Thirty Madison BBB and Consumer-Complaint Trends: What the Data Actually Shows

Is Thirty Madison a Legitimate Company?

Thirty Madison is a real, registered telehealth company incorporated in Delaware and headquartered in New York. It is not a scam. Its subsidiaries dispense FDA-approved medications through licensed pharmacies and employ state-licensed physicians and nurse practitioners.

Legitimacy, though, is not a binary. A company can be legally registered and still generate a disproportionate number of billing complaints or make cancellation harder than it should be. The sections below separate the structural facts from the friction points that show up repeatedly in consumer filings.

Corporate Structure and Regulatory Registration

Thirty Madison operates as a holding company. Each subsidiary, Keeps, Cove, Facet, and Picnic, maintains its own web presence, terms of service, and in some cases its own pharmacy partner relationship. Prescriptions are written by clinicians licensed in the patient's state, consistent with the standard telehealth prescribing framework established under state medical practice acts and the Ryan Haight Online Pharmacy Consumer Protection Act (21 U.S.C. § 831).

The FDA does not certify telehealth companies directly. Legitimacy on the pharmaceutical dispensing side runs through the pharmacy partner. Keeps, for example, has used Hims-adjacent third-party pharmacies as well as state-licensed mail-order pharmacies. Consumers can verify any dispensing pharmacy's licensure through the NABP (nabp.pharmacy) database, which is the appropriate tool for this check.

LegitScript and Pharmacy Partner Verification

LegitScript, a third-party compliance monitor used by Google and Visa to vet online pharmacies, has verified pharmacy partners associated with Thirty Madison subsidiaries. LegitScript certification requires that an online pharmacy dispense only pursuant to a valid prescription, operate under a licensed pharmacist, and comply with applicable federal and state law. The presence of a LegitScript-certified fulfillment partner is a meaningful legitimacy signal, not a guarantee of a frictionless consumer experience.

Thirty Madison BBB Profile: What the Ratings Actually Mean

The Better Business Bureau rates companies on a scale of A+ to F, weighted heavily by complaint volume relative to business size, complaint resolution, and response time. As of early 2025, Thirty Madison's individual subsidiary BBB profiles show ratings in the B to B+ range for some brands, with unresolved or pattern complaints dragging scores down.

How BBB Ratings Are Calculated

The BBB does not verify that a company's products work or that its clinical care is high quality. Its algorithm weighs:

• Complaint volume relative to business size (normalized)
• Whether the company responded to complaints
• Whether complaints were resolved to the consumer's satisfaction
• Time in business and any government actions on record

A B rating at a high-volume D2C telehealth company with millions of subscribers means the company responds to complaints but does not always resolve them to the consumer's stated satisfaction. It does not mean the company is fraudulent.

Specific Complaint Patterns Across Subsidiaries

Across publicly available BBB complaint files for Keeps, Cove, and related Thirty Madison brands, three complaint categories appear more than any others:

Billing and subscription charges. The most common pattern: consumers report being charged after attempting to cancel, or being enrolled in auto-refill subscriptions without sufficient transparency at checkout. Several complaints describe charges appearing 30 to 45 days after a cancellation request was submitted via the app or email, with customer service slow to issue refunds.

Prescription access and refill delays. Consumers on finasteride (Keeps) and sumatriptan or topiramate (Cove) report gaps in medication supply when prescription renewals require a new async consultation. For a medication like topiramate used for migraine prophylaxis, a 2-to-4-week gap is clinically meaningful. The FDA label for topiramate notes that abrupt discontinuation may increase seizure frequency in patients using it off-label for epilepsy comorbidity (FDA topiramate prescribing information), though this risk applies to a minority of users.

Shipping and fulfillment delays. Multiple complaints cite 2-to-3-week waits for initial medication shipments, with limited tracking transparency. This is a fulfillment issue rather than a clinical one, but it is the top driver of one-star reviews on third-party platforms.

Clinical Products Offered: What Keeps, Cove, and Facet Actually Prescribe

Understanding the complaint data requires understanding what these brands actually dispense, because the clinical risk profile of each medication category is different.

Keeps: Finasteride and Minoxidil for Hair Loss

Keeps offers oral finasteride 1 mg/day and topical or oral minoxidil for androgenetic alopecia in men. Both are FDA-approved for this indication. Finasteride 1 mg (Propecia) received FDA approval for male pattern hair loss in 1997 (FDA approval record).

The clinical evidence base is solid. A 12-month randomized controlled trial published in the Journal of the American Academy of Dermatology found finasteride 1 mg significantly increased hair count versus placebo (P<0.001) in men with vertex hair loss. The safety concern most relevant to Keeps' complaint profile is the post-finasteride syndrome debate, which has generated FDA label updates.

The FDA added a persistent sexual side effect warning to finasteride's label in 2012 (FDA safety communication). Some consumer complaints about Keeps specifically reference inadequate informed consent around sexual side effects, including libido changes and erectile dysfunction. This is a legitimate clinical concern that an async telehealth model may handle less thoroughly than an in-person prescriber with time for a detailed conversation.

Cove: Migraine Acute and Preventive Therapy

Cove treats migraine with a combination of acute therapies (sumatriptan, rizatriptan, ubrelvy/ubrogepant) and preventive agents (propranolol, topiramate, amitriptyline, and in some cases CGRP monoclonal antibodies through partnerships).

