Affiliate links on health content: what to disclose

A dentist writes a blog post on choosing an electric toothbrush and links to three models through a retailer’s affiliate program. A med spa nurse injector posts a skincare routine with a discount code that pays a commission. A chiropractic clinic adds a “products we recommend” page with links that earn a referral fee. A supplement company pays practitioners a share of every sale their link produces. Each of these is an affiliate arrangement, and each puts a paid relationship behind what reads as a professional opinion.

This guide reads the FTC’s endorsement guides at 16 CFR Part 255 and the FTC staff FAQ on them, explains what has to be disclosed, where and in what words, and covers the separate federal question that arises when the commission is tied to something a federal health care program pays for. Paid posts by creators are covered in our healthcare influencer marketing guide, paid articles in sponsored articles and advertorials, and claims that lean on a clinician’s authority in “clinically proven” and “doctor recommended” claims. For selling products from the office itself, see selling supplements in a medical practice. Discounts or free months given to a client for a vendor testimonial are covered in our guide to case studies and client success stories.

The short version

• A commission is a material connection. Under 16 CFR 255.5(a), a connection the audience does not expect and that could affect how much weight they give the endorsement must be disclosed clearly and conspicuously. Monetary payment is named as one.
• The guides use an affiliate blogger as an example. 255.5(b)(11) describes a reviewer who earns part of each sale through affiliate links and says the reviews should clearly and conspicuously disclose the compensation.
• Say it plainly, near the recommendation. The FTC staff FAQ suggests wording like “I get commissions for purchases made through links in this post” and says “affiliate link” alone, a “buy now” button, or “commissionable link” are not adequate.
• A site-wide disclosure page is not enough. The FAQ says a single disclosure on a home page will not do, because readers land on individual pages.
• Clinicians get closer scrutiny. The guides’ own example says consumers would not expect a physician endorser to earn a percentage of sales, so that connection should be disclosed.
• Federal program items are a separate question. 42 USC 1320a-7b(b) makes it a felony to knowingly and willfully receive or pay remuneration in return for recommending an item a federal health care program may pay for. A disclosure does not answer that question.

When an affiliate link is an endorsement

The guides define an endorsement in 16 CFR 255.0(b) as any advertising, marketing or promotional message that consumers are likely to believe reflects the opinions, beliefs, findings or experiences of a party other than the sponsoring advertiser. A product recommendation on a practice blog, a clinician’s social post or a “what we use at home” page fits that description: the reader takes it as the practice’s or the clinician’s view, not the seller’s.

Section 255.5(a) then sets the disclosure rule. When a connection between the endorser and the seller might materially affect the weight or credibility of the endorsement, and the audience does not reasonably expect it, the connection must be disclosed clearly and conspicuously. The section lists monetary payment, free or discounted products, and the possibility of being paid among the connections that count, and says a connection needs disclosure when a significant minority of the audience does not understand or expect it. The disclosure does not need the complete details of the deal, but it must communicate the nature of the connection well enough for readers to judge it.

The guides answer the affiliate case directly. Example 11 in 255.5(b) is a reviewer who writes independently but includes affiliate links and receives a portion of each sale; the guides say the reviews should clearly and conspicuously disclose the compensation because it could affect the weight readers give them. The FTC staff FAQ also rejects the idea that everyone already knows links pay: it says some content creators get paid this way and others have no connection to the marketers they mention.

Why a clinician’s link is different

Readers treat a clinician’s product recommendation as a professional judgment. The guides recognize this. In Example 4 of 255.5(b), a physician appears in a television ad for an anti-snoring product. The guides say viewers would expect the physician to be paid for appearing, but would not expect the physician to receive a percentage of gross product sales or to own part of the company, and that either fact should be disclosed. When the same physician is paid to post on social media, the guides say viewers may be more likely to assume an independent professional opinion, so the post should disclose the connection.

