Have you talked to someone at twilio about a high volume discount?
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SIGNL4 can be considered as an alternative to Twilio. It's a mobile alerting platform. Typically there are other use cases, it's primarily focused on incident management and team communication, but it could potentially be used for sending text alerts or push notifications to patients as well. I guess it also depends on your exact budget and how old the patients are as they would need to download an app.
Which provider did you use and what sms gateway? Zender?
what about Amazon SNS? i believe it’s $0.50 for one million sms messages
Might find infobid a good option.
Telnyx, they're very well known, and they run their own network (so it's extremely stable) and it's pretty cheap. Plus you can use Hosted SMS if you want to add SMS capabilities to existing numbers, even land line numbers.
Twilio charges less than a cent for each message. A hundred messages is 79c. I’d be surprised to find any other solution that is dramatically cheaper. On AWS it would be 58c.
Those prices are in US, but I would be surprised if those services weren’t competitive in other markets.