I've been approached by someone who wants to buy our health app in bulk to pass out to patients. Is there any way to do this without using promo codes/App Store? Could I license the software directly?
I'm afraid that the only possible way is through promo codes. If I am not mistaken the person who wants to buy your app in Bulk wants to give it out to patients individually correct? Not that it is a hospital or such where they could simply use the same apple ID to login and put it on all their devices.
From my experience the only solution is through promo codes unless you release the app for free and approach a different monetization model.
I would love to have some specifics to perhaps help you out a bit further, I am currently offering a one time 15 minute free call so just go there https://clarity.fm/giulianosenese/free15
and schedule a call if you need it!
You have two other solutions. You could build the app with an entreprise itunes account ($500/year) and people would just have to download it from a webpage (no app store required). You would have to protect this page though, so that only patient can download it.
The other solution is more a hack. You could use apple beta program (testflight on itunes connect). With this, you can distribute the app up to 1000 people, you just need their email. It's a little more complicated, and it's more a hack than a real solution.
I would love to help you out a bit further, https://clarity.fm/matthieurouif
and schedule a call if you want.