Healthcare Marketing Blog

Email Marketing For Healthcare Businesses: Compliance

Disclaimer: We are a marketing company, not a legal one. Nothing in this article constitutes legal advice; all information, content, and materials available on this site are for general informational purposes only.  

Email Marketing is one of the most effective marketing channels. According to Litmus Report, marketers generate $36 for each dollar spent on email marketing, a 3600% ROI. We experience this as consumers daily. A personalized email with the right promo delivered at the right time will nudge us to take action. 

Email ROI

The benefit of Email Marketing for Healthcare:

There are a lot of ways how Email can help your healthcare business.

  • Automated Lead Nurturing: You can use funnels to nurture your leads and segment them based on priority.
  • Automated Admin Emails: Automate appointment emails, intake forms and other compliance-related admin tasks.
  • Maintain Emotional Availability: By sending regular emails to your patients, you stay on top of their minds when they need your services again.
  • Specials and Promos: When trying to hit your monthly sales quota, you might want to introduce a special. An engaged email list is a primary source for activating that special. 
  • Own the Data: Your rankings and social media following are simply leased media. A legal email list is data that you own. It creates tangible value in your company.

The challenges of Email Marketing for Healthcare:

Healthcare brands have multiple logistical challenges in utilizing email marketing as part of their mix. 

Privacy Regulations

HIPAA Privacy Rule in the US is a federal law that requires you to protect Protect Health Information (PHI). Name and Email are already considered PHI. If you send admin emails about a specific condition, you must do it from a HIPPA-compliant vendor. Vendors must have security rules and sign the Business Associate Agreement (BAA). If the vendor doesn’t sign BAA or states explicitly that they are not HIPPA compliant, it will be almost impossible to use that provider.

For example, Hubspot is a viral marketing automation platform. When you read their Terms of Service (ToS), they state that they are not HIPPA compliant.

Emails in Marketing: HubSpot ToS


We have Health Canada Privacy Act in Canada, and in Europe, there is General Data Protection Regulation (GDPR)

Email Marketing Regulation

CAN-SPAM Act is federal US regulation concerning email marketing. It requires you to include particular items in your Email, including identifying the message as an ad and opt-out mechanism. Each act of non-compliance is subject to a $46,517 fine. 

CASL is Canada’s Anti-Spam legislation that applies not only to email marketing but also to social media and text messages. In addition to elements that need to be included in each communication, you must have explicit consent. Penalties for the most severe violations of CASL can reach $1 million for individuals and $10 million for businesses. That is why you keep seeing those annoying re-opt-in emails. 

You then might local state or provincial legislation like California Consumer Privacy Act. 

Email Service Providers (ESPs)

Most businesses will use Email Service Providers (ESPs) to stay compliant. It’s usually cheaper than trying to maintain your email server. These services will automatically include needed elements for compliance, unsubscribe mechanisms and provide analytics. These days they also act as marketing automation platforms. 

For Healthcare brands, there are significant challenges with working with ESPs. We already mentioned that if you want to be HIPAA compliant, you must select a vendor to sign a BAA. 

How to be HIPAA compliant

Yet another challenge you will face when trying to activate your campaigns. ESPs send emails from their servers. They promote their deliverability and protect all costs. If one of the businesses on the server sends spammy emails, all other businesses on that cluster will suffer.

Because of legal compliance, liability issues and wanting to ensure their deliverability, ESPs make you sign an extended ToS agreement with them. 

Prohibited Content

Here is, for example, a list of Prohibited Content from Mailchimp

Email for Healthcare: Prohibited Content


Notice the “Sexually Explicit Content” prohibition. It means that you will be flagged when you write words like erection, ED or put borderline suggestive images.  

The line “Pharmaceutical Products” means even if you are LegitScript’s verified online pharmacy, you can’t use Mailchimp to send emails about ED medication.


In addition to Prohibited Content, ESPs want to comply with privacy laws and, again, not receive any spam complaints. 

Notice that ToS specifically prohibits renting or buying email lists. 

Email Marketing: Rules and Abuse


What are ESPs going to do if you violate ToS?

0.1% Spam Threshold Rule  – you will get flagged with ESP if you send an email to 1000 recipients and ONE of them marks your Email as spam.

We experienced three different scenarios. 


ESP have people called “Deliverability Specialists” they will ask you to verify how you obtained the email list and prove consent. They might also ask you to remove all contacts that didn’t engage with you in the past 12 months. They can also ask you to send re opt-in Email. This is the Email we got after receiving three spam complaints on the list of 3000.

Thank you for writing back to us about this.

Yes, engagement would constitute opening and/or clicking links within an email message. Contacts that haven’t opted in or engaged with your content within the previous 12 months are likelier to mark a message as “SPAM.” This can have long-term deliverability impacts for your domain across all mailing platforms. Poor reputations may lead providers like Gmail, Yahoo, Hotmail, etc., to populate your message in spam folders.

We kindly ask that you remove contacts from the account that haven’t opted in or engaged with your content within the previous 12 months. You can accomplish this with our Engagement Management Tool. Learn more about this here:

Lastly, we prohibit male enhancement content from ensuring a quality deliverability experience for all our users. The following send has been identified as promoting males.

If you run an SWT clinic, you probably know that 12 months might not be enough time to follow up with the ex-patient. That’s what privacy regulations give us 24 months, unless someone unsubscribes. They also mentioned that we couldn’t advertise male enhancement products even though they tout themselves as HIPPA compliant server and check your medical licenses. 

Close your account

If it’s a repeat violation, they will close and ban your business from using their service ever again.

Shadow Ban

They move your account to a server they use for what they internally classify as spam businesses. Your emails will be sent out, but your open rate will drop. In one of the businesses we worked with, the open rate dropped from 30% to 3%.

Tips on Compliance

Email for Healthcare: Tips on Compliance


Navigating the rules of Email Marketing for Healthcare is complex. Yet the ROI from this marketing channel is still making it worthwhile. 

Don’t Buy or Rent Email Lists

You won’t get any response, and ESPs will make your life hell or close your account. There is literary no upside to this tactic.

What to do instead? Partner up with another brand that has engaged subscribers within your target group. Either get sponsored posts within their newsletter or work on collaboration. That way, you are not violating any laws and can increase your reach significantly. 


Regardless of the rules of ESP you use, make sure you are compliant with privacy and marketing regulations. The fines are ridiculously high.

Avoid Spam Filters

  • When you send a Welcome email, ask subscribers to whitelist your domain.
  • Tiptoe around explicit words.

Maintain Permission

Remember you don’t own Email; you were granted permission to send an email, which can be revoked at any time.

To maintain it:

  • Use double opt-in to ensure users are serious about receiving your marketing materials.
  • Don’t wait too long to contact new subscribers; if they subscribed a few months ago and suddenly get an email, expect spam complaints.
  • Honor Unsubscribes – if a contact unsubscribed from one of the lists, unsubscribe them from everywhere. They revoked their permission to be marketed.
  • List Hygiene – after every campaign, look at bounces and if it’s a hard bounce, unsubscribe and delete them from your list. 

Final Thoughts

ESPs and Privacy rules seem like a pain. However, as marketers, we are on the same page with them (for the most part). We want a list of highly engaged subscribers that act on our offers and share them with their friends. 

Please don’t waste time! Schedule a call with Our Agency to learn everything about Healthcare Marketing Services.

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