Why Reducing Paper Inserts Is About Access as Much as Sustainability

The Prescription Information Modernization Act of 2025 (PIMA) is being hailed as a significant development for the pharmaceutical industry because it represents rare bipartisan agreement on an issue that directly impacts both healthcare providers and patients. In a video interview with Pharma Commerce, Diogo Rau, executive vice president and chief information and digital officer for Eli Lilly and Company, emphasizes that when legislation garners cross-party support, it often signals a transformative change.

One of the core issues PIMA addresses is the outdated, cumbersome nature of prescription information. Unlike other consumer products that spark excitement and social sharing, medicines are often accompanied by an overwhelming amount of paper-based documentation, which dampens the patient experience. Physicians and patients alike must navigate lengthy, jargon-heavy inserts that are difficult to read and understand.

Currently, a typical prescription package insert equates to roughly 45 pages if formatted as a standard book. These inserts are printed in extremely small font sizes and filled with technical language, making them inaccessible to many, especially patients with limited English proficiency. This creates barriers to understanding medication instructions, side effects, and other critical information, undermining both safety and adherence.

PIMA aims to modernize this system by initially focusing on the documentation that healthcare providers receive. While it doesn’t yet solve all issues tied to patient-facing labeling, it represents the first step toward broader improvements. By digitizing and simplifying prescription information, the Act seeks to reduce inefficiencies, enhance accessibility, and ultimately create a better healthcare experience.

For manufacturers, this modernization could mean streamlined compliance and reduced printing costs, while providers benefit from clearer, more usable data that aids in decision-making. Patients stand to gain the most through improved comprehension of their medications, which may lead to greater confidence, adherence, and outcomes. Rau underscores that while PIMA is only a starting point, it lays the groundwork for transforming how prescription information is communicated in the future.

He also comments on the impact reducing paper inserts will have on pharma operations and environmental goals; the challenges that remain for full-scale adoption of electronic prescribing information; and much more.

A transcript of his conversation with PC can be found below.

PC: From a cost and sustainability perspective, what impact will reducing paper inserts have on pharma operations and environmental goals?

Rau: Reducing paper will definitely impact the environment. It's about 90 billion sheets of paper that get printed for medicine inserts, and again, this Act doesn't fix that yet, but that's the path that we're going towards, so an enormous environmental impact there, and I think that's the societal benefit that we all start thinking about first, the environmental impact.

But I actually want to turn your attention towards a different societal impact that I think needs to be part of this conversation as well, which is the ability to access the information that's in there. If your near vision has deteriorated, or your vision is not good to begin with, you're going to have a hard time reading that four-point text. If you don't speak a lot of medical jargon, if you're somewhere on the neurodiverse spectrum, it may be very hard to follow all the instructions that are in there. If you have any sort of motor difficulties, it's literally hard to unfold paper that comes with medicines. And of course, if English is not your native language—in the United States anyway—you're going to have a hard time following those instructions as well.

I think as much as we talk about the environment, I would love to also see us talk about the benefits to society in terms of just making medicines easier to understand what they do and what side effects and what contraindications you may have. The environmental impact, though, like I mentioned, is not small. It's probably not going to make a material gain or material difference for pharma companies. I don't think anybody's going to really post extra earnings just because they stop printing labels, so our interest is not really in just trying to reduce our costs. We would like to do this because it's better for the environment, but it's also better for society because it makes just makes things more accessible to everybody that's out there.