Ecommerce OS · Telehealth10 min readUpdated November 2, 2026

Email Flows for Telehealth Companies

The email flows a telehealth brand needs, triggered by care events: what an email can say, when HIPAA marketing rules apply, required notices.

Article summary

TL;DR

A telehealth brand's emails follow the patient's case, not a calendar: intake started, order placed, clinician decision, shipment, next refill, failed payment. Each email moves the patient one step and carries no clinical detail. Before any promotional email, check whether HIPAA's marketing rules apply, and send the subscription notices card networks and state laws require.

  • Under HIPAA, a refill reminder about a drug "currently being prescribed" is not marketing, as long as any third-party payment only covers the cost of sending it (45 CFR 164.501).
  • Other marketing that uses protected health information needs the patient's written authorization (45 CFR 164.508(a)(3)).
  • In 2023, the FTC alleged BetterHelp used customers' email addresses to have Facebook find and target similar people; it agreed to pay $7.8 million.
  • Visa requires a reminder at least 7 days before a trial or introductory price ends (rules of April 18, 2026).
  • Automated flows click at 5.58% against 1.69% for campaigns (Klaviyo, 183,000+ customers, all industries, 2026).
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This guide is part of our playbook on the best ecommerce platform for telehealth companies. The general guide, for any store: triggered email campaigns. Texts are covered in SMS flows for telehealth companies.

The email flows a telehealth brand needs

A telehealth brand needs about ten flows, grouped around the case: before the decision, after it, and around each refill.

FlowTriggerTimingWhat it says
1. WelcomeEmail signup on a landing pageRight away, then 2 or 3 emails over a weekHow the service works: intake, review by a licensed clinician, delivery, price
2. Unfinished intakeIntake started, not submitted1 hour, then 24 hoursA link back to the saved intake. Nothing about the answers
3. Abandoned checkoutCheckout started, no paymentWithin hours, then 1 dayLink back to checkout, total, how the review works
4. Order receivedPayment or card holdRight awayWhat happens next, how long the review takes, that the card is charged only if approved (if that is your model)
5. Case updateClinician decisionOn the event"Your case has an update" and a portal link
6. ShippedPharmacy shipsOn the eventTracking link, plain-packaging note
7. Next refill noticeUpcoming rebillA few days before the chargeDate, amount, how to skip, pause or cancel
8. Failed paymentRebill declinedDay 0, then within a weekCard update link, what happens to the next shipment
9. Cancellation confirmationPlan cancelledRight awayEnd date, what was charged, how to restart
10. Win-backNoActive plan30 to 90 days laterThe service, the price, a new intake link

Fig. 1The 10 flows along the patient's case

  1. Signup and intake1. Welcome · 2. Unfinished intake
  2. Checkout3. Abandoned checkout · 4. Order received
  3. Clinician decision5. Case update
  4. Pharmacy ships6. Shipped
  5. Before each rebill7. Next refill notice · 8. Failed payment
  6. Plan ends9. Cancellation confirmation · 10. Win-back

Before the decision, after it, and around each refill.

Flows and triggers from the table above.

Abandoned intakes and checkouts have their own guide: abandoned cart recovery for telehealth companies.

Trigger on care events, not on the calendar

In telehealth, the clock is the case. An email sent on day 30 from signup can land before the clinician decides, or after a cancelled shipment.

  1. Start care-status emails from the case status

    Submitted, approved, declined, shipped, delivered.

  2. Time refill emails from the shipment

    Not from signup. If the charge comes at ship date plus 30 days, the notice goes a few days before that date.

  3. Stop every flow when a case is declined or cancelled

    A refill reminder after a decline is the kind of email that turns into a complaint.

  4. Exclude active patients from win-back

    And from promotional sends about the plan they already have.

Example

A patient is approved on day 2, the pharmacy ships on day 4. The next charge is due on day 34 (ship day plus a 30-day cycle). The refill notice goes on day 31, the shipped email on day 4, and nothing goes out on "day 30 from signup".

