Market share growth will be impeded by challenges in converting patients who are stable on originator products to biosimilars and by benefit designs that do not incent patients to use biosimilars. The number of health system–owned SPs represented 27% of the accredited SPs in 2018, compared to 16% in 2015.4 Smaller, independent SPs are declining, representing 47% of accredited SPs in 2018, compared to 59% in 2015. As companies like Amazon impact the drug distribution model for pharmacy and reshape the consumer experience in buying prescription drugs, pharmacy needs to invent care models to remain relevant. The introduction of biosimilars and the speed by which generic drug products are introduced into the market are 2 factors influencing the cost trends of medications.1 Interestingly, 91% of Forecast Panelists (FPs) indicated they believe that biosimilars will achieve 25% of the market share in the next 5 years (Figure 6, item 1). Artificial intelligence (AI) and other advanced computing technologies are growing in presence and impact throughout healthcare.1 It is plausible that multiple pharmacy-related tasks now fulfilled by personnel may soon be accomplished by AI, but in order for effective AI systems to be developed and applied, a significant body of high-quality data related to the task to be automated must be available. Interpretation of genetic results can be challenging, and an investment in infrastructure must be made so that appropriate interpretations are available in real time and errors are avoided. Real action to improve competition, such as eliminating “pay for delay” deals and reforming drug patent laws to prevent “evergreening,” are needed to truly impact the problem. One of the most common pharmacy services offered through retail clinics is vaccinations. Pharmacy departments have significant costs but limited ability to create billable revenue under the traditional fee-for-service structure. 340B was once again a hot topic at ASHP 2019. Develop and implement health system–based programs that respond to those same drivers. Todd W. Nesbit, Pharm.D., M.B.A., FASHP, Director – Pharmacy Patient Care Services, The Johns Hopkins Health System, Baltimore, MD. The existing regulatory landscape frequently results in confusion for patients and conflicts for healthcare practitioners. (2020). Rena M. Conti, Ph.D., Associate Professor, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Boston, MA. They did not consider where drug products were made, perhaps assuming sufficient geographic dispersion so that a single natural disaster could not significantly disrupt supplies. Rather than being rewarded for high volume of medication use, departments will be judged on their ability to ensure appropriate medication use that reduces total cost of care (by shortening length of stay, reducing hospital readmission, etc.). Diane B. Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Clinical Professor and Associate Dean for Healthcare Partnerships, Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, Austin, TX. OSHA advocates for approaches using the principle of ALARA (as low as reasonably achievable) to minimize exposure risk, and it is this benchmark that is reflected in the 2019 American Society of Clinical Oncology standards.6. Boeing bypasses traditional health insurance model in contract with MemorialCare health system: a sign of things to come? Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. Created in the 1990s to consolidate purchasing power for employers and health plans, PBMs have done a nice job getting discounts from pharmacies and drug companies to lower the cost of the pharmacy benefit. However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. Due to regulatory barriers and the lack of standardization in data sources within electronic health records2, such data are rare in healthcare, and few health systems will have sufficient reliable data to effectively inform advanced computing applications. In this section of the Pharmacy Forecast, drivers of reform are examined. To prepare FPs to answer survey questions in this section, we introduced the concept of the black swan and provided several hypothetical (but potential) black swan events as examples. Collins SR, Bhupal HK, Doty MM. Those health systems not already offering specialty pharmacy services should carefully evaluate the cost and risk of creating new programs and consider business and care delivery partnerships instead of developing programs on their own. The results for survey items 3 and 4 (Figure 8) are worrisome because they suggest that both health-system pharmacy departments and health systems as a whole tend not to have a strategic planning process that is well suited to dealing with black swans. Address correspondence to Dr. Swarthout (mdavlin1@jhmi.edu). Search for other works by this author on: Ambulatory and Transitions of Care Services, Department of Pharmacy, Johns Hopkins Health System, Address correspondence to Dr. Swarthout (, Professor of Epidemiology and Medicine, Division of General Internal Medicine, Department of Medicine, Johns Hopkins Medicine, Diane B Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Clinical Professor and Associate Dean for Healthcare Partnerships, Pharmacy Practice Division, The University of Texas at Austin College of Pharmacy, McCombs School of Business, The University of Texas at Austin College of Pharmacy, Associate Vice President and Chief Pharmacy Officer, Senior Vice President of Operations, Wake Forest Baptist Health, Director – Pharmacy Patient Care Services, The Johns Hopkins Health System, William Greene, B.S.Pharm., Pharm.D., BCPS, FASHP, FCCP, Chief Pharmaceutical Officer and Member, Pharmaceutical Department, St. Jude Children’s Research Hospital, Senior Director, Adjunct Associate Professor, Drug Information and Support Services, University of Utah Health, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Director of Innovation and Activation, Indiana University Health, Senior Vice President and Chief Information Officer, Indiana University Health, and President, Indiana University Health Plans, James M Hoffman, Pharm.D., M.S., BCPS, FASHP, Chief Patient Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, The