SMS for Pharma: Reaching patients in the moments that matter 

Pharma marketing budgets have grown enormously, and they've moved decisively toward digital. According to industry estimates, ad spend climbed from roughly $12 billion in 2015 to an estimated $39 billion in 2025, and 2025 was the first year social media outpaced linear TV in healthcare and pharma ad spending.

The bulk of that spending buys awareness. By comparison, very little is designed to reach a patient at the moment something needs to happen: the prescription that's about to lapse, the weekly injection that's due tomorrow, the appointment nobody confirmed.

That gap is where SMS lives. This post covers why the channel fits that moment, the use cases worth building, and the compliance layer you need to plan around before you build anything.

Pharma brands have already proven they can generate awareness at scale. GLP-1s alone accounted for more than a third of the top 10 prescription TV ad spend in the first half of 2025, and more than half of Gen Z and millennials aware of GLP-1s have seen ads for them on social. People know these drugs exist.

The problem is what happens next. Awareness gets someone to ask their doctor. It doesn't get them to fill the script, take the dose on schedule, or come back for month three. And adherence is where the economics actually sit, because a patient who abandons treatment in week six generates a fraction of the value of one who stays.

This matters more now because of how fast the category has moved. According to published analyses, spending on GLP-1s rose more than 500% between 2018 and 2023, from $13.7 billion to $71.7 billion in inflation-adjusted terms. Non-diabetic prescriptions for medications like semaglutide climbed roughly 700% over the same stretch. Some analysts project the global GLP-1 market could reach $200 billion by 2030, inside a pharmaceutical market valued around $2.15 trillion in 2026 and projected to roughly double by 2034.

Categories growing that fast tend to have marketing programs built for acquisition and very little built for what comes after. The patient volume arrived before the lifecycle infrastructure did.

Attention moved to the phone, and SMS is the channel that lives there without asking permission first. More than 93% of people send and receive texts daily and check their messages upwards of ten times a day. There's no app to download, no algorithm deciding whether your message surfaces, and no promotions tab.

It's also personal in a way no other marketing channel is. A text lands in the same place as messages from family. That proximity is exactly why it works for action-moment messages and not for things that feels like a broadcast.

The engagement numbers are strong. Reported SMS open rates run far above email; most texts get read within a few minutes of arriving, and response rates dwarf what email produces. Consumer expectations have shifted to match: more than 85% of consumers have opted into texts from at least one business, so the question isn't whether people accept brand texts, it's whether yours are worth the interruption.

For pharma specifically, there's evidence-based support from the public health community behind this, not just marketing benchmarks. The Community Preventive Services Task Force, an independent panel appointed by the CDC director, formally recommends text messaging interventions to improve medication adherence among patients with chronic conditions. Their review found the effect holds across reminder frequencies, personalization approaches, and one-way versus two-way messaging. That's an unusual thing to be able to say about a marketing channel.

The use cases that follow from this generalize across drug classes: refill reminders, dosing and injection reminders, appointment confirmations, program enrollment, and care-team check-ins.

Three separate systems govern healthcare SMS, each answering a different question. Teams new to the channel tend to plan for one and get surprised by the other two. What follows is orientation, not legal or compliance advice. Work the specifics with your own counsel and compliance team before building anything.

Promotional messages require a higher standard of consent than transactional ones, and the exposure is significant: statutory damages run $500 to $1,500 per violation with no aggregate cap, which means one non-compliant campaign to a large list is a serious liability rather than a fine. The regulatory picture here is genuinely in motion, with recent federal court decisions and FCC orders reshaping both the consent standard and the rules governing revocation. Treat this section as orientation and work the specifics with your counsel.

If your organization handles protected health information, HIPAA shapes message content. It doesn't rule out SMS. It means anything touching PHI needs a compliant workflow rather than a standard marketing send. The practical convention most teams land on is to keep PHI out of the message body entirely and use the text to point someone toward a secure, authenticated portal instead. A text saying your results are ready is fine. A text containing the results is a different conversation.

This is the layer marketers don't see coming. Wireless carriers, messaging providers, and industry practices may impose additional requirements, review campaigns, or filter messages. Carrier requirements and CTIA guidelines aren't law, but carriers write them into contracts and enforce them through automated content filtering and campaign review at 10DLC registration. CTIA’s messaging principles are voluntary, and implementation can vary among providers and under their individual policies and contracts.