This is how a telehealth stack with storefront, doctors, pharmacy and payments like Tagada Rx bills: "Recurring treatments rebill the day the pharmacy ships", not on a calendar date14Tagada docs, How Tagada Rx works, read November 2, 2026. More on the billing side in subscription billing for telehealth companies.

What can go in a telehealth email

Write emails that a roommate could read over the patient's shoulder without learning anything medical.

WriteKeep out of the email
"Your case has an update" and a portal linkThe clinician's decision or notes
Order number, amount, next charge dateTreatment names in subject lines and previews
Tracking link, delivery windowIntake answers, symptoms, conditions
How to skip, pause or cancelPersonal results or progress claims
The brand name and a support addressMessages from the care team (link to the portal instead)
  • Neutral subject lines: "Your order has shipped", "Your next delivery is on March 4".
  • Content-free notifications: say a message is waiting, link to the portal, never copy the message.
  • No medical claims: emails promise service steps (review, delivery, support), not outcomes.

Fig. 2What a roommate sees on the lock screen

What each email keeps out

  1. Case update: not the clinician's decision or notes.
  2. Shipped: no treatment name in the subject or preview.
  3. New message: a link to the portal, never the message text.
  4. Next delivery: date and options, no progress claims.
  1. EmailMonYour case has an updateLog in to your patient portal to see it.
  2. EmailWedYour order has shippedTrack your delivery with the link inside.
  3. EmailFriYou have a new message from your care teamRead it in your patient portal.
  4. EmailMar 1Your next delivery is on March 4Skip, pause or cancel in your account.

A status and a link, never the medical part.

Illustrative example.

Does HIPAA apply to your marketing emails?

It depends on who you are. HIPAA covers health plans, clearinghouses and health care providers that transmit health information electronically in a standard transaction, such as an insurance claim345 CFR 160.103, Definitions, "covered entity" and "business associate", current as of October 29, 2026. Many cash-pay brands sit next to a medical practice, and the answer can differ for each entity.

If HIPAA applies, the test is whether the email is "marketing"145 CFR 164.501, Definitions, "marketing", current as of October 29, 2026:

EmailMarketing under HIPAA?Rule
Refill reminder about a drug currently prescribedNoIf any third-party payment only covers the cost of sending it45 CFR 164.501, (2)(i)145 CFR 164.501, Definitions, "marketing", current as of October 29, 2026
Describing your own health-related servicesNoUnless a third party pays you to send it45 CFR 164.501, (2)(ii)(B)145 CFR 164.501, Definitions, "marketing", current as of October 29, 2026
Treatment and care coordinationNoUnless a third party pays you to send it45 CFR 164.501, (2)(ii)(A)145 CFR 164.501, Definitions, "marketing", current as of October 29, 2026
Promoting a third party's product, using patient dataYesWritten authorization needed, 45 CFR 164.508(a)(3)245 CFR 164.508(a)(3), Authorization required: marketing, current as of October 29, 2026

Fig. 3Which emails count as marketing under HIPAA

  1. Refill reminder about a drug currently prescribedNo, if any third-party payment only covers the cost of sending it45 CFR 164.501, (2)(i)
  2. Describing your own health-related servicesNo, unless a third party pays you to send it45 CFR 164.501, (2)(ii)(B)
  3. Treatment and care coordinationNo, unless a third party pays you to send it45 CFR 164.501, (2)(ii)(A)
  4. Promoting a third party's product, using patient dataYesWritten authorization needed, 45 CFR 164.508(a)(3)

Only for entities HIPAA covers.

45 CFR 164.501 and 164.508(a)(3), current as of October 29, 2026.

If HIPAA does not apply, the FTC does. Its Health Breach Notification Rule covers health apps and records "not covered by" HIPAA5FTC, Health Breach Notification Rule, 89 FR 47028, published May 30, 2024, effective July 29, 2024. In the BetterHelp case, the FTC alleged the company used customers' email addresses so Facebook could "identify similar consumers and target them with advertisements"4FTC, FTC to ban BetterHelp from revealing consumers' data, press release, March 2, 2023 (proposed order at the time). Never upload patient lists to ad platforms without a legal review.

