Nav: Home

ACP issues policy recommendations aimed at mitigating the rising costs of prescription drugs

November 11, 2019

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information.

1. ACP issues policy recommendations aimed at mitigating the rising costs of prescription drugs

ACP calls for increased transparency, lower out-of-pocket costs for patients, and improved access to affordable medications

Note: HD video soundbites of the authors discussing the paper are available to download at

Abstract PBMs:

Abstract Public Health Plans:


URLs go live when the embargo lifts

In two new policy papers, the American College of Physicians (ACP) calls for changes aimed at mitigating the rising cost of prescription drugs. The papers provide recommendations to improve transparency in industry and government, examine the role of the Pharmacy Benefit Manager (PBM), and address issues in public health plans that create barriers to care. Both papers are published in Annals of Internal Medicine.

The new recommendations expand on ACP's 2016 policy paper, Stemming the Escalating Cost of Prescription Drugs, and focus on the need for increased transparency in how drugs are priced, lowering the out-of-pocket costs for patients, enhancing the government's purchasing power, and take a closer look at the roles PBMs and public health plans play in the industry and how to help stem the rising cost of prescription drugs.

To address the complex factors at play, ACP's paper offers a series of recommendations aimed at improving transparency surrounding PBMs and underscores the need for reliable and timely information on prescription drug pricing for physicians and patients. ACP's paper also addresses issues in public health plans, including the Medicare and Medicaid programs, which can add costs to the health care system and increase expenses for patients.

The author of an accompanying editorial from discusses four of ACP's recommendations in detail and notes that many of ACP's policy recommendations are currently being debated by members of Congress. The author suggests that having clear support from physician groups on reforms that focus on drug pricing, out-of-pocket spending, and access are encouraging.

Notes and media contacts: For an embargoed PDF or to speak with someone from ACP, please contact Julie Hirschhorn at

2. 3 Wishes Project proves transferrable, affordable, and sustainable for providing valuable care at end of life


URLs go live when the embargo lifts

The 3 Wishes Project, an end-of-life program designed to honor the dignity of dying patients, has proven to be transferrable, affordable, and sustainable for providing value at end of life. The program, which was pioneered at St. Joseph's Healthcare in Hamilton, Ontario, was analyzed at four additional sites to determine if it could be successfully implemented at other locations. The findings are published in Annals of Internal Medicine.

The 3 Wishes Project was created to enrich the relationships among patients, family members, and clinicians that are foundational to empathetic end-of-life care. By eliciting and implementing wishes from the dying patient, the project gives caregivers and clinicians "something" to do when the goals of care have shifted from curative to palliative. While the program was started at St. Joseph's Healthcare, word of its success spread, and ICU clinicians from all over the world wondered if they, too, could implement the program in their own hospitals.

Researchers from McMaster University set up the 3 Wishes Project in three new North American ICUs to determine whether it could be successfully implemented (defined as demonstrating value, transferability, affordability, and sustainability) beyond the ICU in which it was created. A total of 730 patients were enrolled, and 3,407 wishes were elicited. Qualitative data were gathered from 75 family members, 72 clinicians, and 20 managers or hospital managers. The researchers measured characteristics and processes of care; the number, type, and cost of each wish; and feedback from family and the care teams. They found that the cost was affordable and family members, clinicians, hospital managers, and administrators spoke at length about the value they experienced from the program. In fact, the 3 Wishes Project was continued at all four sites after the research project had concluded. According to the researchers, these findings suggest that the 3 Wishes Program may be successfully implemented at other ICUs.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at To speak with the lead author, Deborah J. Cook, MD, MSc, please contact Veronica McGuire at

3. Online coaching coupled with EHR-based tracking tools may help to maintain weight loss better than using EHR-based tracking tools alone



Free Summary for Patients:

URLs go live when the embargo lifts

Use of electronic health record (EHR) tracking tools plus online coaching helped adults maintain intentional weight loss better than using EHR tools alone. Findings from a randomized trial are published in Annals of Internal Medicine.

