# Clearing Financial Model

D2C telehealth platform delivering personalized, opioid-free chronic pain treatment via prescription compound creams shipped to patients' doors.

- Canonical: https://finamodel.com/startups/clearing
- Excel download: https://finamodel.com/startup-models/clearing.xlsx
- Category: Biotech/Pharma
- Model type: SaaS ARR / Valuation
- Funding round: Seed
- Funding: $20M
- Founded: 2021
- Geography: United States.
- Customer: B2B2C

## About the company

Clearing is a direct-to-consumer telehealth service for opioid-free chronic-pain treatment. Patients complete asynchronous intake, receive a physician-prescribed personalised compounding cream, and can use an app for pain tracking, guided exercise or physical therapy, and refined recommendations.

The care kit can include the compound cream, nutraceuticals, and CBD cream shipped directly to patients. Recurring shipments and telehealth consultations are the current implied revenue sources; broader pharmacy, education, group therapy, and community services are roadmap ideas rather than established revenue lines.

The company compares its ambition to what Curology did for dermatology, but the research provides no patient, revenue, pricing, conversion, or refill statistics. The model should therefore use explicit assumptions for consultations, prescription conversion, shipment cadence, product margin, clinician capacity, acquisition cost, and churn.

## What's included

- 5-year monthly revenue build with stage-appropriate growth assumptions
- Full P&L, headcount plan, and operating-expense schedule
- Cash-flow statement, runway, and burn-rate tracking
- Valuation via exit multiple with a DCF cross-check
- Returns analysis with MOIC and IRR
- Unit economics including CAC, LTV, payback, and cohort retention

## Product & value proposition

- Asynchronous telehealth intake → physician prescribes a personalized compounding cream (topical anti-inflammatories, local anesthetics, muscle relaxants, neuropathics, or botanicals) tailored to the patient's pain profile.
- Physical care kit (compound cream, nutraceuticals, CBD cream) shipped direct-to-door.
- Companion app: pain-level tracking, guided exercise/PT programs, iterative recommendation refinement.
- Long-term vision: integrated pain management platform adding content/education, community (peer groups), and online pharmacy (broader formulary).
- Positioning analogue: "What Curology has done for dermatology we will do for pain."

## Market

- ~$45B total U.S. pain management products & pharmaceuticals market.
- $4B topical pain relief sub-segment (≈10% of total).
- 50M+ chronic pain sufferers in the U.S.; 2M new cases per year.
- 190M opioid prescriptions annually, in secular decline - creates substitution opportunity.
- 191M opioid prescriptions per year per separate appendix slide; 45% written by PCPs.
- Opioid misuse costs: $78.5B annually; 11M+ Americans misuse opioids; 17,000 deaths per year from overdose.

## Revenue model

- **Subscription / recurring shipment**: patients receive a personalized compound cream care kit on a recurring basis (cadence not specified).
- **Telehealth consultation fee**: implied by asynchronous telehealth intake model; fee structure not stated.
- **Product upsell**: nutraceuticals (120-tablet supplement), CBD cream sold alongside compound cream.
- **Future revenue lines** (roadmap): content & education (group PT, group talk therapy), community features, broader online pharmacy.

## Competition / moat

- Positioned in top-right quadrant of "Relevance to Pain Management" × "Personalized D2C Treatment + Pharmacy" matrix - claiming uncontested space.
- Named competitors (lower relevance or less personalized): Rightful, Zocdoc, Capsule, Cove, Hinge Health, Goodpath, Ro, Hims, Noom, Curology.
- Moat claims: personalization (data-driven treatment iteration), compound pharmacy Rx (requires telehealth Rx + compounding partner, not OTC), medical advisory board credibility (faculty from Johns Hopkins, Harvard, Hospital for Special Surgery).
- Macro tailwinds cited: telehealth acceptance post-COVID-19, rise of non-opioid treatments, availability of plug-and-play telehealth pharmacy infrastructure.

## Team & funding ask / use of funds

- **Founders & leadership**:
  - Avi Dorfman - Founder & CEO (Compass, Accretive, McKinsey)
  - Dr. Jacob Hascalovici MD PhD - Co-Founder & CMO (Montefiore, Albert Einstein College of Medicine)
  - Yakov Kagan - Co-Founder & Head of Growth (Uber, Bread, Codecademy)
  - Jeremy Pippin - Head of Product (FanDuel)
  - Alyssa Horneff - Head of Operations
  - Melissa Cullens - Head of Design (Ellevest)
  - Meran Liu - Head of Clinical Operations (SimpleHealth)
  - Cory Goodale - Lead Engineer (Catalant)
- **Medical advisory board**: 6 advisors from Johns Hopkins, Harvard Medical School / MGH, Hospital for Special Surgery (team physicians for NY Rangers, NE Patriots, Boston Red Sox, Boston Bruins).

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## Recommended financial model

- **Archetype + why**: DTC subscription + telehealth P&L model (analogous to Curology / Ro / Hims). Revenue is driven by subscriber volume × ARPU (monthly subscription bundling Rx cream + nutraceuticals + app). Gross margin is shaped by compounding pharmacy COGS and fulfilment. No marketplace or SaaS ARR structure applies.

- **Forecast horizon & granularity**: 3 years monthly (Y1–Y2) → quarterly (Y3). Monthly cohort tracking is essential given subscription churn dynamics and iterative treatment refills.

- **Key drivers & assumptions**:
  - Addressable chronic pain patients (U.S.): 50M; serviceable subset dependent on telehealth eligibility
  - New patient starts per month:
  - Monthly subscription price (ARPU):
  - Monthly churn rate:
  - COGS per subscriber per month:
  - Gross margin target:
  - Customer Acquisition Cost (CAC):
  - LTV / CAC:
  - Telehealth consultation fee (if separate):
  - Compounding pharmacy partner cost-share:
  - Headcount ramp:
  - Revenue mix shift: product-only Y1 → add content/community revenue in Y2–Y3

- **Scenarios (Base / Bull / Bear - which variables flex)**:
  - **Bear**: slow patient acquisition (CAC spikes, conversion drops), high churn (8–10%/mo), low ARPU ($75), thin gross margin (50%) - cash-hungry, path to profitability extends beyond Y3.
  - **Base**: steady paid-social acquisition, 6% monthly churn, $95 ARPU, 62% gross margin - reaches contribution-positive around month 18–24.
  - **Bull**: viral/organic referral loop from community feature, churn <4%, ARPU expands via upsell (nutraceuticals, group PT), partnership distribution channel (employers, health plans).

- **Required sheets / outputs**:
  1. Subscriber cohort model (monthly new starts, cumulative actives, churn waterfall)
  2. Revenue build (subscription + upsell + future content/community)
  3. COGS & gross margin (compounding cream, nutraceuticals, fulfilment, clinical labour)
  4. S&M / CAC bridge (blended CAC, payback period, LTV:CAC by cohort)
  5. OpEx (R&D/engineering, G&A, clinical ops headcount)
  6. P&L summary (monthly → annual)
  7. Cash & runway (with funding assumption input toggle)
  8. Scenario toggle (Bear / Base / Bull on key drivers)

## Frequently asked questions

### Is the Clearing financial model free?

Yes. The Clearing model is a free Excel download with live formulas.

### Can I change the assumptions?

Yes. The workbook is editable and its live formulas recalculate when assumptions change.