Rates by vertical, VAMP context, dispute defense strategy.
Clay Pay's 2026 telehealth chargeback benchmark aggregates observed dispute ratios across compounded GLP-1, FDA-approved GLP-1, HRT, TRT, mental health, ketamine, functional medicine, and compounded pharmacy. Every telehealth vertical operates under Visa VAMP's 0.9 percent combined dispute-plus-fraud threshold with an eight dollar fee per disputed transaction once excessive.
0.4 to 3.0 percent depending on vertical and operator maturity. FDA-approved with active dispute defense at the bottom. Compounded without active defense at the top. LegitScript-certified operators run 0.3 to 0.8 percentage points lower on average.
Highest structural rate. Dispute driver mix: side-effect drop-offs 30-40%, insurance-changed-mind 15-25%, delivery/cold-chain 10-20%, friendly fraud on recurring 15-25%.
Mid-risk. Structural rate lower than compounded because FDA-approved formulations have lower off-label ambiguity and cleaner labeling.
Compounded HRT protocols higher end; FDA-approved-only hormone platforms lower end. Peptide HRT sits in the same regulatory zone as compounded GLP-1.
Household-recognition disputes drive the higher end. Descriptor tuning drops rate 0.2 to 0.4 percentage points.
Clinical protocol drop-off is the largest driver. Ketamine adds DEA Schedule III regulatory exposure without changing dispute rate directly.
Efficacy expectation disputes are the largest single driver because functional medicine protocols often lack FDA-approved efficacy claims.
Lower than telehealth-platform side because pharmacy transaction lands at fulfillment, not consultation. LegitScript internet pharmacy certification correlates with 0.2 to 0.4 percentage point lower rates.