What Longevity Medicine Costs, and What You Are Paying For

TL;DR: The medicine inside a longevity program is a doctor with time, the right labs, screening kept ahead of schedule, a training plan, and follow-through year after year. Programs sell that core at wildly different prices, from direct primary care memberships to concierge practices past $60,000 a year. When you compare them, ask what is clinical work and what is service and scarcity. Our practice delivers the clinical core as a flat monthly membership, priced on our membership page, in Philadelphia and by telehealth in 40 states.

If you have read Outlive or followed the longevity medicine world for a while, you have probably priced what it costs to be cared for this way, and the numbers are disorienting. The same philosophy of care shows up at $200 a month in one practice and $60,000 a year in another. This page is an honest tour of what sits inside those fees, written by a physician who does this work, so you can tell the medicine from the packaging.

What is the medicine inside a longevity program?

Strip away the branding and nearly every serious program is built from the same 5 components:

1. Physician time. Long visits, a doctor who knows your whole story, and answers between visits. This is the scarce ingredient everything else depends on.
2. Deeper measurement. ApoB, Lp(a), fasting insulin, hs-CRP, hormones and thyroid in full, DEXA for body composition, and cardiorespiratory fitness. Read against preventive targets, not just "in range."
3. Screening kept ahead of schedule. Standard cancer screening current first, then honest conversations about coronary calcium scoring, whole-body MRI, and multi-cancer blood tests for people who are up to date and want more.
4. A training and nutrition plan. Strength and fitness treated like vital signs, with programming that survives a busy life.
5. Follow-through. Retests on a calendar, adjustments when numbers move, and somebody accountable for noticing. This is where results come from, and it is the part a single executive physical cannot sell you.

Every one of those is ordinary medical work done with unusual time and attention. None of it requires a private chef or a members' lounge.

Why do prices range from $2,000 to $60,000 a year?

Because the fee buys 3 different things in 3 different proportions: medicine, service, and scarcity.

At the top of the market, nationally known concierge longevity programs charge tens of thousands of dollars a year. Public reporting on Peter Attia's Early Medical program and comparable concierge practices puts their fees in the tens of thousands annually, with some past $60,000, and labs and imaging often billed on top. Part of that fee is medicine. A large part is service, same-day access, extensive staff, curated referrals, and scarcity: a short patient roster is itself the product, and a high fee is how it stays short.

In the middle sit executive physical programs, which sell measurement without the follow-through: an impressive 2-day workup, a handsome report, and then a year of silence. Measurement without a loop is the weakest buy in this market, because the value of a number is what happens after it comes back.

At the accessible end sit direct primary care practices like ours, where a flat monthly fee buys the physician time, and the labs and scans are ordered at transparent cash prices as needed. The roster is kept small enough for the doctor to know everyone, and the model works because overhead stays low, not because access is rationed by price.

What questions separate the medicine from the packaging?

Whatever you are evaluating, including us, these questions sort it fast:

• Who reads my results, and how long do they spend with me? A famous program where you see an associate for 20 minutes is a worse buy than an unknown one where the physician spends an hour.
• What happens in month 7? Ask what the program does between big visits. The honest answer to this question is most of what you are paying for.
• Are labs and imaging included, or on top? Neither answer is wrong, and surprise five-figure add-ons are a known feature of this market.
• What is the exit like? Records should transfer without a fee, and leaving should be as easy as joining.
• Does the practice sell what it prescribes? A program that profits from its own supplement line has a conflict a patient should at least see plainly.

How does Fishtown Medicine deliver this work?

We are a direct primary care practice in Philadelphia. Membership is a flat monthly fee, listed with everything included on our membership page, and the longevity work is not an upsell tier; it is how the practice thinks. Members get the advanced labs read against stated preventive targets, DEXA when body composition is a question, the strength and nutrition focuses built from their own answers, standard screening kept current with honest conversations about the newer tools, and a doctor who reads and answers his own messages.

Philadelphia members add in-person and home visits. Members elsewhere do the same work by telehealth: Dr. Ash is licensed in 40 states, with the current list at AL, AZ, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KY, LA, ME, MD, MN, MO, MS, MT, NE, NH, NJ, NV, NY, ND, OH, OK, PA, SD, TN, TX, UT, VT, WA, WI, WV, WY, and bloodwork drawn at a Quest or Labcorp near you. Many of our members found us after pricing the concierge tier and asking what, clinically, the extra money was buying.

time, deeper measurement, screening, a training plan, and follow-through. - Prices from $2,000 to over $60,000 a year reflect different mixes of medicine, service, and scarcity, and the top tiers are selling the second and third. - Executive physicals sell measurement without the loop; the loop is where the results live. - A handful of questions, who reads the results, what happens between visits, what is billed on top, sort any program quickly. - Direct primary care delivers the clinical core at a flat monthly fee, in Philadelphia and by telehealth in 40 states.

Scientific References

1. Attia P. Outlive: The Science and Art of Longevity. Harmony; 2023.
2. Sniderman AD, et al. Apolipoprotein B particles and cardiovascular disease. JAMA Cardiol. 2019;4(12):1287-1295.
3. Krogsboll LT, et al. General health checks in adults for reducing morbidity and mortality from disease. BMJ. 2012;345:e7191.
4. Eskew PM, Klink K. Direct primary care: practice distribution and cost across the nation. J Am Board Fam Med. 2015;28(6):793-801.
5. Mandsager K, et al. Association of cardiorespiratory fitness with long-term mortality. JAMA Netw Open. 2018;1(6):e183605.

Medical Disclaimer

This article is for educational purposes and is not a substitute for personalized medical advice, diagnosis, or treatment. Program prices cited reflect public reporting at the time of writing and change; confirm current fees with any practice directly.