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GoodRx Holdings, Inc. (NASDAQ:GDRX)
Q3 2020 Earnings Call
Nov 12, 2020, 8:30 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:


Operator

Ladies and gentlemen, thank you for standing by. And welcome to the GoodRx third-quarter 2020 earnings call. As a reminder, today's conference call is being recorded. I would now like to introduce your host for today's call, Whitney Notaro, vice president of investor relations.

Ms. Notaro, you may begin.

Whitney Notaro -- Vice President of Investor Relations

Thank you, Operator. Good morning, everyone. And welcome to GoodRx's earnings conference call for the third quarter of 2020. Our first call as a public company.

Joining me today are; Doug Hirsch, and Trevor Bezdek, our co-founders and co-chief executive officers; and Karsten Voermann, our chief financial officer. Before we begin, I'd like to remind everyone that this call will contain forward-looking statements. All statements made on this call that do not relate to matters of historical fact should be considered forward-looking statements, including statements regarding management's plan, strategies, goals and objectives, our market opportunity, our anticipated financial performance, and the expected impact of COVID-19 on our business. These statements are neither promises nor guarantees, but involve known and unknown risks, uncertainties, and other important factors that may cause our actual results, performance, or achievements to be materially different from any future results, performance, or achievements expressed or implied by the forward-looking statements.

Factors discussed in the Risk Factor sections of our quarterly report on Form 10-Q to for the quarter ended September 30, 2020, on our final IPO prospectus filed with the SEC on September 24, 2020, and our other filings with the Securities and Exchange Commission could cause actual results to differ materially from those indicated by the forward-looking statements made on this call. Any such forward-looking statements represent management's estimate as of the date of this call, and we disclaim any obligation of BP statement even if subsequent events cause our views to change. In addition, we may also reference certain non-GAAP metrics, which are reconciled to the nearest GAAP metric in the company's shareholder letter, which can be found on the overview page of our investor relations website at investors.goodrx.com. I'd also like to remind everyone that a replay of this call will become available there shortly as well.

With that, I'd like to turn the call over to Doug.

Doug Hirsch -- Co-Founder and Co-Chief Executive Officer

Thank you, Whitney. And thank you, everyone, for joining us this morning. I hope you and your families are safe and well. We are pleased to report our first quarterly results as a public company.

I want to thank our new shareholders for their confidence in our company, and recovering analysts for performing such thoughtful and thorough research. I'd also like to thank the amazing GoodRx's team for all their hard work and especially throughout our recent IPO. As this is our first earnings call, I want to spend a few minutes emphasizing what drives us to build America's best consumer healthcare platform. I will then turn the call over to Trevor, who will address key highlights from the quarter and trends in our business.

Then, Karsten will discuss our financial results and guidance. GoodRx helps Americans get the healthcare they need at a price they can afford. Trevor and I started GoodRx to provide affordable and accessible healthcare, information, and guidance to demystify an incredibly complex industry, and perhaps most importantly, to simply help people who have nowhere else to turn. For too many, healthcare in the U.S.

is expensive, complicated, and confusing. Every year, Americans pay more out of pocket costs and face new insurance hurdles and restrictions. Too many families are uninsured or underinsured forcing them to make painful sacrifices just to stay healthy. Lack of affordability and healthcare is a key reason why Americans don't get the care they need, which causes a massive negative impact across our entire nation.

We believe GoodRx can solve these problems. We can provide a better way for people to understand, access, and afford quality healthcare. This is what drives us every day. We're on the heels of a presidential election where healthcare policy became the single most important issue facing our nation.

Much of our economy remains on hold because of the COVID-19 pandemic, while our medical professionals work heroically to provide care. The world is relying on our healthcare industry to provide accessible vaccines and treatments to protect lives and the global economy. I am proud to be joined by a growing team of talented, passionate colleagues who are focused on providing assistance to Americans through this pandemic, unemployment, changes to insurance, and federal and state laws. We have come a long way in the decade since Trevor and I started GoodRx.

I'm proud to report that we've reached a number of major milestones in the last few months. We reached 25 billion in cumulative consumer savings, we extended HeyDoctor, our telehealth service to offer online medical professional visits for over 150 conditions in all 50 states at a price that is often less than the typical insurance copay. We introduced affordable home delivery for hundreds of prescriptions. And we launched GoodRx helps our philanthropic initiative to provide free medications at more than 20 clinics across America.

There's still so much that needs to be done to fix America's broken healthcare system. We believe that the pandemic has accelerated long-needed changes to the way Americans find and receive healthcare. Millions of Americans have embraced telemedicine home delivery. Millions more are turning to the Internet to learn about their care and their choices available to them.

Across the healthcare ecosystem, long-hidden information is flowing more freely, and patients are being empowered to own their healthcare journey. Providers are learning their treatment and prescriptions don't work if patients can't afford them. The old model is broken, and Americans are ready to embrace a new better way to stay healthy. We intend to work toward this opportunity.

We will continue to invest our strong cash flow in our platform, products, user experience, and brand with the goal of creating the best consumer experience and major improvements to healthcare affordability and access for all Americans. We are building much more than a company. We are building the leading consumer-focused digital healthcare platform in the United States. Our impact will ultimately be measured by the lives we positively impact and the care we provide.

We have never been more motivated. And with that, I'll turn it over to Trevor.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you, Doug. Consistent with our historical performance, we continue to deliver strong profitable growth at a very fast pace. In the third quarter, we delivered record monthly active consumers in our prescription offering. Record revenue and adjusted EBITDA, and strong growth in our subscriptions manufacturer solution, and telehealth offering.

Total revenue for the quarter grew 38% year over year to $140.5 million. Prescription transactions revenue grew 30% year over year to $124.4 million, driven by 29% year-over-year growth in our monthly active consumers. Other revenue grew 170% year over year to $16.1 million, reflecting strong growth in our subscription manufacturer solutions, and telehealth offering. And we delivered an adjusted EBITDA of $53.2 million representing an adjusted EBITDA margin of 37.8%, and year-over-year growth of 23%.

Consumer-facing markets are being rapidly transformed by technology, driving greater transparency and convenience, and creating a clearer connection between value and cost. The healthcare market is no exception. GoodRx is at the forefront, pioneering healthcare's transformation. Our approach has always been consumer first, and we've created a trusted brand to guide individuals throughout their healthcare journey.

We're only just beginning our efforts to become the first stop on any healthcare journey. Our expanding suite of offerings, deep brand-building investment, and differentiated content is accelerating consumers' understanding of how we help. We will continue to increase our engagement in healthcare providers particularly, around affordability, adherence, and access solutions. We aim to accelerate this trajectory by launching new services, and organizing existing products as we continue to grow our business and expand into new categories.

We're focused on providing value for consumers and are fortunate to have a platform that positively impacts both consumers and key stakeholders in the healthcare ecosystem. We deliver value to consumers through our mobile-first offerings that make access to healthcare simple and more affordable. We help people fill prescriptions that they may otherwise not have filled. We provide telehealth visits that allow access when care may have been avoided, due to cost long wait times or COVID concerns.