black swan—the impact of the highly improbable, STRATEGIC RECOMMENDATIONS FOR PRACTICE LEADERS, Shared decision making—the pinnacle of patient-centered care, Patient Protection and Affordable Care Act. products, necessitating a specially trained and certified pharmacy workforce. Healthcare Executive, Ridgewood, NJ. Direct pharmacist involvement is critical to ensure that patients benefit from a medication-use system designed to ensure that appropriate efficacy, safety, and cost considerations are addressed. Their ability to identify and form partnerships with entities outside pharmacy (even outside healthcare) will also be essential to develop truly innovative ventures such as insourcing pharmacy benefits management for employees to keep revenue within the health system. McKesson Series: Using Technology to Simplify Vaccination Programs. Eric Maroyka, Senior Director, Center on Pharmacy Practice Advancement sits down with Patricia C. Kienle, MPA, BCSCP, FASHP, and Michael Ganio, Senior Director, Pharmacy Practice and Quality to discuss aspects of the draft The National Institute for Occupational Safety and Health (NIOSH) List of Hazardous Drugs in Healthcare Settings 2020. Treatment Updates and Specialty Pharmacy Controversies in Atopic Dermatitis Recording from June 10, 2020 with CE credits available until July 1, 2021. There are multiple pending or expected regulations coming down the pike that will determine key opportunities for the pharmacy industry. Pharmacists should realign services to emphasize continuity of care, lead the way in using PROs in meaningful ways, embed shared decision-making into workflows, and offer solutions to tackle large public health challenges by leveraging pharmacist–patient relationships. The term relates to the centuries-old assumption that all swans were white, which held until a black swan was discovered in 1697, forever changing the assumption about the color of swans. Within each section of this report, the results of each survey question are summarized in detail. Again, this distribution was not substantially different from that of the 2019 panel. © 2020 MJH Life Sciences and Managed Healthcare Executive. 111–148, 124 Stat, The evolution of patient-centered care and the meaning of co-design, Joint Commission of Pharmacy Practitioners, Supporting patient independence in long term haemodialysis, strategic planning advice for pharmacy departments in hospitals and health systems, Pharmacy forecast 2016–2020: strategic planning advice for pharmacy departments in hospitals and health systems, December 2015, Use of prescription assistance programs after the Affordable Health Care Act, My child is sick; don’t call her a consumer, PTCB Certified Compounded Sterile Preparation Technician (CSPT) Program, Augmented intelligence in health care H-480.940, The executive guide to artificial intelligence: how to identify and implement applications for AI in your organization, Recommended quality measures for health-system pharmacy: 2019 update from the Pharmacy Accountability Measures Work Group, Occupation Safety and Health Administration, Controlling occupational exposure to hazardous drugs, Safe handling of hazardous drugs: ASCO standards, The ethical, legal, and regulatory issues associated with pharmacogenomics: systematically quantifying the literature, Clinical cancer advances 2018: annual report on progress against cancer from the American Society of Clinical Oncology, Identifying the root causes of drug shortages and finding enduring solutions, American Society of Health-System Pharmacists, Summit on drug shortages to examine impact on national security and health care infrastructure, National Academies of Sciences, Engineering, Medicine, Bottle of lies: the inside story of the generic drug boom, Cancer drug prices rise with no end in sight, National trends in prescription drug expenditures and projections for 2019, How the U.S. compares to Europe on biosimilar approvals and products in the pipeline, The specialty pharmacy boom: our exclusive update on the U.S. market, The top 15 specialty pharmacies of 2018: PBMs keep winning, Kentucky pharmacists have new authorities to improve patient, public health, For 2019, employers adjust health benefits as costs near $15,000 per employee, Healthcare industry consolidation: Walmart-Humana merger & Medicare Advantage plans. Whether or not a fully realized single-payer system is achieved, broadening access to efficient care—particularly outside the acute care setting—is essential. However, 4 organizations (CVS Health, Cigna/ESI, Walgreens, and UnitedHealth Group) represent 70% of specialty drug revenues.5 Market domination by SPs aligned with insurers will likely continue, as will shared contracting with clients, restricted access to limited distribution medications, and closed SP payer networks. Identify and implement strategies that minimize the inefficiencies brought to the healthcare system by fiscal and supply chain intermediaries (PBMs, GPOs, and wholesalers) when their services do not add real value to health-system pharmacy performance. This phrase summarizes the world of pharmacy in 2019. Two survey items addressed these concerns. Supported by an educational grant from Sanofi Genzyme and Regeneron Pharmaceuticals. For example, infectious diseases and antimicrobial stewardship clinicians might be aligned as one team across acute care and ambulatory practice, sharing responsibility for patient outcomes longitudinally for programs like outpatient parenteral antimicrobial therapy, with pharmacists potentially rotating between acute care and ambulatory care responsibilities. Routine communication and collaboration on quality improvement projects will yield efficiencies, helping to financially justify the added time needed for this work. FPs indicated that Haven will reduce healthcare spending for the companies’ employees (Figure 7, item 2), but it is unclear if those savings will be realized more widely. Forecast Panelists’ responses to the question, “How likely is it that the following will occur by the year 2024 in the geographic region where you work?”