The Medical Letter CME and subscription cost: $179 a year, $65 for trainees, 52 credits included

The Medical Letter publishes 26 issues a year, and each issue has an online exam worth 2 AMA PRA Category 1 Credits. Take all of them and you earn 52 credits. For a subscriber that credit is free, so the effective price is $179 divided by 52, or about $3.44 a credit, and you get the issues themselves on top.

Buy the same credit without subscribing and the numbers change. Per-issue exams cost $15 each, or $10 each once you buy three or more. Twenty-six exams at $10 is $260, which is $81 more than the subscription that includes them. The semi-annual Comprehensive Exams are a third route: $79.50 each for 26 credits, so $159 for 52 credits a year, still without the issues.

The breakpoint is simple. If you will complete more than about 17 exams a year, subscribe. If you need six or eight credits to close out a renewal cycle, buy three or four exams and stop there. Most buyers who regret a subscription are in the second group and bought it for a handful of credits they could have bought for $40.

The Medical Letter is accredited by ACCME for physicians, and completing an activity with its evaluation earns ABIM MOC points equal to the credit claimed, reported through ACCME. The same activities count toward the American Board of Surgery's Continuous Certification. The AAFP has approved the program for 2026, with a term running from 1 January to 31 December.

Pharmacists get credit too. The Medical Letter is an ACPE provider, and each exam is accepted for 2.0 hours of knowledge-based continuing pharmacy education (0.2 CEU). For PAs, the program has been reviewed by the AAPA panel and found compliant with its CME criteria.

Nurse practitioners are named in the program's intended audience, but the vendor does not list ANCC accreditation. Most NP certification boards accept AMA PRA Category 1 credit for part of the requirement, so check your own board's rules before you count on it. If you need nursing contact hours specifically, the Prescriber's Letter subscription cost page covers the edition sold with APRN CE.

Not for individuals. The vendor offers a free trial to institutions weighing a site license, and publishes sample articles anyone can read, but a personal subscription starts paid. What replaces the trial is the refund rule: the FAQ says you can cancel for any reason within 30 days of purchase for a full refund, and no refund is given after 30 days.

So treat the first month as the trial. Read the two issues that arrive, take both exams, and decide before day 30. That is a better deal than the final-sale terms some clinical references use: PEPID, for example, states that all its sales are final, as we note on the PEPID cost page.

The checkout offers the one year term at $179 with AutoRenew or without it, at the same price. With AutoRenew the subscription renews at the prevailing rate when it expires, and the only cancellation route the page names is a phone call to 1.800.211.2769. If you prefer to decide each year, choose the option without AutoRenew and nothing is lost.

The second trap is the exam calendar. Per-issue exams close on fixed dates, which the current catalog prints next to each one. A subscriber who saves every exam for the month before a license renewal can find the early ones already expired. Take them as issues arrive.

The mobile app is a free download for subscribers, but set expectations: the US App Store listing shows 2.6 stars from 8 ratings and a last version from March 2021. The mobile website carries the same issues and exams, and many subscribers read there instead.

The Medical Letter tells you which drug the evidence favors for a condition, what a new approval adds, and what it costs. It is one of the best independent sources for that. What it cannot do is look at the patient in front of you: the eleven medications on their list, the eGFR from last week, the allergy recorded in another system.

Prescriber.io works at that moment. You enter the prescribing scenario once, and it checks interactions across the whole list, flags contraindications and allergy blockers, and surfaces renal and hepatic dose adjustments together in one card with cited sources. It is decision support for licensed clinicians, priced per seat from $29 to $59 a month, and it sits beside a subscription like The Medical Letter rather than replacing it. You review every flag, verify against official sources, and sign.