We drive greater medication adherence, faster treatment, and better patient outcomes. All of which creates a healthier, happier population. We deliver value to healthcare professionals by providing information and strategies for their patient's financial burdens on prescriptions or treatments. We improve patient outcomes by increasing medication adherence.

We deliver value to pharmacy benefit managers, pharmacies, and pharmaceutical manufacturers by helping them reach more consumers who seek their services and products. We operate in a massive industry with a combined total addressable market of over $800 billion. The annual prescription market in the U.S. alone, including prescriptions left on the counter, is estimated to exceed $500 billion.

The telehealth opportunity is estimated at $250 billion, and our manufacturer's solutions business has a potential annual addressable market of over $30 billion. In the third quarter, our team continued to deliver value to our consumers and strengthen our relationships with stakeholders in the ecosystem, increasing our penetration in these large markets. During the quarter, we helped a record 4.9 million monthly active consumers, save money on their prescriptions through our prescriptions offering to allow consumers to save money on their medications by simply presenting GoodRx at one of the 70,000 pharmacies were GoodRx is accepted. We continue to have strong relationships with our pharmacy and PBM partners and have recently launched the additional PBM on our platform.

We continue to focus on user experience to ensure we can provide consumers with prices, savings, and information through a simple easy-to-use, and convenient digital interface. Our proprietary platform now aggregates over 200 billion prescription prices from a variety of different healthcare sources every day. With GoodRx consumers can efficiently and conveniently search for their medication, choose from a list of prices a very strong suit near them, and save money on prescription medication. Our relationships with consumers and pharmacies continue to strengthen and repeat activity exceeded 80%.The GoodRx network strengthens with every transaction.

Our leading platform and trusted brand allow us to reach more consumers. This increased volume drives improved pricing and consumer saving, strengthening engagement, and expanding the unit economics. This allows us to continue to expand on our platform and enhance our products creating a hard to replicate virtuous cycle and a deep competitive mode. Our prescription offering continues to deliver solid growth with strong revenue and consistent unit economics.

Every time a consumer uses GoodRx to save money from the first prescription filled the subsequent refills, we earn a fee from our partners creating alignment between the value we deliver to consumers and the lifetime value they generate for us. Our prescription offering has demonstrated resilience during this challenging time, as the COVID-19 pandemic continues to impact the economy. We believe our prescription offering continues to be impacted by the pandemic, as many consumers continue to cancel it for non-urgent physician visits. However, we've seen a significant quarter-over-quarter increase in our prescriptions offering, and in the number of our monthly active consumers as people have begun to resume typical healthcare purchasing.

The continued incredibly fast growth of our prescription offering demonstrates our valued proposition and a large market in which we operate. As we already mentioned, we're working closely with our pharmacy partners on additional programs to drive value for both them and the consumers. One highlight is our Flu Vaccine Program, where we're working with retailers to drive additional flu vaccine participation, as well as consumer spending. We've grown our program from two pharmacies in 2019 to eight pharmacy chains this year.

It would likely be a big year for flu vaccination pharmacies, and we're happy to help facilitate and look forward to expanding this program in the future. Our subscription offerings had a successful quarter as well. We closed the multi-year extension of our relationship as the exclusive prescription savings program for Kroger, the largest grocery chain in the U.S. The Kroger Rx Savings club powered by GoodRx offers access to lower prescription prices at Kroger Pharmacy.

To date, the program has provided hundreds of thousands of customers with exclusive access to discounts on commonly prescribed generic medications. We are very excited to continue this fruitful relationship with Kroger and plan to invest more in marketing and this product with this extension. We continued to enhance the user experience at GoodRx Gold. At the GoodRx program where subscribers pay a monthly fee, taxes even lower prices at a participating pharmacy.

Gold offers over 1,000 prescription medication that is available for under$10.00 with savings of up to 90% of standard list prices. We've been focused on better integrating this program into our platform and optimizing acquisition and conversion, which resulted in accelerating new subscriber momentum. As the pandemic has made it more challenging for Americans to visit retail pharmacies, we launched prescription mail order services for Gold enabling Americans to receive medications by mail in just days. Today, we offer more than 300 common medications by mail for less than $10.00, which improves access, saves patients money, and offers needed convenience when leaving home is not an option.

We also added mail-order services to HeyDoctor, our low-cost online telehealth service. In addition, HeyDoctor expanded to provide care for Americans in all 50 states and growing the number of conditions we treat. The combination of convenient online provider visits and our new mail order service gives Americans access to medical professionals and medication all through an integrated online experience at a time when they need it most. Finally, we increased our focus on providing assistance to reduce the cost of brand prescriptions for Americans.

We launched more than 30 integrated programs with manufacturers as we continued to grow our manufacturing solutions offering. We also launched CarePortals for several brands. This new functionality provides additional ways to help patients find book savings and resources to help manage their condition. Overall, we are very pleased with our results for the third quarter.

The growth of our offering, and the continued progress we're making with our various products and services. We see exciting growth potential as we continue to attract new consumers for our existing offerings and launch new services to improve healthcare affordability and access for all Americans. As we extend our platform, we are helping more people at different stages of a consumer healthcare journey delivering more value to our consumers and generating higher consumer lifetime value. And with that, I'll turn it over to Karsten.

Karsten Voermann -- Chief Financial Officer

Thank you, Trevor. Good morning, to everyone and thank you for joining us today. Our third-quarter results highlight the unique combination of scale, growth, and profitability. Our business provides strong unit economics with large markets in which we operate, and our ability to execute and generate strong cash flow.

Total revenue for the quarter was $140.5 million, growing 38% year over year, driven by continued growth in our prescriptions offering, as well as our newer offerings. Prescription transactions revenue grew 30% year over year to $124.4 million, driven by a 29% year-over-year increase in our monthly active consumers. As a reminder, monthly active consumers represent the number of unique consumers who use GoodRx to save on their prescriptions in a given month, and it does not include consumers of our other offerings. When presented for a quarter, monthly active consumers represent the average of the calendar month in the quarter.

Other revenue grew 170% year over year to $16.1 million, with strong growth and all of our other offerings, subscriptions, manufacturing solutions, and telehealth. This reflects our ability to deliver value to consumers at various points in their healthcare journey, as well as our ability to create multiple entry points into our growing platform. Cost of revenue is $7.5 million or 5.4% of revenue, compared to $3.4 million and 3.3% of revenue in 3Q '19, this increase was driven by providing costs related to our telehealth offerings, driven by an increase in the number of online provider visits, and an increase in outsourced and in-house personnel-related consumer support expense to support our growth. We continue to deliver strong gross margins at the mid-90's levels.

Product Development and Technology expenses were $15.8 million, compared to $7.8 million in the comparable period last year. This increase is primarily, due to continued investment in the team and product, as well as an increase in stock-based compensation, including awards made in connection with our IPO. Excluding stock-based compensation and various items related to acquisitions, adjusted product development, and technology expenses 8.9% of revenue, compared to 7.1% of revenue in 3Q'19. As Doug said, we plan to continue to invest in our products and platform with the goal of creating the best consumer experience continuing to scale our existing offerings, and developing new offerings to help more consumers in different stages of their healthcare journey delivering more value to them and increasing the lifetime value we generate.

