As in the past, we have specifically avoided discussions of issues that are prone to dynamic change on a day-by-day basis, such as emerging trends in medication shortages. 3 DEC 2020 16:23. Creation of the Pharmacy Forecast 2020 report was supported by an unrestricted grant from Omnicell, Inc., to the David A. Zilz Leaders for the Future Fund of the ASHP Research and Education Foundation. 2. We welcome your comments on this new edition of the Pharmacy Forecast. 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?”, Nearly all states currently enable collaborative drug therapy management by pharmacists in some form or fashion along a continuum from most restrictive to least restrictive (including independent prescribing authority). While it is not possible to be “black swan proof,” it is possible to be “black swan robust”—with deliberate, consistent, and effective strategic planning, an individual, organization, or community can be better prepared to successfully respond when black swan events inevitably occur, and preparation for those events is an essential leadership challenge. Capital investments beyond what most health systems can invest will also continue. In one, a majority (76%) of FPs agreed that new performance metrics will be based on evidence of improved patient outcomes (Figure 4, item 2), and a similar majority (76%) agreed that mandates related to handling of hazardous products will be based on evidence of lower risk to patients and healthcare workers (Figure 4, item 3). It is intended to stimulate thinking and discussion, providing a starting point for individuals and teams who wish to proactively position themselves and their teams and departments for potential future events and trends rather than be reactive to those things that occur. As shown in Table 1, response rates per million population in each U.S. region ranged from 0.5 in the Pacific region (Oregon, California, and Washington) to 1.7 in the Western Plains states (Iowa, Kansas, Minnesota, Missouri, North Dakota, and South Dakota). 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. However, research topics still need to do enough research and gather a lot of data and facts from reliable sources in … bBased on 2018 U.S. Census population data (estimated). Prioritize the development of entrepreneurial skills among pharmacy leaders to ensure that innovative programs meeting the needs of both patients and health systems are identified and implemented. PBMs are currently selling commodity services (e.g., pharmacy claims processing, pharmacy network contracting, Â and drug rebates) to employers and health plans. Oxford University Press is a department of the University of Oxford. or Pharm.D./M.H.A. During the strategic planning process, the Pharmacy Forecast can be used as a provocative springboard for brainstorming and discussion; however, those leading strategic planning discussions should be open to opinions that differ from those expressed by the Forecast Panel members and the chapter authors. While affiliations with regional and national systems will likely continue, as reflected in FP responses (Figure 6, item 6), other strategies that integrate new telehealth technologies, such as home monitoring and electronically controlled medication administration, will become the norm in supporting rural healthcare. Healthcare Executive, Ridgewood, NJ. The editor also again recognizes the leadership and vision of William A. Zellmer, the founding editor of the ASHP Foundation Pharmacy Forecast series, for creating a resource for the profession that continues to have significant value. Such therapies are analogous to blood and stem cell transplantation in many aspects. Our focus is on larger-scale trends, and our goal is to look beyond ethereal whims of politics and practice in an attempt to address deeper patterns that will impact us over months and years. Tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite Pharma). The near-even split of Forecast Panelists (FPs) in perceptions regarding this topic (Figure 4, item 1) demonstrates that there is a need for greater understanding of the potential for AI and the conditions required for AI to be effective. 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. Nat Rev Drug Discov, doi: 10.1038/d41573-020-00001-7. Invest in the collection of PRO data using validated questionnaires, and make the information readily retrievable in the EHR for frontline staff. Most drug shortages are caused by quality and manufacturing problems at the factory, which presumably will continue to occur in production facilities employed by new supply chain entities. Forecast Panelists’ responses to survey items regarding preparedness to respond to black swan events. Also acknowledged for assistance with various aspects of the process are Eliza Asherian, Julia Beatty, James Blackmer, Kelly Brookbank, Stephanie Brown, David Chen, Lillian Clark, Dan Cobaugh, Rachael Freeman, Camryn Froerer, Brandi Gore, Laura Halsey, Clayton Hamilton, Chanese Hampton, Ryan Hays, Lynn Hoffman, Collin Jakubecz, Erica Krantz, Jennifer Lee, Jordan Long, Alexandrea Lux, Scott Mambourg, Maryam Mohassel, Derek Montgomery, Barbara Nussbaum, Shea O’Brien, Antoniette