Op-Ed: Why Is Prescribing Information Still on Paper?

The Biden administration has committed the U.S. to an ambitious net-zero emissions climate plan that will require every sector of the economy to evaluate its respective contribution to emissions if we are to hit the targets.

The health sector is no different, as one of the largest contributors to the world’s carbon footprint, accounting for nearly 5% of global net emissions. If the healthcare sector were a country it would be the fifth largest emitter in the world.

Some examples of environmental impact by the health sector include anesthetic gases and inhaler propellants, pharmaceutical packaging, and disposal of medical waste and equipment. But one solution that could make a significant difference involves the prescribing information given to prescribers and pharmacists. A simple change now could save millions of trees every year and enough energy to power thousands of homes.

Prescribers need access to comprehensive, up-to-date technical information on the safe and effective use of medicines. This is provided in the prescribing information, which is 30 pages of printed paper on average. In 2014, the FDA recommended that electronic distribution of prescribing information should be the default method for the safe and effective use of prescription drugs, with paper versions only used when necessary.

Practitioners agree. Almost all access prescribing information from the NIH DailyMed website, where they receive real-time updates provided by the FDA. This reflects a paradigm shift toward digital prescriptions — 99% of U.S. pharmacies now use e-prescribing.

And yet, in the U.S. it remains mandatory to provide a printed copy of the prescribing information with every prescription, as Congress continues to block progress on this outdated practice. That’s more than 100 billion pages of paper every year. Pages that are often out-of-date and read by very few. Pages that rarely even reach the prescriber because they are discarded when prescriptions are re-packaged at the wholesaler or pharmacy level.

We must — and can — stop this huge, unnecessary waste of precious natural resources, and the devastating impact that such waste has on our climate.

Making the change is straightforward because the drug manufacturers, prescribers, and regulators have already shifted to using online information. To realize this substantial decarbonization impact we need to take three simple steps.

First, Congress must remove its outdated objection to the FDA implementing its recommendation to make electronic prescribing information the default and paper versions the exception. Congress is failing in its duty to serve the people, the patient, the practitioner, and the planet.

Second, when Congress allows, all prescribers should be notified when the change will come into force and should be offered someone to contact if withdrawal of paper versions would be difficult. Ideally, we would ensure all practitioners have reliable internet access; but other accommodations, including providing paper prescribing information just to those who need or want it, would stop the production and waste of huge quantities of paper.

Third, we will need a back-up system for times when the digital information is not accessible — temporarily or typically — starting with a universal number to call.

All this could be quickly achieved as soon as we commit to decarbonization and to saving, not squandering, natural capital.

An ambitious decarbonization target has been set, and while it is easy to become daunted by the task or to believe only complex innovations will be successful, we should not overlook the prosaic, impactful solutions hidden in plain sight. We must see them and act upon them. Helen Keller, one of healthcare’s most inspirational changemakers said it well:

“I long to accomplish a great and noble task, but it is my chief duty to accomplish small tasks as if they were great and noble.”

The decarbonization of healthcare will depend on accomplishing the small tasks, and completing the change to electronic prescribing information is a small change with a great impact. It’s time.

Nazneen Rahman, MD, PhD, is a physician, scientist, founder of YewMaker Sustainable Healthcare, and director of the Sustainable Medicines Partnership.