Sales and Marketing expenses were $65.1 million, compared to $45.0 million in 3Q'19. We increased advertising spend by $13.3 million, year over year, and continued to build a strong team, including hiring our first Chief Brand Officer, all with the goal of increasing our consumer base and building the GoodRx brand, which we believe will yield positive returns for us long term. Adjusted Sales and Marketing expense as a percent of revenue was stable year over year, making up 43.3% of our revenue in 3Q'20, compared to 43.9%t last year. After reducing advertising spend in certain channels in the second quarter of 2020, due to the impact of COVID-19, as many consumers avoided visiting healthcare professionals and pharmacies in person, we increased our advertising spend in the third quarter as more consumers resumed their interaction with the healthcare system.

We will continue to evaluate the impact of COVID-19 on our business, and actively manage our consumer acquisition spending according to market conditions. General and Administrative expenses were $108.5 million compared to $4.1 million in the third quarter of 2019. The majority of this increase, $98.1 million was due to stock-based compensation related to the co-CEO awards made in connection with the IPO, which I'll provide more detail on shortly in the context of guidance. Excluding stock-based compensation and other items, adjusted G&A As a percent of revenues 4.6%, compared to 3.2% in 3Q'19 with the incremental cost primarily related to our IPO and associated with starting to operate as a public company at the end of September.

We include a net loss of $50.0 million in the third quarter. Again, this is due primarily to stock-based compensation of $106.8 million in the quarter, $98.1 million of which related to the co-CEO grants made at the time of the IPO. Adjusted net income with $35.6 million, compared to $23.2 million in 3Q '19. Adjusted EBITDA grew 23% year over year to $53.2 million.

The adjusted EBITDA margin continued to be strong at 37.8% reflecting our ability to deliver profitable growth, due to compelling unit economics of our business and repeat activity on our platform. Our adjusted EBITDA margin decreased approximately 460-basis-points year over year, due to the growth of our telehealth business, and continued investments in product development and technology, as well as in our general and administrative infrastructure all of which I have discussed. On a quarter-over-quarter basis, our adjusted EBITDA margin decreased 220-basis-points, primarily, due to an increase in advertising spend, which we pulled back in the second quarter due to COVID. As I previously mentioned, we continue to generate strong cash flow with net cash from operating activities of $32.7 million for the quarter.

On the capital investment front, our main investments related to the non-recurring one time build of our new headquarters in Santa Monica was approximately $13 million spent to date, net of tenant improvement reimbursements, and additional investments in our platform and product. We expect to substantially complete the construction of our new headquarters by the end of this year. We ended the quarter with $1.1 billion of cash and cash equivalents after netting approximately $1 billion from our IPO, and private placement in September. I'll now turn to guidance.

As we begin our journey as a public company, we want to ensure that we provide clarity and transparency to our shareholders, while maintaining our long-term focus, as well as our ability to make the right investments to maximize value for our consumers, the Company, and our shareholders. To balance these priorities, we'll be providing guidance on total revenue and adjusted EBITDA margin. We are committed to being transparent about both our performance as well as our investments in the years to come, so shareholders are informed and understand our operating decisions. For the fourth quarter, we expect revenue of approximately $148 million, reflecting 31% year-over-year growth.

This would translate to full-year total revenue of approximately $545 million, representing year-over-year growth of 40%. While we won't be providing guidance for monthly active consumers regularly, we did want to provide our short-term expectations on this call since our business is still impacted by COVID-19, and because this is such an important driver of our prescription offering. For that reason, we expect our quarter-over-quarter growth of monthly active consumers to be approximately between 4% and 5% for the fourth quarter. Remember that consumers of our other nonprescription transaction offerings like for example, our high growth subscriptions offering, which delivers two times the contribution do not contribute to our monthly active consumer figure.

A final note on revenue. While we won't be providing guidance for each revenue line item, but just for total revenue, we expect the other revenue align to continue to gradually make up a higher percentage of our revenue. Looking at stock-based compensation, we expect stock-based compensation related to the co-CEO Grants we made in connection with the IPO to be approximately $275 million in the fourth quarter, compared to $98 million in the third quarter. This will bring the total expense recognized for this grant to $273 million, out of the total expense of $533 million.

The performance-based portion of this grant will be fully recognized by the end of the year as the price target criteria for investing have been met. The remaining $160 million is time-based and will be recognized over the following 15 quarters on a great investing basis. With the expense moderately front-loaded, we plan to provide quarterly updates related to Grant, until they're fully expensed or become material. Turning to adjusted EBITDA margin.

We expect it to be between 30% and 31% for the fourth quarter, translating to a full-year adjusted EBITDA margin of approximately 36.5%. We plan to make significant marketing investments in the fourth quarter to continue to grow our brand, this coupled with a shift in the timing of certain marketing investments from the third quarter is the primary driver of the lower adjusted EBITDA margin in the fourth quarter, compared to our year-to-date margin. As Doug said, we are building the leading consumer-focused digital healthcare platform in the country, and plan to invest our strong cash flows in our platform product user experience, and our brand with the goal of creating the best consumer experience, and improved healthcare affordability and access for all Americans. This is a scale platform with a rare combination of high growth and profitability.

We benefit from a strong brand first-mover advantage and a decade of experience and relationships that benefit all key stakeholders and our ecosystem. And we believe, we've only just begun to scratch the surface of a massive market opportunity. We're pleased with our third-quarter results, and we're excited about our future. Thank you for joining us on our mission to help Americans get the healthcare they need at a price they can afford.

We look forward to sharing our progress in the quarters to come. And with that, I'll now turn the call over to the operator for questions.

Questions & Answers:


Operator

Thank you. [Operator instructions]. Our first question comes from Ricky Goldwasser with Morgan Stanley. Please, go ahead.

Ricky Goldwasser -- Morgan Stanley -- Analyst

Hi. Good morning. And congratulations on your first quarter as a public company. When we look at the performance, I mean clearly, monthly active consumers are now above pre-pandemic levels.

And you're seeing momentum in subscription and growth is picking up. But to your point is, if we think about the metric, subscribers are not included in December. And in your ability to negotiate and scale, can you maybe help quantify for us the subscription growth. What would be the gross monthly active consumer metrics look like if we normalize for the edge on the subscription side.

Doug Hirsch -- Co-Founder and Co-Chief Executive Officer

Good morning Ricky. Thank you very much for the question. Let me have Carsten speak to this question.

Karsten Voermann -- Chief Financial Officer

Hi, Ricky, great to speak with you again. Ricky, we're very excited about our subscription plans because they're a natural extension of our successful prescriptions offerings and they allow us to deliver more savings and value to our consumers will increasingly LTV as evidenced by their two years one contribution. And it allows us to create really tight relationships with the consumers throughout their healthcare journey. We're not just one big subscriber count or mixed pipeline winning Gold versus Kroger on an ongoing basis, but a [Inaudible] that goes to show high positive growth and great momentum.

