# What Drives the Cost of a Telehealth Ad Agency, and What Is Billed Separately?

Reviewed October 12, 2026 · By Michael Borgia, MedScale Health

## Short answer

As of October 2026, the work drives it: how many ad platforms run, how many states and locations are targeted, how much new creative each month needs, how many landing pages there are, and how much certification and policy work the treatments require. Ad spend, LegitScript's own fees, paid creators and shoots, and your own software are separate costs. MedScale Health, a paid acquisition agency for telehealth brands and clinics, puts its scope in writing after a free audit.

## What this means for you

- As of October 2026, the cost of running telehealth ads follows the amount of work in the account, and that work grows with platforms, states, locations, creative volume, landing pages and certification.
- Ad spend is paid to Meta, Google, Microsoft or TikTok, from ad accounts the brand should own.
- LegitScript publishes its own fees: a $975 application fee and a $2,150 annual certification fee per website.
- Creators, shoots and product samples are paid per campaign, and the FTC's Endorsement Guides treat payment and free product as connections that must be disclosed.
- Intake, EMR, pharmacy, scheduling and payment software stays on the brand's own contracts.

MedScale Health, a paid acquisition agency for telehealth brands and clinics, shows no prices on its site, and buyers still ask the fair question behind any quote: "Where do you start and stop?" This page sets out the work that drives the cost of running telehealth ads and the costs that sit outside it, so you can read any scope line by line. For how MedScale scopes its own work, see the pricing page. This page is marketing guidance, not medical, legal or financial advice. Platform policies change, so check the sources listed at the end before acting on a specific rule.

## Platforms

Each ad platform is its own build: campaigns, audiences, ad formats, policy rules and reporting. Health rules differ by platform, so an ad that passes on one can be rejected on another. Meta says it may consider an advertiser's historical compliance when deciding whether an ad warrants further review, which is why every new ad in a health account should be checked against the rules before it is submitted. A second platform adds its own build, review and reporting, whatever the spend.

## States and locations

For telehealth, licensing sets the map. The Federation of State Medical Boards' telemedicine policy says a physician must be licensed, or appropriately authorized, by the medical board of the state where the patient is located, and LegitScript requires certified websites to clearly disclose every state where services are available. Each state in the plan has to match across the targeting on every platform, the website and the intake. For clinics, each location adds its own targeting radius, landing page details and reporting line.

## Creative volume

Ads wear out. Meta flags creative fatigue when an audience has seen the same creative too many times, which can raise cost per result, and recommends a new ad that is materially different from the original. The more a brand spends, the sooner the same people see the same ads, so creative needs grow with budget. Statics, motion and creator video take different amounts of work, and each new ad in a regulated category goes through platform review.

## Landing pages

Google defines ad quality to include the experience people have once they reach your landing page, and says higher quality ads typically cost less per click. Each offer, state set or audience that needs its own message needs its own page, and every page in a telehealth funnel carries claims and disclosures that have to hold up to platform review. More offers mean more pages to build, test and keep compliant.

## Certification and policy work

Meta limits prescription drug ads to authorized online pharmacies, telehealth providers and pharmaceutical manufacturers, and requires telehealth providers to be actively certified with LegitScript before they apply. Google requires certification for prescription drug services, applied for in each Google Ads account at the child account level, with that account's customer ID and the certified domain. LegitScript assesses its fees per root domain, so a second brand domain is a second set of fees. A brand that needs certification before launch, or an account that is restricted, adds work that a certified account in good standing does not.

## What is billed separately

- Ad spend. Paid to the platforms from ad accounts the brand owns, so the brand sees every charge and keeps the accounts and their history.
- LegitScript. LegitScript's published fees are a nonrefundable $975 application fee per website and a $2,150 annual certification fee per website, due once approved. Expedited processing is an extra $2,500 per application, and probationary certification carries a $3,995 annual fee per website.
- Creators, shoots and samples. Paid per campaign when a campaign uses them. Under the FTC's Endorsement Guides, payment and free or discounted products are material connections, which must be disclosed clearly and conspicuously when the audience would not expect them.
- Your own software. Intake, EMR, pharmacy, scheduling and payment platforms stay on your contracts with those vendors.