Weight regain after intentional loss is common, yet few randomized clinical trials to date have focused on weight maintenance. Weight maintenance interventions can be integrated into routine primary care by using the EHR to identify potentially eligible patients, establish ongoing contact with those patients, and engage the primary care provider. It was hypothesized that incorporating personalized coaching and primary care physician support into the intervention would help to maintain recent weight loss.

Researchers from the University of Utah and University of Pittsburgh randomly assigned 194 participants who had lost at least 5 percent of their body weight in the previous 2 years to a weight maintenance intervention consisting of either EHR-based tracking tools alone or the tracking tools plus online coaching to evaluate their benefit in helping to maintain weight loss. The EHR tools included weight, diet, and physical activity tracking flow sheets; standardized surveys; and reminders. Participants in the coaching group received 24 months of personalized coaching through the EHR patient portal, with 24 scheduled contacts. The researchers found that, on average, the participants in the tools-only group regained about twice as much weight as those in the tools plus coaching group. At 24 months, 65 percent of participants in the coaching group and 50 percent in the tracking group maintained weight loss of at least 5 percent.

According to the author of an accompanying editorial from Kaiser Permanente Colorado, the study represents an important step forward in the integration of obesity treatment into routine medical care because it utilizes the electronic health record. However, there were some limitations to the study. Participants were socioeconomically advantaged and had mild to moderate obesity. Also, despite the relatively low burden of participation, 60 percent of the persons who qualified for the study declined to participate, suggesting that not all patients want formal assistance with behavior change.

Notes and media contacts: For embargoed PDFs please contact Lauren Evans at To speak with the lead author, Molly B. Conroy, MD, MPH, please contact Julie. Kiefer at

Also new in this issue:

The Hamman Sign: A Case Report With Audio Recording

Gabby Reijnders, MD

Case Report

Embargoed for release until 5:00 p.m. ET on Monday November 11 2019

Annals of Internal Medicine Tip Sheet


American College of Physicians

Related Prescription Drugs Articles:

One quarter of prescription drugs in Canada may be in short supply
Research from the Centre for Health Evaluation and Outcome Sciences (CHÉOS) sheds new light on the factors behind drug shortages in Canada, a common problem across the country.
Prescription opioid use, misuse among cancer survivors
This survey study looked at the frequency of prescription opioid use and misuse among adult cancer survivors compared with individuals without cancer.
Medicare Part D favors generic prescription drugs over branded counterparts, study finds
Published this week in Health Affairs, the study led by Stacie Dusetzina, PhD, Ingram Associate Professor of Cancer Research and associate professor of Health Policy, compared Medicare Part D coverage of more than 1,360 pairs of generic and brand-name drugs.
Regular use of prescription drugs for pain and sleep increases frailty risk by 95 percent
Regular use of prescription drugs for pain and sleep increases frailty risk by 95 percent among older adults.
ACP issues policy recommendations aimed at mitigating the rising costs of prescription drugs
In two new policy papers, the American College of Physicians (ACP) calls for changes aimed at mitigating the rising cost of prescription drugs.
Codeine misuse in Australia reduced by prescription-only changes
The move to prescription-only codeine in Australia has seen a 50 percent reduction in the monthly rate of codeine-related poisoning calls and halved codeine sales, finds new research led by the University of Sydney.
Nearly 1 in 3 patients with lupus use prescription opioids for pain
A new study finds nearly one in three adults with lupus use prescription opioids to manage pain, despite a lack of evidence that opioids are effective for reducing pain from rheumatic diseases.
Negotiation: A three-step solution to affordable prescription drugs
Criteria are offered by Harvard University and George Mason University experts for Medicare to negotiate drug prices and prioritize specific drugs for maximum savings.
Prescription drug monitoring program mandates
States that require prescribers to register with and use prescription drug monitoring programs in most clinical circumstances saw notably fewer opioid prescriptions and reduced opioid-related hospital use by Medicaid patients compared to states with weak or no drug monitoring program mandates, according to a new study from investigators at Weill Cornell Medicine.
One-third of pre-approved prescription drugs have not completed the FDA approval process
The Food and Drug Administration's (FDA) Accelerated Approval Program was created in 1992 to significantly accelerate the ability to bring certain new drugs to market.
More Prescription Drugs News and Prescription Drugs Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at