We've integrated the Gold experience onto our platform, and added additional features like mail order as well. Mail order is added during the third quarter specifically. We also agreed to a multi-year renewal of Kroger, which means we'll make more marketing and product investments going forward. We're really excited about those offerings.

The subscription site launched but again, isn't disclosing specific numbers on a scale.

Ricky Goldwasser -- Morgan Stanley -- Analyst

Understood. So when we think about this new mail-order offering, and we think about the opportunity within your user base. Can you be able to give some data about what percent of the users or chronic medication over time could Kroger to mail solutions?

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Sure. And thank you, again for that question. Also, Karsten is there -- do you wanna answer that with regards to the mail specifically.

Karsten Voermann -- Chief Financial Officer

I think the more general question. First of all, it is chronic versus acute. And I think in general like the industry we skew toward chronic as you'd expect. With respect to the intersection of chronic and mail order more broadly, I think that as evidenced by some of the analyst's reports that have even come out over the last few days, mail order continues to not be the dominant mode for our users to get subscriptions.

And I think Trevor, will likely want to address mail order in a little more detail.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Yes. What I would say on mail is, in the U.S, mail order penetration is pretty low. The COVID I think is more of an accelerant. You would have imagined it would be more of an accelerator for that than almost anything else.

And yet you look at this year and it hasn't changed mail penetration too much. For us, GoodRx, and what we're trying to provide to consumers, we just want to meet consumers where they are. We want to provide consumers the -- what they're looking for. And so, we want to work with our partners, like the retail pharmacies and mail and those retail pharmacy by mail and other partners so that where consumers want to use mail and where it's the appropriate solution variable together.

Operator

Thank you. Our next question will come from Heath Terry with Goldman Sachs. Please, go ahead.

Heath Terry -- Goldman Sachs -- Analyst

Great. Thank you. I was wondering if you could give us a little bit of a sense of the progress with HeyDoctor, as well as the marketplace itself. Do you realize things are still very early stage? But if you could maybe just aggregate for us a little bit the growth that you're seeing in the two parts of your telemedicine platform.

That would be really helpful. And then as we look at this quarter and beyond, especially as we see cases rising. How much of a factor do you continue to see delayed medical visits or delayed procedures being taken. And having on overall prescription, and particularly the generic prescriptions that are such a big part of your business.

Having an impact on that in this most recent quarter, as well as the quarter that we're in now.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much for the question. I'll be glad to answer both about the telehealth about the marketplace and then about COVID impact. Then -- when we look at Telehealth, this is continuing to be a great area of growth. We're seeing positive momentum with HeyDoctor on a month-over-month basis, quarter-over-quarter basis.

We've really done a lot of expansion. We've increased the number of conditions treated to 25, and we've expanded the offering to all 50 states. And then as we mentioned, we've added mail-order options, and we've also increased the cross-sell numbers from Telehealth to our prescription offerings. When we look at Telehealth, we are -- we see it both as an additional way for us to acquire customers into the broad set of services.

We offer as well as being part of this additional expansion of our mission to provide affordable community healthcare across all of healthcare. We continue to make productive investments in Telehealth and to make us like a great user experience for consumers. We want to enable Americans to have access to affordable doctor visits to get medication and have that I'll be a completely integrated experience. And it allows us really to be with the consumer at a broad set of points in their healthcare journey.

To the marketplace, we launched the marketplace in late March for providers, and we added labs in April. This was something that had been on our product roadmap, but then because of COVID, we accelerated this development. And I want to make sure consumers had options when it came to getting the care they need. In the third quarter, we continue to add additional partners and grow our marketplace.

Although this is still in an early stage, this is they -- are part of our broad effort to access and get -- take on a broader set of healthcare as we do around the prescription area. So this marketplace gives the GoodRx consumers much broader provider choice and physicians and covered by HeyDoctor, and it addresses areas not addressed by HeyDoctor. So we plan to keep adding services and adding providers to our marketplace and introducing some new ways to monetize those large consumer base like sponsored listings and partnerships. So, again like Telehealth, just another entry point into the broader set of our offerings.

So, I'd like to also speak about the impact of COVID a bit more generally. As we said, what we have seen is consumers have certainly -- COVID certainly caused consumers to not visit doctors and pharmacies as much as normal. The pharmacy space I believe is impacted less than almost any other industry and is 80% -- and so, I think that factor as well as our 80% plus repeat activity rate has made us continue growing at a really good rate even during COVID. And COVID, it has accelerated a number of trends that we've predicted and fit into this roadmap.

We've had around where the industry and where the consumer is getting healthcare is going. But I would say as far as the impact of COVID and hopefully decreases at some point in the future there is upside there. But we are not making real assumptions. Any real assumptions here that happen anytime soon.

We're assuming the status quo, but hopefully, for the country, it gets better.

Heath Terry -- Goldman Sachs -- Analyst

Great. Thank you very much.

Doug Hirsch -- Co-Founder and Co-Chief Executive Officer

Thank you.

Operator

Thank you. Our next question will come from Doug Anmuth with JP Morgan. Please, go ahead.

Doug Anmuth -- J.P. Morgan -- Analyst

Great. Thanks for taking the questions. Your two years into Kroger partnership and you talked about recently extending the contract for multiple years. Can you just talk about the potential to work with other large retail pharmacies on a subscription basis? And then, just on sales and marketing, it ramps pretty aggressively in '19 and then in early 20, and then slowing somewhat COVID.

Just curious how you're thinking about that going forward, I know it's early. Obviously, to talk about next year, but assuming that we're in a somewhat better place. Just how you're thinking about that. Thanks.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Great. Thank you Doug very much for the question. For your first question. What I would -- we really enjoyed working with Kroger that I believe has been a very successful program for both us and them.

And we are excited for it to continue growing. Excited for our continued and extended partnership there. We want to work with all of our -- retail pharmacies on different programs to help them. So one day, I would want to highlight is our Flu Vaccine program.

So in the Flu Vaccine program, this is where we are going -- working with pharmacies to help expand availability, and help consumers get good access to good pricing on Flu vaccination. That's a program we've expanded from two pharmacies in 2019 to eight pharmacies this year. And just to meet this increased demand for flu vaccines in the current environment. And what I say is that's an example of where we want to find the right programs for each of our partners to help drive what's important for them, and highlight what's really special and good about each of these partners due to consumers.

So we want to meet -- work to find the right programs for each partner. On the sales and marketing spend, and how we forecast that in this may be in this year, and in the future years, what I would say there is -- what I personally highlight where we are currently on sales marketing, which is -- this has been a complex year for marketing spend like the media environment has changed significantly in this period. And I want to compliment our Marketing team that we've been able to spend into this period and do with great performance even an environment where it's -- where a lot of things are changing. So, as we look through, in Q4, we plan to make significant marketing investments in the fourth quarter and beyond to continue to grow our brand.

And we also anticipate there are some seasonal customer acquisition opportunities that often occur at start-up plan years. So, we will continue spending steady making investing and marketing in Q4 and beyond. And I'd say just maybe about -- we really plan to continue to build our brand, increase awareness, enhance our offerings. We have been able to drive this really strong long-term profitable growth, and we are very focused on driving that long-term growth, increasing our penetration in these multi-hundred billion dollar markets.

