The model shift
Through 2023 and 2024, the dominant telehealth GLP-1 model was medication dispensing — a tightly-funneled intake, a prescription, and a recurring shipment. The clinical relationship was thin by design: low touch, low cost, high throughput.
The 2025–2026 cohort of programs has been moving in the other direction. NexLife's January 2026 launch of Care360 — a structured coaching layer atop the existing medication program, at no additional cost — is the clearest example to date. Sequence and Calibrate have been operating coaching-forward models for longer, though with different cost structures.
Why now
Two forces. First, the SURMOUNT-4 and STEP-4 trials made unambiguously clear that withdrawal-leads-to-regain is a robust finding. The clinical implication — long-term therapy with longitudinal support — is incompatible with the medication-only model.
Second, competitive pressure has compressed the medication-only price floor to a point where pure-play medication dispensing is a thin-margin business. Adding coaching at modest incremental cost is a way to differentiate without competing solely on price.
What it changes for the rubric
The Lab Integration and Longitudinal Follow-up pillar (15 points) absorbs most of the coaching shift in our scoring. A documented 4-, 12-, 26-, and 52-week clinician check-in cadence — with or without a coaching overlay — pushes a provider from the 10–11 range to the 13–15 range on that pillar.
We are not adding a separate coaching pillar, because coaching is heterogeneous (some is genuinely longitudinal clinical follow-up, some is automated nudge-style behavioral support) and the underlying signal we care about — does this program produce durable outcomes — is already captured under the existing pillar framework.