An affiliate commission is a percentage of sales. So a dentist, nurse practitioner, chiropractor or physician who links to a product and earns on each purchase is in the position the example describes. Two more rules from the guides apply at the same time:

• Expertise has to be real and used. Under 255.3(a) and (b), when an endorsement presents the endorser as an expert, the endorser must have that expertise and must actually have exercised it in evaluating the product. Example 2 in 255.3 says an ad that calls an endorser “doctor” for a hearing aid implies expertise in hearing.
• Claims still need support. Under 255.1(a), an endorsement may not convey any representation that would be deceptive if the advertiser made it directly. Example 6 in 255.3 says a doctor who endorses a drug’s cholesterol claim based on consumer letters or a rodent study makes a deceptive endorsement, and both the doctor and the advertiser are liable. Our clinically proven claims guide covers the evidence the FTC expects.

Where the disclosure goes and what it says

Section 255.0(f) defines clear and conspicuous: difficult to miss and easily understandable by ordinary consumers. A visual disclosure should stand out by size, contrast and location, and in an interactive medium such as a website or social media the disclosure should be unavoidable. It must not be contradicted or softened by anything else in the communication. When the content targets a specific audience, ordinary consumers means members of that group.

The FTC staff FAQ applies that to affiliate links:

• Wording. It suggests something like “I get commissions for purchases made through links in this post.” It says “paid link” right next to an affiliate link should be adequate. It says consumers might not understand “affiliate link” by itself, a “buy now” button would not be adequate, and “commissionable link” is probably not a clear disclosure.
• Placement. The closer the disclosure is to the recommendation, the better. The FAQ says readers may miss a disclosure at the very top of a page outside the post, or at the bottom, and that one placed very close to or as part of the endorsement is more likely to be seen.
• One disclosure or several. When the link sits inside the review and the reader can see the disclosure and the link at the same time, a single disclosure may be adequate. If they are separated, readers may not make the connection.
• No home page only. The FAQ says a single disclosure on a home page is not sufficient because visitors read individual reviews without seeing it.
• Video and social. For a reviewer who links products in a video description and earns a commission, the FAQ says to disclose the affiliate relationship both in the video and in the description near the links. It says the same guidance applies to reviews on someone else’s site and in short posts.
• Unpaid links need nothing. If you link to a product or retailer as a convenience and are not paid, the FAQ says there is no connection to disclose.

Rankings and “best of” pages

A practice or health company that publishes a “best” list or ranking needs to look at more than the disclosure. In Example 3 of 16 CFR 255.4, a review site that takes money from manufacturers in exchange for higher rankings is deceptive whether or not it claims independence, the manufacturers who pay may also be liable, and a disclosure of the payments would be inadequate because the payments determine the rankings. If the site does not sell rankings but receives affiliate referral payments, the example says it should clearly and conspicuously disclose those payments. A methodology that ranks products higher because of their relationship to the operator is also misleading.

The FAQ adds one narrow case where no disclosure is needed: a manufacturer that links to all of its authorized sellers and gives no preference to the ones that pay referral fees.

If your company runs the affiliate program

Health companies that pay clinicians, practices or creators per sale are advertisers under the guides. Section 255.1(d) says an advertiser may be liable for a deceptive endorsement even when the endorser is not, and that advertisers should give endorsers guidance on avoiding misleading statements and disclosing unexpected material connections, monitor their compliance, and act to remedy and prevent non-compliance. It says good faith guidance, monitoring and remedial action are not a safe harbor but should reduce the incidence of deceptive claims. The FAQ says a company that recruits, pays and directs endorsers on behalf of marketers needs, like an advertiser, reasonable programs to train and monitor them, so an affiliate network or agency in the middle carries the same duty.

In practice that means written disclosure rules in the affiliate agreement, approved claim language for anything health related, a way to see what affiliates actually publish, and a record of what you did when a post went wrong. Our advertising records guide covers keeping that file. The guides also cover employees: Example 8 in 255.5(b) says an employee promoting the employer’s product online should disclose the relationship, and the employer should train and, where it directs the posts, monitor them.

