealth companies and pharmacy-adjacent businesses initially rely on payment facilitators (PayFacs) or “aggregator” platforms—often embedded within e-commerce, electronic health records (EHRs), or pharmacy management software. While these solutions offer rapid onboarding, they also place merchants under a master merchant account controlled by the platform rather than the business itself.

In regulated health care sectors, this structure introduces material risk. Aggregators pool thousands of merchants under a single underwriting framework, meaning policy changes, sector-level scrutiny, or transaction pattern shifts can result in sudden funding holds, reserves, or account termination.³

For pharmacies and telehealth operators processing prescription medications, subscription care, or lifestyle treatments, these disruptions can have immediate downstream consequences: delayed payroll, interrupted medication fulfillment, and patient dissatisfaction. By contrast, direct merchant account structures in which the acquiring bank underwrites the health care business to its specific model tend to provide greater predictability, transparency, and long-term stability when aligned correctly with card-network and banking requirements.

Payment Processing as a Compliance Function

As regulatory oversight tightens, payment processing increasingly functions as an extension of health care compliance rather than a purely financial utility.

Card networks and acquiring banks now scrutinize factors such as^4,5:

• Prescription drug advertising and promotion practices
• Subscription billing transparency and refund policies
• Marketing claims subject to Federal Trade Commission enforcement
• Cross-state telemedicine operations and physician licensure alignment

Payment processors that lack health care specialization may flag these businesses retroactively, triggering account reviews or restrictions that operators are unprepared to navigate.

Organizations such as BLVD Merchant Group, which focus specifically on health care, pharmacy-adjacent, and telemedicine payment models, emphasize proactive underwriting, aligned transaction descriptors, and billing logic that mirrors clinical workflows—reducing friction between financial systems and regulatory expectations.

Health Savings Account/Flexible Spending Account Acceptance and Merchant Category Code Classification

One increasingly common challenge for pharmacies and telehealth providers is health savings account (HSA)/flexible spending account (FSA) payment acceptance. Eligibility depends in part on correct merchant category code (MCC) classification and transaction structuring. For example, businesses classified under merchant category code (MCC) 8099 (Medical Services) are often better positioned for HSA/FSA acceptance than those categorized under MCC 5912 (Drug Stores and Pharmacies), depending on how services and products are bundled.⁶

In practice, some operators benefit from maintaining multiple merchant accounts, separating professional medical services from product fulfillment to align with tax-advantaged payment rules. These decisions require coordination between legal counsel, payment processors, and acquiring banks—underscoring why payments strategy can no longer be treated as an afterthought.

Cash Flow, Settlement Timing, and Business Viability

Beyond compliance, payment processing directly affects operational liquidity. Standard settlement timelines vary widely, and newer or higher-risk health care accounts may experience extended delays following reviews or volume increases.

According to the Federal Reserve Bank of Atlanta, settlement timing and funding predictability are key determinants of small and mid-sized health care business resilience.⁷ For pharmacies managing inventory costs and telehealth platforms funding provider networks, daily or next-day settlement models can materially impact growth capacity.

Transparent reporting also plays a critical role. Blended or flat-rate pricing models often obscure interchange costs and network fees, making it difficult for operators to understand their true cost of acceptance or evaluate processor performance over time.

The Platform Lock-In Problem

An emerging concern among pharmacy owners is payment processor lock-in imposed by certain EHR, electronic medical record, and pharmacy management platforms. While integrated payments may appear convenient, they can restrict a business’s ability to negotiate rates, change providers, or adapt billing structures as the business evolves.

Before committing to a software platform, operators should ask:

1. Are payment processing rates fixed or negotiable?
2. Can the business choose its own merchant account provider?
3. What are the termination or migration restrictions?

Industry experts increasingly recommend separating clinical technology decisions from financial infrastructure decisions to preserve flexibility and long-term leverage.

Looking Ahead to 2026

As telehealth, digital pharmacy, and medication-based care continue to expand, payment processing will remain a critical—but often underestimated—determinant of success.

Health care businesses that treat payments as a strategic, compliance-aligned function, supported by specialized partners with deep industry experience, will be better positioned to navigate regulatory scrutiny, optimize cash flow, and scale sustainably.

For pharmacy owners and telehealth operators alike, the question heading into 2026 is no longer whether payments matter, but whether their current infrastructure is built for the realities ahead.

References

1. Bestsennyy O, Gilbert G, Harris A, Rost J. Telehealth: a quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. July 9, 2021. Accessed January 30, 2026. https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality

2. Telehealth market (2025-2030). Grand View Research. Accessed January 30, 2026. https://www.grandviewresearch.com/industry-analysis/telehealth-market-report

3. Visa ecosystem risk programs guide. Visa. October 2024. Accessed January 30, 2026. https://usa.visa.com/dam/VCOM/download/merchants/visa-acceptance-risk-standards.pdf?utm_source=chatgpt.com

4. Health claims. Federal Trade Commission. Accessed January 30, 2026. https://www.ftc.gov/business-guidance/advertising-marketing/health-claims

5. Advertising and promotion. FDA. Updated November 29, 2025. Accessed January 30, 2026. https://www.fda.gov/animal-veterinary/guidance-industry/advertising-and-promotion-guidances

6. How merchant settlements and installments are processed. Updated January 16, 2026. Accessed January 30, 2026. https://developers.pismo.io/pismo-docs/docs/how-merchant-settlements-are-processed

7. Publication 969 (2024), health savings accounts and other tax-favored health plans. Internal Revenue Service. Updated January 23, 2025. Accessed January 30, 2026. https://www.irs.gov/publications/p969