Parris, Jeff Schempp, Leticia Vargas, and Kjersti Vharen. All past editions of the Pharmacy Forecast can be found on the ASHP Foundation website at http://www.ashpfoundation.org/pharmacyforecast. What is the value of pharmacy benefit management (PBM) companies? Medicare for All? As you plan for 2020 and beyond, here are some key questions to consider: 1. Who is the customer for pharmaceuticals and pharmacy services? About the Pharma 2020 series. (Drivers of Healthcare Reform). Join APhA today for free access to Hot Topic Webinars! Katie O. Pritchett, Ph.D., Lecturer, McCombs School of Business, The University of Texas at Austin College of Pharmacy, Austin, TX. Pharmacy practice leaders can enhance the effectiveness of their planning process by considering proactively how to optimize their department’s resiliency when confronted with unanticipated events that have enormous positive or negative consequences. In addition, 36% of Americans say healthcare is the top issue facing America today, according to a recent poll. Institutions that achieve recognition advertise the designation as a means of improving recruitment of talented staff and raising their organization’s brand strength.1 FPs were split on the possibility of creating a similar recognition program for health-system pharmacy (Figure 3, item 4). Pharmacists’ acknowledged ability to drive efficiency will allow them to contribute substantially to their organizations. The author has declared no potential conflicts of interest. The authors have declared no other potential conflicts of interest. In the 2020 survey, every region was represented by a minimum of 19 FP respondents (up from a minimum of 16 in 2019). Dr. Knoer and Mr. Zellmer are contributing editors of AJHP. 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. Many educators and residency preceptors use the report as part of coursework, seminars, or journal club sessions to help engage pharmacy trainees in thinking about the future of the profession they are preparing to enter. Pharmacy departments should take advantage of institutional resources aimed at managing that risk but should also focus on prevention of events that are unique to their physical space and their staff workflows. In 2019, the size of the Forecast Panel was increased in an effort to obtain
a more representative geographic distribution of FPs. Conduct an honest assessment of departmental structure and culture vis-à-vis conduciveness to black swan resiliency (see “Black Swans in Strategic Planning” above); make plans to address any critical deficiencies; consider the prospect of creating a strategy-accelerator network, as advocated by Kotter.3,4, Encourage pharmacy team members to pay attention to major scientific, economic, political, social, and cultural trends in the world at large that could evolve into black swans that affect the pharmacy enterprise.f. Fifty-seven percent of FPs indicated they believe it is likely that colleges and schools of pharmacy will offer a joint doctor of pharmacy (Pharm.D.) Similarly, pharmacologic effects of medical cannabis include the potential for adverse effects and drug interactions and will be more common with increased use. The editorial staff of AJHP has provided substantial support for this publication, and we appreciate their assistance. The rise of violence, particularly gun violence, in the United States, as well as increasing risks associated with the opioid crisis, make pharmacy departments particularly vulnerable. Actively participate in discussions around increasing the transparency of medication and healthcare costs to the public, and contribute to the development of mechanisms of helping patients make more informed healthcare decisions. As public concern and public health risks grow with a resurgence of diseases previously eradicated by vaccines, this represents an opportunity for the profession. © 2020 MJH Life Sciences⢠and Managed Healthcare Executive. Genomic testing is rapidly advancing into patient care as technology improves, new knowledge is applied, and testing cost decreases. December 22, 2020 05:10pm. Conrad Emmerich, M.B.A., Senior Vice President of Operations, Wake Forest Baptist Health, Winston-Salem, NC. Pharmacy Tech Topics™ accredits at least one hour of pharmacy law and one hour of patient safety CPE credit in alternating years. The Pharmaceutical industry's long successful strategy of placing big bets on a few molecules, promoting them heavily and turning them into blockbusters worked well for many years, but its R&D productivity has now plummeted and the environment’s changing. 