A prescription at Telehealth manufacture solutions we're scratching the surface of the opportunities. So, we're definitely leaning in to all these opportunities. And so at last point on our marketing spend, the other thing I guess I highlighted is even in that challenges, even increased spend, we've been able to keep marketing our acquisition cost below an eight-month payback even at increasing spend levels. So thank you for the question.

Doug Anmuth -- J.P. Morgan -- Analyst

Thank you.

Operator

Thank you. Our next question will come from Ross Sandler with Barclays. Please, go ahead.

Ross Sandler -- Barclays -- Analyst

Hey guys, congrats on the first quarter out of the gate. I guess, a question on the total addressable market. So we heard a lot of questions about this since the IPO process kicked off. And just wanted to get to hear your guys take on TAM at the high end you've got 5 billion U.S.

generic scripts flowing through retail pharmacies. At the low-end, you've got 300 million or so cash pay annual scripts. So that's a pretty wide range. How do you guys think about the TAM for your core scripts business? Thanks.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you. Thank you Ross for asking the question. Appreciate it. When we look at our users most of our users have insurance.

So 75% plus of our user base today has some normal insurance and had a significant portion of those are on Medicaid, which is often the best insurance someone could get. So generally what I'd say is that we don't actually think cash pay is a relative's, a relevant segment that when we look broadly, these are -- and this is all Americans that were serving. I think when we've even looked at the market just since we began, I think looking back at health plans have only become more complex. We only now have more 3 Tier plans, 4 Tier plans.

And the reality is you can be limited narrow network, utilization management like prior authorizations all of which makes access to prescriptions challenging for people. And so within prescriptions, there is a large opportunity, and that 5 billion or 5 billion scripts are much more than the set of services we can offer. I mean, you look at some of this also of where we're helping, and it's really the broad set of prescriptions where we can help. In addition, we are very focused on the broader healthcare market.

How do we help Americans get access to convenient affordable healthcare broadly, which is really the need that Americans have? And so, I hope that answers the question.

Operator

Our next question will come from Justin Post with Bank of America. Please, go ahead.

Justin Post -- Bank of America Merrill Lynch -- Analyst

Great. Thank you. Just wanted to ask as we did coming up for election, and people are learning the company. What healthcare policies are you focused on at the federal level.

And do you foresee any changes under a Biden Administration we should be thinking about? Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you, Justin. Doug, could you speak with us.

Doug Hirsch -- Co-Founder and Co-Chief Executive Officer

Sure I'd be happy to. One of the nice things is about GoodRx in history, we've been here for about a decade. And I can recall back in 2010 when we first got started, it was prior to the ACA, Obamacare and at the time there was a lot of feedback that there would be significant changes that would make healthcare so much easier for Americans to access. And obviously, our Company has existed long through Obamacare, and to be honest what we've seen consistently over the course of the last decade is, despite whatever administration, whatever executive order is floating around at the moment, the reality is that the burden on Americans just continues to increase.

Right. There have been so many policies and so many attempts, and yet I feel like it's often lost in the shuffle. It's just, there are just so many gaps in healthcare policies and what has been done to date. And we're very focused ultimately just helping the consumer and really driving solutions for them.

And with anyone, any politicians who engage or that is fantastic and helps consumers. But we're going to be there no matter what to fill in those gaps and make sure that consumers get the care they need at a price they can afford.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

And I'll just add that with a new administration, we don't anticipate any legislative concerns to the business. We're really fundamentally aligned with the political objectives of driving affordability and access to healthcare for Americans. And so, we don't foresee any issue.

Justin Post -- Bank of America Merrill Lynch -- Analyst

And then maybe one follow-up because vaccines so important next year. But how would you expect people to be outdoors more and just normalization of activity in stores and pharmacies? How would that affect your business next year? How would you think about that?

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Yes. When we look at this I mean, this is the -- what I spoke to previously on the consumer -- on the impact of COVID, there is an impact to consumers, current -- both earlier this year as well. Now, going to their physicians and getting prescriptions, at the very beginning of COVID, we saw people really not going to their physicians. Now people are going to physicians, but there's not going to physicians for non-urgent care.

And that does have an impact. Obviously, we're still growing at a very fast rate even through that. That said, it is good. There is upside if that amount of going out -- if people going after the vaccine if any of these things have had a positive impact this is all better for just the economy in general, and our business.

But we've modeled in so I can speak with you but there is a person maybe don't speak to the current course words there.

Karsten Voermann -- Chief Financial Officer

Appreciate the question. So as we contemplate it from a modeling perspective more broadly, we model in a gradual recovery. We've seen some of that happen already. Some from 2Q and to 3Q and benefited from that.

So if there is a significant lockdown that could impact that. But we also have a presence assume that the V shape incredibly steep recovery is likely. If that's helpful.

Justin Post -- Bank of America Merrill Lynch -- Analyst

Great. Thank you.

Operator

Thank you. Our next question will come from Nick Jones with Citigroup. Please, go ahead.

Nick Jones -- Citi -- Analyst

Great. Thanks for taking the questions. Can you touch on the manufacturer solutions you mentioned 30 plus new partnerships? Can you talk about I guess how they view to get our channel as an advertising channel? And then maybe talk about the rate of consumers searching for branded drugs that are maybe looking for generic and just don't know it or actually looking to try to get a discount on the branded drug. Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much Nick for the question. We continue to increase our focus on providing assistance to reduce the cost of brand prescriptions for Americans. We want to serve consumers as they try to save across all of healthcare, which includes prescriptions that include all of the different types of prescriptions that consumers can get. In Q3, we really continued to build out that team.

Focused on that area, and as we spoke to and you and mentioned, we rolled out more than 30 integrated programs with approximately, 20 manufacturers. And we've also launched these several of these new care portals for some additional new piece of functionality here, which has driven this really strong year-over-year revenue growth. Along with helping consumers, this is also one of the highest margin offerings. These are really high-end consumers who are already searching for brand drugs on our platform.

About 20% of our 15 million-plus monthly visitors are looking for savings on brand drugs. And that's really not changed as a portion of the user base looking for brand versus generics. It really has just scale relative to that overall growth. We're able to help consumers save on these brand medications.

And to what you're asking on how they perceive it, we deliver a lot of value to these pharmaceutical manufacturers by helping them reach these purchase ready consumers at the right time. And this -- what's also good about I think this line of business is there's no incremental cost of acquisition to us. These are searches on our platform that are already there. These are users who are just trying to use GoodRx to help them find affordable convenient healthcare.

And these are -- now we're able to just make that user experience better for them, and also enable -- unable to grow up in this area. We do have a lot of additional inventory I guess, I call it left across our platform to sell. So a lot of huge room for expansion here. And while we're not breaking out the other revenue, the year-over-year growth was in line with we provided originally and we expect this area to keep being a great area moving forward.

Nick Jones -- Citi -- Analyst

Great. Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you, very much.