## Questions to settle before you sign

- Which platforms, states and locations are in scope, and what would change the scope?
- How many new ads a month, in which formats, and who writes and checks them?
- How many landing pages, and who owns them and the ad accounts?
- Which certification filings are included, and which fees go straight to LegitScript or the platforms?

If a proposal leaves any of these blank, ask before you sign. The healthcare agency red flags answer covers what else to check.

## What MedScale does

MedScale Health scopes each engagement after the free growth audit, from the platforms, states, locations, creative volume, landing pages and certification work the plan needs, and puts the scope in writing. Ad spend stays in the brand's own accounts, LegitScript's fees are paid to LegitScript, and creators are agreed per campaign. Check LegitScript's fees for your domains in the LegitScript cost calculator.

## Next step

**Planning a launch?** The budget calculator turns your price and target cost per patient into a starting budget for the first 90 days.

- [Open the ad budget calculator](https://medscale.health/tools/telehealth-ad-budget-calculator)
- [Plan a launch with us](https://medscale.health/build)
- [Telehealth marketing agency](https://medscale.health/telehealth)
- [Get a free Growth Audit](https://medscale.health/audit): a written read of your ads, pages and eligibility, with a plan

## FAQ

**Is ad spend included in a telehealth agency's fee?**

Ad spend is a separate cost paid to Meta, Google, Microsoft or TikTok. At MedScale it is paid from ad accounts the brand owns, so the brand sees every charge and keeps the accounts and their history if the relationship ends.

**What does LegitScript certification cost on top of agency work?**

As of October 2026, LegitScript publishes a $975 nonrefundable application fee and a $2,150 annual certification fee per website, with optional expedited processing at $2,500 per application. These fees are paid to LegitScript directly.

**Why does the number of states change the scope?**

Every state has to match across clinician licensing, the website's list of states, the targeting on each platform and the intake. More states means more of that to keep in step, and more pages and reporting where offers or state rules differ.

**Are creator videos part of the agency's scope?**

At MedScale, creator fees, shoots and product samples are agreed per campaign when a campaign uses them. Paid creators must disclose the connection under the FTC's Endorsement Guides, and the ads still go through each platform's health rules.

## Sources

- [LegitScript: Healthcare Certification (standards and fees)](https://www.legitscript.com/certification/healthcare-certification/) (checked October 12, 2026)
- [LegitScript: Healthcare Certification FAQs](https://www.legitscript.com/certification/healthcare-certification/faq/) (checked October 12, 2026)
- [Meta Business Help Center: About Meta's Prescription Drugs advertising policy](https://www.facebook.com/business/help/263390265553560) (checked October 12, 2026)
- [Google Ads policy: Prescription drug services (how to apply)](https://support.google.com/adspolicy/answer/15598647?hl=en) (checked October 12, 2026)
- [Meta Business Help Center: About ads in review](https://www.facebook.com/business/help/204798856225114) (checked October 12, 2026)
- [Meta Business Help Center: About creative fatigue recommendations in Meta Ads Manager](https://www.facebook.com/business/help/1346816142327858) (checked October 12, 2026)
- [Google Ads Help: About ad quality](https://support.google.com/google-ads/answer/156066?hl=en) (checked October 12, 2026)
- [FSMB: The Appropriate Use of Telemedicine Technologies in the Practice of Medicine (adopted April 2022)](https://www.fsmb.org/siteassets/advocacy/policies/fsmb-workgroup-on-telemedicineapril-2022-final.pdf) (checked October 12, 2026)
- [16 CFR 255.5: FTC Endorsement Guides, disclosure of material connections](https://www.ecfr.gov/current/title-16/chapter-I/subchapter-B/part-255/section-255.5) (checked October 12, 2026)

## Related

- [How Much Does LegitScript Certification Cost in 2026?](https://medscale.health/answers/legitscript-certification-cost)
- [What Are the Red Flags When Hiring a Healthcare Ad Agency?](https://medscale.health/answers/healthcare-ad-agency-red-flags)
- [What Does a Telehealth Paid Ads Agency Actually Do?](https://medscale.health/answers/what-a-telehealth-paid-ads-agency-does)
- [What Does a New Telehealth Patient Cost on Paid Ads, and How Do You Bring It Down?](https://medscale.health/answers/telehealth-cost-per-patient-and-launch-budget)

Canonical page: https://medscale.health/answers/what-drives-telehealth-ad-agency-cost