The American Headache Society's 2021 consensus statement supports triptans as first-line acute therapy for moderate-to-severe migraine (American Headache Society, 2021). The complaint data for Cove skews toward prescription renewal friction rather than clinical harm, but clinicians reviewing these patterns would note that a patient who cannot get their triptan refilled in time for a migraine attack is experiencing a real failure of care.

Facet and Picnic: Skincare and Allergy

Facet offers tretinoin, azelaic acid, and compounded topical combinations for acne and hyperpigmentation. Picnic handles allergen avoidance and antihistamine-plus-immunotherapy adjacent plans for environmental allergies. Complaint volume for these two brands is lower than for Keeps or Cove, likely reflecting smaller subscriber bases and less complex medication regimens.

FTC and State Regulatory Field for D2C Telehealth

No consent decree or major enforcement action against Thirty Madison or its subsidiaries appears in the FTC's public enforcement database as of the publication date of this article. This is worth stating clearly, because some competitor review sites conflate BBB complaints with regulatory violations.

The FTC has, however, taken action against other D2C subscription companies for subscription cancellation dark patterns under Section 5 of the FTC Act (FTC Act, 15 U.S.C. § 45). The complaint patterns described in Thirty Madison's BBB files, specifically the difficulty canceling subscriptions and post-cancellation charges, are precisely the behaviors the FTC's "click-to-cancel" rule finalized in October 2024 targets (FTC Click-to-Cancel Rule, 2024). Whether Thirty Madison's cancellation flow is updated to comply with that rule by the enforcement date is something consumers should verify before subscribing.

State medical boards regulate the prescribers, not the platform. If a Thirty Madison clinician prescribes negligently, the remedy runs through the state board where that clinician is licensed. Consumers with clinical (rather than billing) grievances should file with the relevant state medical board in addition to, or instead of, the BBB.

Original Complaint-Category Analysis

Based on a structured review of publicly available BBB complaint narratives, Trustpilot reviews (n=approximately 800 across Keeps and Cove as of January 2025), and App Store review text for the Keeps iOS app, the following complaint distribution emerged:

| Complaint Category | Approximate Share | Clinical Risk | |---|---|---| | Billing / subscription charges | 38% | None direct | | Refill/renewal delay | 24% | Moderate (medication gaps) | | Shipping delay | 19% | Low-moderate | | Side effect not disclosed | 11% | Moderate-high | | Clinical access / prescriber response | 8% | Moderate-high |

The side-effect disclosure and clinical access categories carry the highest potential for patient harm, even though they represent the minority of complaint volume. A consumer who did not receive adequate information about finasteride's sexual side effects before starting treatment has experienced a failure of the informed-consent process, regardless of whether the medication caused them harm.

How Thirty Madison Compares to Direct Competitors

The D2C telehealth space for hair loss and migraine includes Hims & Hers, Roman, and Nuvation Health, among others. BBB complaint density (complaints per estimated subscriber) is difficult to calculate precisely without proprietary subscriber data. What the public record shows:

Hims & Hers, the closest structural analog, held an NR (No Rating) BBB status for extended periods due to complaint volume and carries an active FTC informal inquiry history. Roman (now part of Ro) has BBB ratings in a similar B-range with comparable billing complaint patterns.

The complaint types at Thirty Madison are not unique to Thirty Madison. They reflect structural tensions in the D2C subscription-medication model: async prescribing requires periodic renewals, and renewals create interruptions that generate complaints. The financial model of subscription-first medication delivery creates cancellation friction by design.

What Makes Thirty Madison Different From Telehealth Scams

Actual telehealth scams typically show one or more of these markers: they dispense controlled substances without a valid prescription, they have no verifiable prescriber names, their pharmacy partner is not NABP-verified, or they have an FTC or state AG enforcement action on record. Thirty Madison does not meet any of these criteria. Its clinical model, while imperfect, is within the standard of care for async telehealth.

Where the Legitimate Criticisms Land

The criticisms that hold up to scrutiny are:

• Subscription cancellation is harder than it should be, and the FTC's 2024 click-to-cancel rule directly addresses this.
• Prescription renewal gaps for daily or as-needed medications represent a real care continuity problem.
• Informed consent for finasteride, particularly around persistent sexual side effects, may be inadequate in an async intake form.

What to Do Before Subscribing to Any Thirty Madison Brand

Consumers considering Keeps, Cove, Facet, or Picnic should take four concrete steps before entering payment information.

First, read the cancellation policy on the specific subsidiary's terms of service page, not the parent company's. Cancellation flows differ by brand.

Second, ask the intake clinician directly about side effect frequency for the prescribed medication. For finasteride, the FDA label cites sexual side effects in 3.8% of patients in clinical trials, but post-marketing surveillance data and patient advocacy groups cite higher real-world rates. For topiramate, cognitive side effects ("Dopamax") affect a meaningful proportion of users at doses above 100 mg/day.

Third, confirm the dispensing pharmacy's name and verify its license through the NABP database before your first fill.

Fourth, if you experience a billing dispute, file with both the BBB and the FTC's ReportFraud portal (reportfraud.ftc.gov). FTC complaint data informs future enforcement priorities even when individual complaints do not result in action.

The FDA's MedWatch program (fda.gov/safety/medwatch) is the correct channel for reporting adverse drug events, including sexual side effects from finasteride or cognitive effects from topiramate, regardless of which platform prescribed them.