Operator

Thank you. Our next question will come from Jailendra Singh with Credit Suisse. Please, go ahead.

Jailendra Singh -- Credit Suisse -- Analyst

Thanks, and good morning everyone. Congrats on your first quarter as a public company. My first question regarding the sequential increase of around 477,000 monthly active consumers you saw in the quarter, compared with a decline in second-quarter around 455,000. Can you talk about how many of these monthly active consumers you gained sequentially in the third quarter were part of that cohort which you lost in 2Q which is how many a company needs new users? Any color around that.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you. Thank you, very much for the question. Karsten, would you like to speak with this.

Karsten Voermann -- Chief Financial Officer

Sure thing. And thanks for the question, Jailendra. Great to talk to you again. We're happy with the increase in max and monthly active consumers, which hit an all-time high of 4.9 million in 3Q '20.

And with the overall growth of our offering. Max increased in the third quarter as activity in the prescription market primarily improved, and as consumers started to go back to their doctors. And on a year-over-year basis, macs grew significantly up about 29%. And of course, that's a comparison to a non-COVID quarter.

I think your question is more specifically related to quarter-over-quarter growth or we saw max growth grow 11%. We generally haven't gotten specifically into retention/attrition, but as you can imagine given the reopening of the economy, we believe that a significant number of our users with the reopening of our new users. But we're confident as well that a certain number of them may have been folks who delayed or otherwise elected not to see other their healthcare providers or go to pharmacies during the height of the COVID period in 2Q. That's helpful, and I appreciate the question.

Jailendra Singh -- Credit Suisse -- Analyst

Yes. And then a quick follow-up. I know you guys just announced this partnership would know your meds. Can you talk about how that integration will work? How many consumers that integration provides you with.

And what is reflected in your guidance that respect for that partnership with knows your meds?

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Sure. You know this is just one of many partnerships we have in the ecosystem. We have a goal of reaching more consumers at a time, at just any time where they're accessing different healthcare solutions, help them save on prescription medications. So, we really just look at across opportunities as we really look where can we increase our reach through scaling existing marketing channels, creating new marketing channels, partnering with affiliates in the ecosystem.

And so, we are broadly looking around it at opportunities of that nature, and hope each of them provides some incremental value. And almost more importantly, provide just really good consumer experience people where they're able to really access the information they need when they need it across the healthcare journey.

Jailendra Singh -- Credit Suisse -- Analyst

All right. Thanks.

Operator

Thank you. Our next question will come from Mark Mahaney with RBC. Please, go ahead.

Mark Mahaney -- RBC Capital Markets -- Analyst

Thanks. I want to ask about the manufacturer's solutions. You talked about launching 30 plus new partnerships. Any more color on those how many total partnerships do you have now.

Is there something in the process that's allowed you to launch these new partnerships more quickly than they were in the past? Is there a reason to think that these new partnerships could be more material than the ones you've had to date? Thanks a lot.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you Mark very much for the question. We see general growth in this area. We're in a situation where on the manufacturer solutions where we're not just getting the benefit of the growth of our overall platform. There's a huge amount of growth here just because this is an area where we have a huge number of users, 20% of our 15 million-plus monthly visitors are coming to look for savings on these brand drugs.

And we've not really monetized you know this much in the past. I mean, we really want to have a really small portion. So we're really also just getting now monetizing across those existing set of people. So we've been adding these 13 a large reason for that just us building a strong team there.

We've really built an experienced team. We've grown that team. We have been rolling out additional premium customized solutions. But mostly this is just our focus.

We hired Bansi Nagji from McKesson who was our chief business trauma chief strategy officer. We invested in more technology here. Their premium solutions like Patient Navigator. So I would -- we anticipate this continuing to grow quickly in the future just like it has in this past year or last quarter.

Mark Mahaney -- RBC Capital Markets -- Analyst

Ok. Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much.

Operator

Thank you. Our next question will come from Eric Sheridan with UBS. Please, go ahead.

Eric Sheridan -- UBS -- Analyst

Thanks, for taking the question. Maybe if I can just zoom out for a minute. Obviously, we're seeing a little bit of margin pressure over the shorter term as in deploy some of the investments you've talked about in the past to position the business in the long term. Can you just refresh investors on what you see as some of the key investments you have to make over the next couple of quarters against your broader long-term goals? And how people should think about the trade-off between growth and margin volatility in the coming quarters.

Thanks so much guys.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much, Eric. Let me have Karsten speak to the big question.

Karsten Voermann -- Chief Financial Officer

Sure. Always good to talk to you. We plan to make significant marketing investments in the fourth quarter and also beyond of course to continue to grow our brand and in anticipation of the seasonal consumer acquisition opportunities that occur at the start of plan years. When we think of that in terms of increased investment, marketing is just one component though.

We're also making increased investments in product and technology, supported by our detailed product roadmap at the same time. And those are really the key drivers of lower adjusted EBITDA margin for the fourth quarter, compared to our 2020 year to date margin or to our 3Q '20 margin specifically. I think you also need to keep in mind that the fourth quarter will be our first full-quarter operating as a public company, and there are of course new costs associated with that like an increase in D&O, auditor fees, various other things that have an impact on margin. We expect to continue making these product and marketing investments, and of course, every public company expenses going forward into next year too.

With respect to all of that, the reason we're doing it of course is we have a huge TAM. I think a question came up earlier related to TAM, and we talked about the fact that we feel like we continue to be massively under-penetrated and with a lot of room for expansion. So in terms of your growth versus spend trade-off, we believe that we're going to continue to make efforts to penetrate more deeply into that TAM. And as the relative market share leader, it's in our interest to make sure that we can grab as much of it as we can.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

And what I want to bring in there is other that we were discussing the service like we are super focused on capturing this larger opportunity of being the digital hub platform for all of healthcare. And we are going to deliver on this product vision that we have to provide that. So we're really focused on these, and I'm building a great product and building a brand.

Eric Sheridan -- UBS -- Analyst

Thank you very much

Operator

Thank you. Our next question will come from Charles Rhyee with Cowen. Please, go ahead.

Charles Rhyee -- Cowen and Company -- Analyst

Yes. Hi thanks for taking the question, guys. And congrats on your first quarter here. I wanted to ask about the monthly active consumers.

And if there's any of color you can give about you mentioned earlier that your Golden Kroger members are double the contribution to your revenues than the typical prescriptions customers. But even within that group, is there a cohort like what sort of the average number of scripts someone's filling either in a month or in a quarter. And does that skew to -- is there a subset of heavy users versus people who occasionally use it.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you. Thank you very much for the question. Let me actually pass this to Karsten [Inaudible].

Karsten Voermann -- Chief Financial Officer

Sure. And thanks, Charles. I think there are a couple of things, like any business we have different users with different rates of utilization. But again, going back to the concept we discussed earlier as with most businesses in the base, we benefit from a reality of having.

No.1, a significant number of chronic medications that are users are buying a majority in fact. No.2, and over 80% repeat transaction rate. So those things are critical and are what allows us to drive the unit economics we've discussed earlier like the -- for example 8 month payback on marketing spend. With respect to subscriptions, specifically, we look to subscriptions to be a way of continuing to push incremental value for users.