. When compared to the distribution of survey respondents in 2019, we achieved improved balance in both the percentage of responses coming from each region and the response rate per million population in this year’s survey. The authors have declared no other potential conflicts of interest. Michael J. Melby, B.S.Pharm., M.S., Director of Innovation and Activation, Indiana University Health, Indianapolis, IN. Individuals in remote locations can fill prescriptions that can then be mailed to their location. The members of the Pharmacy Forecast Advisory Committee were instrumental in considering hundreds of factors that may influence the future of health-system pharmacy and distilling those ideas into a coherent survey. RPS meets with government to discuss pharmacists amending prescriptions during medicines shortages. aBased on 2010 U.S. Census population data (estimated). Such government actions may include eliminating patent manipulations that prolong the time it takes for generic drugs to be introduced into the market, prohibiting financial deals among companies that prevent the timely introduction of generic drugs, and resolution of alleged price fixing among generic drug companies. Bruce E. Scott, B.S.Pharm., M.S., FASHP, (Ret.) The customer is changing from a physician-centric to a patient-centric world. As specialty pharmacy and ambulatory care practice continues to expand in health systems, there is a greater need for enterprise-wide communication among pharmacists providing care across these settings. Adopt practices that support occupational risk levels for handling of hazardous drugs in accordance with the ALARA principle while pursuing research that explores the validity of risk assessment and the effectiveness of risk mitigation, particularly as they relate to regulations. All past editions of the Pharmacy Forecast can be found on the ASHP Foundation website at http://www.ashpfoundation.org/pharmacyforecast. As senior leadership teams become smaller in order to reduce labor costs, pharmacy leaders may be asked to take on additional responsibilities. For example, technologies that provide consumer awareness of drug pricing disparities between retail pharmacies will impact their decision on where to get the prescription filled. In early 2018, in the midst of the flu season, basic i.v. Pharmacy is responsible for preparing and distributing some hazardous products. However, research topics still need to do enough research and gather a lot of data and facts from reliable sources in … In a continuing discussion of the future of pharmacy education and pharmacy workforce issues, Diane Ginsburg and Katie Pritchett provide a section exploring a number of challenges that will face health-system pharmacy leaders in the coming years. Pharmacies will increasingly use analytics such as EHR (Electronic Health Records) systems to gain a better picture of the overall health of the patient and in turn provide better services to its customers. The forecast survey instructed FPs to read each of the 48 scenarios represented in survey items and consider the likelihood of those scenarios occurring in the next 5 years. The importance of improving diversity in our workforce is a national priority in all fields. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. Unique characteristics of each hospital and health system may suggest important differences in the potential impact of emerging trends, or individuals may simply disagree with the predictions made in this report. Without a strategic plan, leaders are forced to hastily react rather than thoughtfully respond to each new challenge, without the benefit of a guide making the best course clear. The size of the Forecast Panel in 2019 was deliberately increased in an effort to capture opinions from a wider range of pharmacy leaders than in past Forecasts, and the size of the Forecast Panel remained large this year. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The methods used to develop the 2020 Pharmacy Forecast were similar to those used in the previous editions, drawing on concepts described in James Surowiecki’s book The Wisdom of Crowds.1 According to Surowiecki, the collective opinions of “wise crowds”—groups of diverse individuals in which each participant’s input is provided independently, drawing from his or her own locally informed points of view—can be more informative than the opinion of any individual participant. Just last month LexisNexis Risk Solutions hosted its annual Pharmacy Partner Summit. Trending Topics in Ambulatory Care is a recertification curriculum designed by APhA's expert faculty and focuses on a series of hot topics and timely issues in the world of Ambulatory Care specialty pharmacy. The term value is ubiquitous in discussions around healthcare expenditures but is rarely used to determine prices paid for drugs in the United States. As the role of the pharmacist continues to emphasize cognitive services and include fewer distributive tasks, a higher-educated and higher-trained technician force will be necessary to support pharmacists performing clinical functions. The continued advancement of pharmacy technicians and their role in health systems, as well as operational challenges surrounding the handling of hazardous products, are highlighted in this edition of the Pharmacy Forecast. There is a dearth of evidence linking most current metrics with truly impactful patient outcomes, yet huge investments are made in structural and process improvements in the hope that outcomes will also improve. The authors have declared no other potential conflicts of interest. Another possible solution discussed at various stakeholder meetings is the establishment of an essential drug list (such as the list maintained by the World Health Organization7), with targeted incentives to ensure availability of key products. Each section of the advisory board for Civica RX, new Knowledge is applied, and alternative! Mailed to their organizations ’ acknowledged ability to develop and implement new technology telemedicine. But is rarely used to track productivity, assure quality, and make the information in this year, is. Practice which features a variety of episodes covering emerging trends, key topics and areas across medicine telemedicine... 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