The kickback question for practices

The FTC guides deal with what readers are told. A different federal statute deals with whether the payment can be made at all. Under 42 USC 1320a-7b(b)(1)(B), whoever knowingly and willfully solicits or receives any remuneration, including a kickback, bribe or rebate, in cash or in kind, in return for purchasing, ordering, or arranging for or recommending purchasing or ordering any good or item for which payment may be made in whole or in part under a Federal health care program commits a felony. Paragraph (b)(2) covers the party that offers or pays. Subsection (f) defines Federal health care program to include federally funded health plans and State health care programs, and subsection (h) says a person need not have actual knowledge of the section or specific intent to violate it. Under subsection (g), a claim that includes items or services resulting from a violation is a false claim for purposes of the False Claims Act.

For an affiliate link, the statute’s text points to one question: can a federal health care program pay, in whole or in part, for the item the clinician recommends? A commission on a consumer product that no federal program pays for is a disclosure question under the FTC guides. A commission tied to an item such as durable medical equipment, a covered device or a covered supply, recommended by a clinician who treats patients in those programs, is a question for health care counsel before the link goes live. The statute has exceptions in (b)(3), including amounts paid to bona fide employees, and regulatory safe harbors exist at 42 CFR 1001.952; this guide did not read the safe harbors. Our guides to patient and physician referrals and DME supplier marketing cover related ground.

A pre-publish check

1. List every paid link. Retailer affiliate programs, manufacturer referral fees, discount codes that pay you, free products and anything else of value tied to a recommendation.
2. Ask whether a federal program pays for the item. If it can, stop and get a health care counsel review before publishing.
3. Check the claim, not only the link. Every health benefit stated or implied in the post needs the same support it would need in an ad. A clinician byline does not supply it.
4. Write the disclosure in plain words. “We earn a commission if you buy through links on this page.” Not “affiliate link” alone, not “partners.”
5. Put it where the recommendation is. Next to or inside the review, visible with the link. In video, say it in the video and put it near the links in the description.
6. Repeat it per page and per post. A disclosure page in the footer can explain your policy, but it does not replace the disclosure on each page.
7. Do not sell rankings. If payments affect order or placement, a disclosure will not cure it under 255.4 Example 3.
8. Keep a dated record. The page as published, the disclosure, the affiliate terms and any review you did.

Use and avoid

• Use: “We earn a commission if you buy through the links below. Our hygienists chose these brushes before we joined the program.” (only if true) Avoid: a footer link titled “Disclosures” and nothing on the page.
• Use: “Paid link” next to each product link. Avoid: “Affiliate link” or “Shop now” as the only signal.
• Use: “Dr. [name] earns a commission on sales from this code.” in the caption itself. Avoid: the disclosure only in the profile bio.
• Use: a “tools we like” page with unpaid links and a note that no one paid for placement. Avoid: a “top 5” list ordered by commission rate.
• Use: counsel review before linking to a covered item. Avoid: a commission from a supplier for recommending equipment billed to Medicare.

An illustration

This is a made-up example, not a client. A family dental practice publishes “Our favorite at-home whitening and oral care products” with eight links. Six are retailer affiliate links that pay a percentage of each sale; two are unpaid. The only disclosure is a line on the About page. The post is bylined by the dentist and says one whitening product is “the safest option.”

The fix: a plain statement near the top of the list and beside each paid link that the practice earns a commission on purchases through those links, nothing added for the two unpaid links, removal or support of the “safest” claim, and a short note on how the products were chosen. None of the products are paid for by a federal health care program, so the kickback statute’s payment condition does not arise; if the practice later adds a link to a covered device, that link goes to counsel first.

How we help

We write and edit practice website content and search-focused articles for independent practices, with disclosures placed and worded against the FTC guides as read on the day, and we can review a product page or recommendations list before it goes live. We also run Google Ads, lead generation and an AI front desk. We are not a law firm and do not give legal or medical advice. Related guides: running a practice blog, a practice YouTube channel, celebrity and spokesperson endorsements and our guide to healthcare marketing rules.

Sources

• 16 CFR Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising
• FTC: FTC’s Endorsement Guides: What People Are Asking (June 2023)
• 42 USC 1320a-7b: Criminal penalties for acts involving Federal health care programs

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