So the subscription offering will have a monthly fee associated offers even lower drug prices. And despite that, we've still as you mentioned been able to generate a 2x LTV in the first year off of that subscription business. So, hopefully, that's relatively helpful in terms of giving you a perspective on how our user base and its usage applies in our case.

Charles Rhyee -- Cowen and Company -- Analyst

Yes. That was helpful. And you said there's a lot of modest payback on marketing spend. I guess when you think about marketing then, are you like targeting within the active consumers that spend directly to get people who are more likely users to use more, or are you really focused on trying to track always.

Obviously, one always struck New users but is there a division within how you look at marketing.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Yes. I'd say, we do. We have a pretty sophisticated, I believe marketing operation. There are certain types of marketing that are really general in nature.

So if we're running television, for example, that's generally going to get us a wide set of all these healthcare users and prescription users. Whereas on the digital, we may be able to focus as you said on people and on particular products that are even more chronic and interesting. So, we do spend more or less on digital campaigns relative to the type of prescription user we think they are. But we try to just optimize out as best we can.

But a lot of them are going to do is more general in nature and isn't too targeted in that fashion.

Charles Rhyee -- Cowen and Company -- Analyst

Great. Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much.

Operator

Thank you. Our next question will come from Lloyd Walmsley with Deutsche Bank. Please, go ahead.

Lloyd Walmsley -- Deutsche Bank -- Analyst

Thanks. Got a couple. First, can you talk about any changes you're seeing in the competitive environment? Any competitors stepping up advertising or any impact from new pharmacy discount cards that you're seeing. And then secondly, can you just talk about some of the other potential areas of healthcare you see yourself potentially at adding product around for price transparency over the next five year period leveraging that existing user base.

Anything you can share there will be great. Thanks.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you. Thank you, very much Lloyd. On the competitive side, we really spent a decade building this brand that's a trusted, consumer. First, we have 90 [Inaudible] or we have this platform that's scalable central is deep network relationship integrations.

Everything we've done, I just built a deeper competitive note for us. And what we've seen is, we have not seen any competitors that have really impacted our business in any way historically or currently. There are cases where we're seeing some increased advertising, but we don't from people in the state. But I feel like that's what we've seen in the last decade of people try putting some type of solutions.

But us really being able to capture the vast majority of games in this space. Just due to the scale, the data pricing power, the products, and a lot of this also let us know business now build these better and new products. We're able to build new products that make the consumer experience better and offer more and more tools for consumers to go navigate their healthcare. Navigate affordability as well as lets us make more money from each of those users.

So this really does create this virtuous cycle that has made us the far leader in helping consumers save money on their healthcare. And that's what we continue to see in looking for. The Telehealthcare in general, as I mentioned this whole marketplace has been and this marketplace that's now expanded into other areas is the beginning of where we have expanded these areas. What we see is a large step across healthcare or services where consumers are struggling to afford them.

And so, we aim to provide help across the broad set of these. So we'll be rolling out more and more products to address these needs in a much shorter time frame than five years. And then the five year period.

Lloyd Walmsley -- Deutsche Bank -- Analyst

All right. Thank you, guys.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much.

Operator

Thank you. Our next question will come from Lee Horowitz with Evercore ISI.

Lee Horowitz -- Evercore ISI -- Analyst

Great. Thanks for the question. Maybe one more on mail order given a number of announcements from both partners and competitors recently. Ultimately, how important do you think that short e-commerce like delivery windows are seeing greater adoption of mail-order delivery.

And do you believe that these shorter delivery windows can potentially be done profitably?

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you, very much. We hear the question. Yes. As I spoke to on mail order, mail order still is really a small portion of prescriptions.

And I think you really can't think of something that would accelerate adoption more than COVID causing people to often not want to go places or not be able to go places. And yet, you look at the end of the year and it looks like that mail adoption as a percentage of your subscriptions has not really changed much. I think the faster delivery is a factor. But I actually would say I don't think it's the critical factor.

I think it's one factor out of many. Then make it so that in a lot of situations that it's just not the preferred solution for consumers. I think there are other issues such as general onboarding, the general experience of getting those prescriptions. There was a [Inaudible] just low consumer interest in general.

And so, I think it's a variety of factors that will be required to make that work for us. We want to meet consumers where they are where consumers have want mail. We want them to go to get mail whether that's from a retail pharmacy providing that as mail or other partners. We want to meet consumers where they are providing them the services they want, and our business works well in all these different environments.

Lee Horowitz -- Evercore ISI -- Analyst

Ok, thanks. And one follow up for Karsten. Circling back on the vaccine a bit. Can you spend a bit on how you're thinking about modeling the COVID recovery? You talked about not a feel like a recovery, but specifically with the vaccine now generally expected in the second quarter of next year, can you comment at all on whether this vaccine timeline was consistent with your prior view or if your expectations around the pace of recovery and the proliferation of the vaccine have changed at all given the news earlier this week.

Any color there would be helpful. Thanks so much.

Karsten Voermann -- Chief Financial Officer

Surely. I think, first of all,l with respect to the fourth quarter it doesn't really change anything. Obviously, and in the longer-term, I think we'd expected a gradual recovery where the economy would be fully open to next year regardless. So I think the vaccine more than anything else reaffirms that reality will manifest itself versus being a significant shift to our expectations generally.

So again I think for 4Q, I think the vaccine doesn't impact, and I think our views on guidance continue to be entirely like we discussed. And I think in general, we're looking forward to the coming year, we're excited to see the economy potentially reopening further. But we also modeled in a reopening generally speaking. So, I don't expect it to have a dramatic impact beyond what we're thinking about.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

That said, we certainly have not assumed that there's a couple of factors when we look at the impact of COVID. One is access to healthcare in general, which has been pretty good. There's been access to pharmacies broadly throughout this period. Second is access to healthcare providers, which was really constrained and now is also quite good.

The thing that we've assumed and have continued to assume it takes well is just like people just feeling comfortable going to get healthcare. So the people going to get there's none or two things people having their annual physical and finding out they have low blood pressure, high blood pressure, and going to get the medication for it. So those a lot of new starts related to that. Those just take -- we just think that takes a while for that to come back theoretic.

Hopefully, it is possible that something you know that a vaccine or the effect of the vaccine causes that to really happen sooner than we imagine in that activity, in general, goes back in a more meaningful way to normal in the next year. But even the vaccine news is amazing. But, we certainly haven't changed. We certainly feel like we don't know enough of when that happens.

What happens when things are distributed to make any real assumptions. But one other thing I'd say is, just about vaccines in general. I think this is a great opportunity for pharmacies. As I spoke to you about the Flu Vaccine program where we've gone from two partners last year to eight partners this year, we really want to help the pharmacies drive additional volume into that.

We want to help the public health side of this to help people get these vaccinations, and will help consumers to get these to help their quality of life. There's probably a similar opportunity at some point here around the globe in vaccines where hopefully, depending on the type of vaccine that the pharmacies can be a really important distribution partner for those. And then, we want to make sure consumers are able to get those, get access to them and get people into pharmacies to get them to help people through that period. And then, hopefully, recovery does happen faster than any of us have expected.

