Thirty Madison Pricing History and Trajectory: An Independent Review

What Is Thirty Madison and How Did It Start?

Thirty Madison launched in 2018 as a holding company built around a single insight: patients with chronic, manageable conditions were underserved by traditional primary care. The company's co-founders, Folio Ezekoye and Steven Gutentag, structured the business as a portfolio of verticals rather than a single brand, each targeting a distinct condition category.

The Original Vertical: Keeps

Keeps launched in 2018 targeting male androgenetic alopecia with FDA-approved finasteride and minoxidil. Finasteride 1 mg is the only oral drug with an FDA-approved indication for male pattern hair loss [1], and minoxidil 2%/5% topical solution carries a separate OTC approval [2]. Keeps positioned both as affordable generics at prices below retail pharmacy.

Early pricing for Keeps finasteride was reported by consumer outlets at approximately $25 per month for a 90-day supply on subscription. Minoxidil topical started near $10, $15 per month. These prices undercut CVS and Walgreens cash-pay rates by a meaningful margin at launch.

Expansion Into Migraine and Beyond

Cove launched in 2019 targeting episodic migraine. The company offered sumatriptan (a 5-HT1B/1D agonist with FDA approval dating to 1992) [3], rizatriptan, and later preventive agents including propranolol and amitriptyline. These are all generic drugs with established efficacy in guideline-concordant migraine care [4].

Picnic for allergies and Facet for skincare followed between 2020 and 2022. Each brand uses a subscription model with an initial clinical consult fee layered onto recurring product charges.

Pricing Trajectory: A Year-by-Year Analysis

Thirty Madison has never published a formal pricing history page. The data below is reconstructed from archived web captures, consumer complaint records, and FDA enforcement filings.

2018 to 2019: Below-Market Launch Pricing

Keeps finasteride launched at approximately $25/month on a 90-day auto-ship. This was below the $30, $35 per month cash-pay average at major pharmacy chains for the same 1 mg generic at the time. The strategy mirrored what Ro (Roman) and Hims were executing simultaneously: use low introductory pricing to capture subscription volume.

Cove's 2019 launch priced sumatriptan 50 mg at roughly $9 per tablet and sumatriptan 100 mg at $12, $13 per tablet. For context, the wholesale acquisition cost (WAC) of generic sumatriptan in 2019 was approximately $2, $6 per tablet depending on volume tier, meaning Cove's margin was meaningful even at those entry prices [5].

2020 to 2021: Pandemic Demand and Price Stability

Telehealth usage in the United States rose sharply in 2020. The CDC reported that telehealth visits in Q1 2020 increased 154% compared to the same period in 2019 [6]. Thirty Madison's brands benefited from this shift. Prices for core products remained relatively stable during 2020, likely because the company was prioritizing user acquisition over margin expansion.

By mid-2021, Keeps began offering compounded oral minoxidil as a new SKU. Compounded drugs are not FDA-approved products; the FDA's position is that compounding pharmacies may prepare drugs for individual patients under specific conditions defined in 503A and 503B of the Federal Food, Drug, and Cosmetic Act [7]. This distinction matters for pricing: compounded products carry no price ceiling tied to a reference listed drug's generic competition, allowing the brand to set prices based on formulation novelty rather than commodity comparison.

2022 to 2023: Price Increases and Product Expansion

Starting in 2022, documented price increases appeared across Keeps and Cove. Keeps finasteride moved from approximately $30 to $35, $40 per month for many customers. Cove's preventive options, particularly topiramate and valproate, saw higher co-pay equivalents in cash pricing.

Consumer complaints filed with the Better Business Bureau (BBB) during 2022 to 2023 referenced unexpected subscription price increases and difficulty canceling auto-renewing subscriptions. The BBB complaint file for Thirty Madison shows multiple unresolved complaints related to billing, though Thirty Madison is not BBB accredited [8].

The FTC's guidelines on negative option marketing, updated in 2023, specifically require that subscription services obtain affirmative consent before charging consumers and must provide simple cancellation mechanisms [9]. Several Thirty Madison-adjacent complaints align with the fact patterns the FTC describes as problematic.