Watch out

A newsletter signup is not a HIPAA authorization, and an email list built from intake forms is not a marketing list. Keep patient data and marketing consent in separate fields. This is general information, not legal advice: confirm your status with a health care lawyer.

Subscription emails the rules require

Treatment plans billed every cycle are subscriptions. Some emails are required, not optional.

EmailWhenRequired by
Terms and how to cancelAt signupROSCA: clear terms before billing, express consent, simple cancellation10Restore Online Shoppers' Confidence Act, 15 U.S.C. § 8403; Mastercard8Mastercard, Subscription/recurring payments and negative option billing merchants: FAQs, 2022
Trial or intro price endingAt least 7 days beforeVisa7Visa Core Rules and Visa Product and Service Rules, edition of April 18, 2026, table 5-21
Notice before billingBefore renewals, for cycles of 6 months or lessMastercard8Mastercard, Subscription/recurring payments and negative option billing merchants: FAQs, 2022
Annual reminderOnce a yearCalifornia, contracts since July 1, 20259California Business and Professions Code § 17602, contracts from July 1, 2025
Cancellation confirmationWhen the plan endsProof of cancellation, and fewer disputes

Tagada follows Visa and Mastercard rules and the laws that apply to payments.

Regulators look at this. In its July 29, 2026 complaint, the FTC alleges Hims & Hers made cancellation hard "by hiding the cancellation button from consumers"11FTC, FTC and states act against Hims & Hers, press release, July 29, 2026 (allegations, case pending). These are allegations in an open case. Cancellation rules by state are in subscription cancellations for telehealth.

Commercial emails: the CAN-SPAM basics

Promotional emails (win-back, new services) follow CAN-SPAM, whatever HIPAA says6FTC, CAN-SPAM Act: A compliance guide for business, read November 2, 2026:

  1. Accurate sender and an honest subject line.
  2. A valid physical postal address.
  3. An opt-out, honored within 10 business days.
  4. Transactional content first: if it does not appear "mainly at the beginning", the email is treated as commercial6FTC, CAN-SPAM Act: A compliance guide for business, read November 2, 2026.

Each violating email can cost up to $53,088 (FTC, January 2024 inflation adjustment).

Each violating email can cost up to $53,088 (FTC, inflation adjustment of January 2024)6FTC, CAN-SPAM Act: A compliance guide for business, read November 2, 2026.

Measure your flows

MetricRead it byWatch for
Intake completion after the reminderFlow 2Where patients drop in the intake
Paid orders per recipientFlows 1, 3, 10Which email sells
Refills charged on timeFlow 7Skips and cancellations right after the notice
Cards updatedFlow 8Recovered rebills
Unsubscribe and spam complaintsEach emailToo many or unclear emails
Disputes after a rebillNotices sent or notMissing notices

There is no published email benchmark for telehealth. For scale, Klaviyo reports flows at a 5.58% click rate against 1.69% for campaigns, across 183,000+ customers in all industries12Klaviyo, 2026 Email Marketing Benchmarks by Industry, read November 2, 2026.

Fig. 4Flows get clicked more than campaigns

  1. Flow click rate5.58%
  2. Campaign click rate1.69%

Source: Klaviyo, 2026 benchmarks, all industries

All industries: compare your flows with each other.

Klaviyo, 2026 Email Marketing Benchmarks by Industry, 183,000+ customers.

Klaviyo itself is not an option for a telehealth brand: its Acceptable Use Policy (April 9, 2026) says you may not use its services for "Prescription medications, pharmaceutical products or services, medical therapies, telehealth"16Klaviyo, Acceptable Use Policy, updated April 9, 2026. Compare your flows with each other, month to month.