Operator

Thank you. Our next question comes from Aaron Kessler with Raymond James. Please, go ahead.

Aaron Kessler -- Raymond James -- Analyst

Great. Thank you, guys. Just quickly on converting your customers. Our survey work to some pretty high brand orders for GoodRx.

How are you thinking of converting more of these customers that obviously, occurred before and or as we get our act, but maybe not customers yet? And then maybe, start them working with employers to promote GoodRx some especially as they move more toward high deductible plans as well. Thank you.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Yes. So in terms of converting customers and brands, we think we have lots more to add to our brand awareness. We think we have -- actually, extremely high brand awareness month healthcare professionals that among pharmacists it's almost everyone among physicians two out of three, more than two-thirds of physicians better act. Most of those recommended to their patients.

It's a really good brand awareness among the healthcare professional side. But we think there's actually a huge amount of additional room to gain around brand awareness among consumers. When we think of what are accomplishments that are their question, the real companies and we have as people most not knowing that there is this opportunity in general to get -- to save on prescriptions to save on healthcare and to TV shoppers. So, most consumers just don't know that there are tools to help them navigate our complex healthcare system.

And we really believe we can help them with about 70% of consumers don't know that prescription prices can vary. And everyone just thinks everything is thinking the same. So this is a great opportunity there. So, we're obviously, focused on converting customers on increasing use to their customers.

But we still think there's so much additional awareness we can gain across the cross user base. In terms of employers, we're not focused on employers. I think we are focused on consumers. So when we look at the market, something we think, we are uniquely good at it.

Speaking of consumers about their healthcare experience providing tools to consumers or their healthcare experience, and really reaching there. There are plenty of companies that are good at working with employers, but we think we're really uniquely good at working with consumers in healthcare and that is our focus. And then, in terms of HDHPs, when we look at our users, our users have all forms of insurance, 75% plus of our users do have insurance more than a third of those have Medicare. So, this is not just HDHPs.

These are just all across all the commercial insurance we see good usage. So we really want to deliver value to users across their healthcare journey. We really want to continue to invest in our product build. Build great new products, have more entry points, add more services.

It's just a really big opportunity. So, we're super excited about the progress we've made in Q3. And just all the work we're doing now is to increase awareness, extend the platform and just increase penetration broadly across the broad of consumers and offer them and make everyone's healthcare experience better in America.

Aaron Kessler -- Raymond James -- Analyst

Got it. Thank you.

Operator

Thank you. And today's final question will come from Stephanie Davis with SVB. Please go ahead

Stephanie Davis -- SVB Leerink -- Analyst

Hey, congratulations on a strong first public order out the gate guy.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Thank you very much.

Stephanie Davis -- SVB Leerink -- Analyst

Comment on CMSs transparency in coverage rule and how we should think about the puts and takes of increased trade transparency not just on the market, but maybe on your competitive dynamics and specific.

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Sure. Thank you, Stephanie, very much for the question. We are really in favor of anything that increases transparency. When we see as to what regulator, what the public, what lawmaker, what people want.

People want transparency, and they want lower out-of-pocket costs for consumers. And so, we think we are entire -- those are the things we want. Those are the things I think the country wants. And we think we are really aligned with that in regards to specifically the new rules around transparency, which there is a variety of -- this is something we definitely want and think is good.

We think it opens up new opportunities in some other portions of healthcare. And we think it's only good for us and our business, our ability to deliver these solutions for consumers. And I think that fits into just our overall goals as a business. Our overall goals are to deliver affordable healthcare for all consumers to help them navigate this to be this leading digital platform for all of healthcare.

And it's just a huge opportunity. And we are at the early points of it, so we're excited that larger trends are also pushing in the same direction of more pricing, more transparency being available. And so, we're excited to capture these new opportunities, as well as continuing the strong profitable growth we've been able to deliver in the businesses that we're in.

Stephanie Davis -- SVB Leerink -- Analyst

Appreciated much. As a quick follow up for Karsten, just to give him some airtime too. On the fourth year guidance, holding all else equal it implies a pretty healthy sequential step down in that. Is there anything to call out that drove up mac and 3Q or is it just some uncertainty around a pandemic drive that for 4Q metric?

Karsten Voermann -- Chief Financial Officer

Sure. Thanks for the question, Stephani. And thanks for giving me an opportunity here to talk. We continue to see the impact of COVID-19 on our prescriptions offering realistically, primarily due to the impact of doctor visits and access that Trevor talked about a little bit.

Monthly active consumers in the third quarter increased by about 11% quarter over quarter, as activity in the prescription market improved. When we think about that, that's the third quarter is a bit of a rebound quarter though because 2Q is just such a tough one for our COVID. And because of that, I think we've got the benefit of a bit more rebound in that quarter than the gradual improvement that we're forecasting going forward. So, as we look forward, we still see nice growth 4% to 5% macros going forward, which translates to about 20% year over year, even as we see the economy open up in a more gradual fashion, and not instantaneously.

Of course, that also assumes things on the COVID front they stay fairly constant. I think the other reality is that total revenue growth, we expect to have grown significantly faster in part because of the rapid growth of our other revenue lines. And frankly in part because of the recurring nature of prescriptions the fact that we continue to benefit from most of the growth in this space, given where the largest relative market share player. And the general reality of all of our offerings intersecting in a way that's helpful.

Meaning that Telehealth is an entry point for prescriptions and vice versa. All of those things are helping us to drive even faster revenue growth than macros. I think the other thing to which I should remind folks of generally is that macs are the users of our prescriptions offering. So things like subscribers etc., of those counts do not form a part of the core mac count, which is part of the reasons your a see revenue per mac is growing.

And it's also part of the reason as its prescription offering continues to expand quite quickly. Why we've modeled out our mac count for the fourth quarter as we have. Hope that's helpful Stephanie. And thanks again for the great question.

Operator

[Operator signoff]

Duration: 82 minutes

Call participants:

Whitney Notaro -- Vice President of Investor Relations

Doug Hirsch -- Co-Founder and Co-Chief Executive Officer

Trevor Bezdek -- Co-Founder and Co-Chief Executive Officer

Karsten Voermann -- Chief Financial Officer

Ricky Goldwasser -- Morgan Stanley -- Analyst

Heath Terry -- Goldman Sachs -- Analyst

Doug Anmuth -- J.P. Morgan -- Analyst

Ross Sandler -- Barclays -- Analyst

Justin Post -- Bank of America Merrill Lynch -- Analyst

Nick Jones -- Citi -- Analyst

Jailendra Singh -- Credit Suisse -- Analyst

Mark Mahaney -- RBC Capital Markets -- Analyst

Eric Sheridan -- UBS -- Analyst

Charles Rhyee -- Cowen and Company -- Analyst

Lloyd Walmsley -- Deutsche Bank -- Analyst

Lee Horowitz -- Evercore ISI -- Analyst

Aaron Kessler -- Raymond James -- Analyst

Stephanie Davis -- SVB Leerink -- Analyst

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