Clearing TCPA and HIPAA review doesn't mean you'll clear the carrier layer. It's a separate gate with its own reviewers, and options may be limited if a number gets filtered. Whether a specific campaign is approvable depends on evolving factors, including a product's FDA-approval status. Work that through with your platform or provider before you build the campaign, not after it gets rejected.

Every SMS you send falls into one of two categories, and the consent you need depends on which one. In pharma, the line between them is blurrier than in almost any other industry.

Transactional messages relate to something the recipient already did or is owed: appointment reminders, refill-due notices, dosing check-ins, prescription-status updates. These generally require a lower consent standard, since the person provided their number as part of an existing care or service relationship.

Marketing messages are promotional: new program announcements, copay card offers, patient-support enrollment prompts, or anything designed to move someone toward a purchase or enrollment decision. These require express written consent and draw the most scrutiny under both TCPA and carrier content review.

The risk is that a single edit can reclassify a message. A dosing reminder is transactional. Add a line promoting a savings card or copay program to that same reminder, and the entire message may be treated as marketing,. That reclassification happens at the copy level, often during a routine content update, and it's why this distinction is worth building into your review process as a policy rather than evaluating per campaign.

Here are examples of where SMS may fit in a patient engagement program, though approvability depends on your specific product, regulatory status, and carrier review. Most programs should be able to pursue two or three of these immediately.

Onboarding. Enrollment confirmation for a medication program or patient support service. Welcome messages with next steps after a new prescription is filled. Device or companion-app instructions sent at pickup, when questions are fresh.

Adherence and active treatment. Dosing reminders for daily or weekly medications. Injection-day nudges for products on a fixed schedule. Symptom and side-effect check-ins during titration, when patients are most likely to drop off.

Refills and retention. Refill-due reminders before a prescription lapses. Ready-for-pickup notifications. Re-engagement messages for patients who have gone quiet on a recurring program.

Appointments and logistics. Reminders and confirmations for prescribing visits or telehealth check-ins. Rescheduling prompts when a slot opens. Prior-authorization and insurance-status updates are among the most genuinely useful texts a patient can receive.

Every channel has a different gatekeeper and a different tolerance for content, and using them interchangeably wastes all of them.

Email tolerates detail. Risk disclosures, program specifics, dosing documentation, anything long. It's governed by CAN-SPAM and opt-out mechanics, and messages aren't subject to carrier content filtering the way SMS is.

Push and in-app work well for engaged patients who've already installed something, with their own review layers and a reach ceiling set by who has the app.

SMS typically commands the most immediate attention and carries the strictest compliance requirements. It's the only one of the three subject to both a heightened consent standard and a carrier content filter.

So the strongest programs use SMS for short, time-sensitive, action-oriented messages, and let those messages hand off to richer channels for anything that needs explaining. A text that says your refill is due with a link to a page covering the details plays to both channels. A text trying to be the page fails at both.

Customer.io runs SMS on the same data and workflow layer as email, push, and in-app, so segmentation and orchestration logic is shared across channels rather than stitched together per channel. That matters for adherence programs in particular, where the same patient state needs to drive a text on Tuesday and an email on Friday without the two contradicting each other.

On SMS specifically, we can provision sender numbers and walk you through carrier registration end-to-end, or you can connect your own SMS provider account. Which path fits depends on where you're based, where you're sending, and your compliance requirements. If your program involves protected health information, we ask that you sign a BAA.

Our SMS setup docs cover the options, and our HIPAA and privacy guidance covers consent handling, BAAs, and access controls. If you're weighing paths, talk to us before you register, since the right configuration depends on your specific compliance requirements.

SMS earns its place in the pharma marketing mix by owning the action moment: the dose, the refill, the appointment. It's not a replacement for the channels that build awareness or carry detail, and it comes with a three-layer compliance stack that's much easier to plan for than to discover after a campaign gets rejected.

If you're building patient engagement in a category that grew faster than its lifecycle program did, that's a solvable problem, and it starts with mapping which moments actually need a text. Talk to us about building a compliant multi-channel patient engagement program.

Transactional messages relate to something the patient already did or is owed, like a refill notice or appointment reminder, and run on a lower consent bar. Marketing messages are promotional and require a higher consent standard. Adding promotional language to an otherwise transactional message can reclassify it, which changes what consent you needed.

10DLC is the registration system for standard 10-digit numbers used in application-to-person messaging in the US. You register your brand and your use case, and carriers review both. It matters for pharma because prescription drug messaging is one of the content categories that receives additional scrutiny during that review. Registration is separate from legal compliance: passing TCPA review doesn't get you through carrier review, and options for contesting a rejected or filtered campaign may be limited.