Metformin and rapamycin programs, scored

Both drugs are FDA-approved for other conditions, so every longevity use is off-label: a licensed prescriber's call, not a labeled indication. Bionomy Health scores highest at 87. The Healthspan Score adds four checks: price (35 points), care (25), pharmacy (25) and clarity (15). How we score covers every sub-check. Metformin and rapamycin share one price band, $40 to $160 a month. A plan at $40 or below collects all 35 price points. At $160 or above it collects none, and near $100 about half.

The pill is often a small share of the bill here. Visits, memberships and lab work can be most of it, which is why the care check asks whether labs are offered and who pays for them.

Metformin and rapamycin are both sold as generics. What separates these programs is the care around the prescription: who decides you're a fit, whether labs come first, and how often someone checks in.

That's why the Care chip deserves a long look on this lineup. A program that orders baseline blood work and repeats it is doing what an off-label prescription calls for.

With only 17 scored providers, one price change can reorder the list. Open the reviews before you choose; each one lists what the plan includes.

Decide which drug you're asking about first. Metformin and rapamycin work differently and carry different risks, so a provider that prescribes both should explain why it would pick one for you.

Then look for a plan that says what happens after the first prescription: how often you'll be seen, when labs repeat, and who adjusts the dose.

Already taking metformin for blood sugar? Tell the program. A second prescriber adding to a diabetes prescription is a different conversation from starting fresh.

If none of these programs fits, a local doctor can prescribe either drug off-label too. The two drug guides lay out the evidence worth bringing to that visit.

• Price (35). The starting monthly price with any membership folded in. When a provider prices both drugs, the plate uses whichever is lower, and the review shows both.
• Care (25). Who prescribes, a clinician's review before the first prescription, labs and who pays for them, a stated check-in schedule, and dose changes without a new consult fee, worth 5 each.
• Why labs weigh more here. Both drugs are off-label on this lineup, so the labs check carries extra weight: blood work is how a prescriber sees what the drug is doing.
• Pharmacy (25). Whether the provider names the pharmacy that fills the prescription (10), gives its state or 503A/503B status (5), says plainly whether the drug is brand, generic or compounded (5), and avoids calling a compounded product FDA-approved (5).
• Clarity (15). A visible price before intake, published cancellation and refund terms, and a state list, at 5 points each.
• Check the state list first. On a lineup this short, a provider that doesn't serve your state is out before price comes into it, so read the state list on its review before anything else.

Plates here run $25 to $162 a month, about $1,644 apart over a year by our math. The middle of the lineup, $63, comes to roughly $756 a year.

Across the site, 10 programs offer metformin at $25–$162 a month and 5 offer rapamycin at $65–$207.

In this band, each ten dollars off the monthly price is worth about 2.9 price points.

Lab work is the cost to watch. Some plans include it and some bill it separately, so a low plate can turn into a higher first month once blood work is added.

The generic drug itself is often a small part of the bill next to the program fee. Ask whether the monthly price covers the medication or only the care.

Over a year, visit and lab fees can matter more than the gap between plates. Ask for the year-one total in writing before you pay.

1. Which drug and dose do you have in mind for me, and why?
2. Which labs do you order before I start and while I'm taking it, and are they in the price?
3. How will you watch for side effects, and how do I reach a clinician between visits?
4. Which pharmacy fills the prescription?
5. What do I pay if I stop after a month?
6. Will you still prescribe if my labs come back outside the normal range?
7. Can I fill the prescription at my own pharmacy?
8. If I want to stop, who decides how, and is there a fee to end the plan?