2024: Compound Drug Disruption and Price Volatility

2024 introduced the most significant pricing disruption in Thirty Madison's history. The FDA had listed semaglutide (Ozempic, Wegovy) as a drug in shortage, which allowed compounding pharmacies to produce it legally under 503A/503B provisions [7]. When the FDA removed semaglutide from its shortage list in early 2025 [10], many telehealth platforms were forced to discontinue or reformulate compound semaglutide offerings. Thirty Madison did not operate a direct GLP-1 vertical, but the regulatory action clarified enforcement posture toward all compounded drug telehealth pricing models, including Keeps' compounded minoxidil offerings.

The FDA has issued multiple warning letters to 503A compounding pharmacies for distributing drugs without valid patient-specific prescriptions [11]. Thirty Madison's pharmacy partners source from compounding facilities, and any enforcement action against those facilities would directly affect pricing availability.

Are Thirty Madison Products Priced Fairly?

Fair pricing in D2C telehealth depends on three variables: the cost of the underlying drug, the clinical consultation layer, and the platform's margin.

Drug Cost Benchmarks

Finasteride 1 mg generic (30-day supply) has a GoodRx cash price in 2024 of approximately $15, $25 at major retail pharmacies [12]. Keeps charges $35, $50 per month for the same molecule on subscription, a premium of roughly 40 to 100% over retail cash pricing. That premium funds the telehealth consult, the platform infrastructure, and company margin.

Sumatriptan 100 mg generic has a GoodRx cash price of approximately $15, $30 for a 9-tablet pack at retail [12]. Cove's per-tablet pricing at $12, $18 is competitive with, and sometimes below, retail cash pricing, making it a reasonable option for patients without prescription drug coverage.

Consultation Fee Structure

Thirty Madison brands typically charge a one-time or recurring clinical consultation fee of $0, $20. The FDA requires that a valid prescriber-patient relationship exist before a prescription drug is dispensed [13]. Telehealth platforms must document that a licensed clinician reviewed the patient's information. How thoroughly that review occurs in an asynchronous questionnaire model is a standing criticism of D2C telehealth broadly [14].

Insurance and Out-of-Pocket Costs

Thirty Madison brands are almost entirely cash-pay. Finasteride for androgenetic alopecia is not covered by most commercial insurance plans because it is classified as cosmetic by most payers. Migraine preventive drugs like propranolol and amitriptyline are covered when prescribed through in-network providers, meaning Cove may charge more than a patient's copay would be at an in-network pharmacy.

Patients with commercial insurance should compare Cove's cash prices against their plan's formulary before subscribing.

Is Thirty Madison Legit?

Thirty Madison operates legally as a telehealth holding company. Its prescribers are licensed clinicians, and its pharmacy partners are licensed pharmacies. "legit" has multiple dimensions worth separating.

Regulatory Legitimacy

The FDA has not issued a warning letter directly to Thirty Madison as of mid-2025. The company's pharmacy partners must hold valid state pharmacy licenses and, for compounded products, comply with 503A or 503B requirements [7]. The FDA maintains a public database of warning letters where consumers can verify the status of compounding facilities [11].

LegitScript, which certifies online pharmacies, classifies telehealth platforms based on their pharmacy partner credentials. Consumers can verify a dispensing pharmacy's status through the NABP's .pharmacy domain program or LegitScript's database.

Clinical Quality Concerns

The American Academy of Neurology's 2021 guideline update on migraine preventive treatment [15] recommends shared decision-making between patient and provider, including discussion of contraindications and titration schedules. Asynchronous questionnaire-based prescribing, as used by Cove, may not fully replicate that process. Topiramate, for example, carries a FDA Boxed Warning for cognitive side effects and fetal harm [16]; whether an asynchronous intake form adequately screens for these risks is a legitimate clinical question.

Similarly, finasteride carries a post-marketing safety communication regarding persistent sexual side effects [17]. Keeps' intake process must communicate this risk, but whether it does so with the same depth as an in-person consultation is a reasonable area of scrutiny.

Consumer Complaint Profile

BBB records for Thirty Madison show complaints concentrated in three categories: billing/subscription disputes, shipping delays, and difficulty reaching customer service [8]. The pattern is consistent with the broader D2C subscription telehealth segment. The FTC's 2023 negative option rule update [9] places specific obligations on platforms like Thirty Madison to make cancellation straightforward. Patients should document all cancellation requests in writing.