Payment failures are covered in failed payment recovery for telehealth companies.

How Tagada helps

Transactional emails from the checkout, on your own domain

The Tagada checkout sends transactional emails on its own events15Tagada docs, Emails, read November 2, 2026, with "24/7 human support on Slack Connect"17TagadaPay, homepage, read November 2, 2026 from TagadaPay:

Building the whole telehealth brand? Tagada Rx runs "Storefront, doctors, pharmacy and payments in one stack"13Tagada, Tagada Rx, read November 2, 2026, and its emails are "content-free": "You have a new message from your care team" and a portal link, never the message text14Tagada docs, How Tagada Rx works, read November 2, 2026. US patients only, by selection.

Transactional emails from the checkout, on your own domain

Nick Bonnassies

CMO at Tagada

CMO at Tagada. Before Tagada, Nick built direct-to-consumer brands that generated over $115M in sales, raised over $25M in crowdfunding and sold two of them. He also works as a fractional CMO on marketing operations and AI systems.

Frequently asked questions

What email flows does a telehealth company need?

Welcome, unfinished intake, abandoned checkout, order received, case update, shipped, next refill notice, failed payment, cancellation confirmation and win-back. Trigger them on case events (decision, shipment, rebill), not on days since signup, and stop them when a case is declined.

Can a telehealth refill reminder mention the medication?

If HIPAA applies, a refill reminder about a drug currently prescribed is not marketing, provided any third-party payment only covers the cost of sending it. Even so, keep the drug name out of the subject line and preview, and link to the portal for details.

Do I need a HIPAA-compliant email platform?

If your brand or practice is a covered entity and the email tool handles protected health information for it, the vendor is a business associate and needs an agreement. If you keep clinical data out of emails entirely, the question narrows, but have counsel confirm it.

Can I use my patient list for Facebook or Google audiences?

Treat it as a legal question first. The FTC alleged that BetterHelp used customers' email addresses to target ads and settled for $7.8 million. Health data shared with ad platforms is also central to the FTC's pending Hims & Hers complaint.

Which subscription emails are mandatory?

Visa requires a reminder at least 7 days before a trial or introductory price ends. Mastercard expects a signup confirmation with cancellation steps and notices before billing for cycles of 6 months or less. California adds an annual reminder for contracts since July 2025.

Sources

Checked November 2, 2026
  1. 45 CFR 164.501, Definitions, "marketing", current as of October 29, 2026
  2. 45 CFR 164.508(a)(3), Authorization required: marketing, current as of October 29, 2026
  3. 45 CFR 160.103, Definitions, "covered entity" and "business associate", current as of October 29, 2026
  4. FTC, FTC to ban BetterHelp from revealing consumers' data, press release, March 2, 2023 (proposed order at the time)
  5. FTC, Health Breach Notification Rule, 89 FR 47028, published May 30, 2024, effective July 29, 2024
  6. FTC, CAN-SPAM Act: A compliance guide for business, read November 2, 2026
  7. Visa Core Rules and Visa Product and Service Rules, edition of April 18, 2026, table 5-21
  8. Mastercard, Subscription/recurring payments and negative option billing merchants: FAQs, 2022
  9. California Business and Professions Code § 17602, contracts from July 1, 2025
  10. Restore Online Shoppers' Confidence Act, 15 U.S.C. § 8403
  11. FTC, FTC and states act against Hims & Hers, press release, July 29, 2026 (allegations, case pending)
  12. Klaviyo, 2026 Email Marketing Benchmarks by Industry, read November 2, 2026
  13. Tagada, Tagada Rx, read November 2, 2026
  14. Tagada docs, How Tagada Rx works, read November 2, 2026
  15. Tagada docs, Emails, read November 2, 2026
  16. Klaviyo, Acceptable Use Policy, updated April 9, 2026
  17. TagadaPay, homepage, read November 2, 2026

Tagada

Emails that follow the case, with nothing medical inside

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