How Thirty Madison's Pricing Compares to Competitors

The D2C hair and migraine telehealth space includes Hims and Hers Health (NYSE: HIMS), Ro, and Nuo (formerly Nurx). A direct comparison on finasteride pricing as of Q1 2025:

| Brand | Finasteride 1 mg (monthly equivalent) | Consult Fee | |---|---|---| | Keeps | $35, $50 | $0 initial | | Hims | $25, $35 | $0 initial | | Ro | $15, $30 | $15 one-time | | Retail (GoodRx) | $15, $25 | N/A |

Keeps is consistently priced above Hims and at or above Ro for the same generic molecule. The premium is not supported by a branded drug advantage since all three dispense generic finasteride. Patients primarily choosing on cost should compare GoodRx prices at their local pharmacy before subscribing to any D2C platform.

For migraine, Cove's sumatriptan pricing is competitive with retail cash pricing and significantly cheaper than branded Imitrex (sumatriptan brand name), which can exceed $200 per dose without insurance [5]. Patients with insurance migraine coverage should verify their formulary first.

What the Clinical Evidence Says About the Drugs Thirty Madison Sells

Finasteride for Androgenetic Alopecia

A randomized controlled trial published in the Journal of the American Academy of Dermatology (N=1,553) demonstrated that finasteride 1 mg daily produced a statistically significant increase in hair count versus placebo at 12 months (P<0.001), with 65% of men rated as improved by investigator global assessment [18]. The drug's efficacy is well-established. The pricing premium of D2C platforms over retail generic is not justified by clinical uniqueness.

Sumatriptan for Acute Migraine

Sumatriptan 100 mg produces headache relief at 2 hours in approximately 57 to 67% of patients versus 26 to 29% for placebo, based on a Cochrane meta-analysis of 26 randomized trials (N=8,884) [19]. It is a guideline-concordant first-line treatment for moderate-to-severe migraine. The American Headache Society 2021 consensus statement endorses triptans as first-line acute therapy for patients who lack cardiovascular contraindications [20].

Minoxidil Topical and Oral

Topical minoxidil 5% is FDA-approved for men; the 2% solution is approved for women [2]. Oral minoxidil for hair loss is an off-label use. A 2022 systematic review in the Journal of the American Academy of Dermatology (N=634 across 8 studies) found oral minoxidil 0.25 to 5 mg daily produced hair density improvements, but noted that the evidence base consists largely of retrospective studies without placebo controls [21]. Patients should understand that oral minoxidil prescribed through Keeps is off-label, meaning the FDA has not evaluated it specifically for hair loss, even though the drug itself is FDA-approved for hypertension [22].

Red Flags and Practical Guidance for Patients

Patients considering Thirty Madison brands should evaluate five specific factors before subscribing.

Drug price vs. Retail. Run a GoodRx search for the identical molecule and dose at a local pharmacy. If the telehealth platform charges more than retail after accounting for the consult fee, the platform's only value-add is convenience.

Compound vs. Branded or generic. Compounded drugs are not FDA-approved and are not subject to the same quality controls as manufactured generics [7]. Ask explicitly whether the product dispensed is an FDA-approved generic or a compounded preparation.

Subscription cancellation terms. Read the cancellation policy before providing payment information. Document all cancellation requests with timestamps. The FTC's negative option regulations require that cancellation be as easy as enrollment [9].

Prescriber accessibility. Verify that a licensed prescriber is available for follow-up questions, not only for the initial intake. The FDA requires an ongoing prescriber-patient relationship for continued controlled substance prescriptions, and many states extend similar requirements to all prescription drugs dispensed via telehealth [13].

State licensing of the dispensing pharmacy. Each state pharmacy board maintains a public license lookup. Confirm the dispensing pharmacy holds a valid license in your state before the first shipment.

Thirty Madison's Business Trajectory and What It Means for Pricing

Thirty Madison raised $140 million in Series D funding in 2021, valuing the company at over $1 billion. Post-2022, the broader telehealth sector saw valuation compression. Hims and Hers Health, Thirty Madison's closest public comparable, reported a gross margin of approximately 81% in Q3 2024, driven heavily by GLP-1 compounded semaglutide revenue [23]. When the FDA removed semaglutide from the shortage list, Hims' stock dropped sharply, illustrating how dependent D2C telehealth margins have become on compounded drug revenue.

Thirty Madison has not pursued an IPO as of mid-2025. Private companies do not disclose margins. The sustained price increases in Keeps finasteride since 2020 suggest the company is moving toward margin expansion rather than growth-through-discount, a common shift as venture funding tightens.

Patients should expect continued price increases across Thirty Madison brands, particularly for any formulations that rely on compounded pharmacy partners, since regulatory pressure on 503A compounders is increasing [11].