7. What is a managed healthcare executive to do? The 2020 Pharmacy Forecast Advisory Committee (see membership list in the Foreword) began the development of survey questions by contributing lists of issues and concerns they believed will influence health-system pharmacy in the coming 5 years. The authors have declared no other potential conflicts of interest. In the future, to drive efficiency, reforms that focus on population health, incentivizing care delivery in the most efficient location possible, and encouraging investment in nonhealthcare interventions that directly impact health and healthcare resource consumption (e.g., food insecurity and housing) will be necessary. Within each section of this report, the results of each survey question are summarized in detail. Identify and participate in programs that may improve the supply of essential medications, such as joining not-for-profit drug manufacturing consortiums, but plan to continue to invest in shortage management resources. The Pharmacy Benefits Division is responsible for setting policy and coverage for outpatient pharmacy services for the Medi-Cal program. Purchase pharmaceutical products produced in the United States or European Union whenever possible. While these clinics may serve an important role in some communities as a “consumerist” delivery model that frames healthcare as transactional rather than relationship based, they often conflict with principles of patient-centered care.11. Placing multiple departments under the leadership of one executive also makes it easier to reduce silo budgeting by identifying and implementing interventions that may increase cost in one department while reducing cost to a greater degree in another (for example, using a high-cost medication to reduce blood utilization, resulting in lower total cost of care). Approximately half of FPs believe that a publicly accessible hospital charge master will provide value to consumers (Figure 6, item 5). © 2020 MJH Life Sciences and Managed Healthcare Executive. Health insurance coverage eight years after the ACA: fewer uninsured Americans and shorter coverage gaps, but more underinsured (February 7. Various legislators and policy analysts have proposed the introduction of a single-payer system as a comprehensive reform plan to reduce administrative costs endemic in multipayer systems, better align investment in healthcare interventions with returns, ensure access, and improve quality. As you plan for 2020 and beyond, here are some key questions to consider: 1. Who is the customer for pharmaceuticals and pharmacy services? This phrase summarizes the world of pharmacy in 2019. Dr. Fox is also a member of the AJHP editorial board. Mark A. Lantzy, Senior Vice President and Chief Information Officer, Indiana University Health, and President, Indiana University Health Plans, Indianapolis, IN. Although this seems overly optimistic for the general market, it is possible in health systems with strong formulary controls and active clinical programs. 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. The mixed survey response is likely a reflection of the complexity that would be involved in establishing such a recognition program. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, William A Zellmer, B.S.Pharm., M.P.H., FFIP. 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). Pharmacy Tech Topics™ provides quality continuing education for pharmacy technicians. It will be difficult for health-system SPs to compete with market-dominating SPs. 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. Importantly, the process of strategic planning should not be limited to an annual process, producing a strategic plan which is then largely ignored until the following year when a revised plan is created. Through engagement with state and national professional associations, support legislative and regulatory efforts aimed at preventing industry strategies (such as patent manipulation) for delaying the market entry of biosimilars and conventional generics. Andrawis M, Ellison C, Riddle S et al. The American Nurses Association has been successful with its Magnet Recognition Program. 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. This result is a clear recognition that the composition of our health-system pharmacy staff—including technicians, pharmacists, and pharmacy leaders—will not become more diverse unless and until we focus on diversity in our training programs. Address correspondence to Dr. Ginsburg (diane.ginsburg@austin.utexas.edu). Forecast Panelists (FPs) differed as to whether any increased patient burden from the demands of engagement may decrease health outcomes (Figure 1, item 1). The panel was carefully balanced across the census regions of the United States to reflect a representative national picture. That is not only acceptable, it is desirable. However, they quickly learned that 80 pharmaceutical manufacturing facilities were concentrated in Puerto Rico. The safe handling of hazardous drugs is obviously important, but while exposure risk was established decades ago, limited data have been generated since the adoption of Occupational Safety and Health Administration (OSHA) guidelines in 1986.5 Evidence supporting many strategies, such as closed system drug transfer devices and external ventilation, is lacking. Lee C Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, Meghan D Swarthout, Pharm.D., M.B.A, G Caleb Alexander, M.D., M.S, Diane B Ginsburg, B.S.Pharm., M.S., Ph.D., FASHP, Katie O Pritchett, Ph.D., Lecturer, Sara J White, M.S., FASHP, Jennifer Tryon, Pharm.D., M.S., FASHP, Conrad Emmerich, M.B.A, Todd W Nesbit, Pharm.D., M.B.A., FASHP, William Greene, B.S.Pharm., Pharm.D., BCPS, FASHP, FCCP, Erin R Fox, Pharm.D., BCPS, FASHP, Rena M Conti, Ph.D, Bruce E Scott, B.S.Pharm., M.S., FASHP, Frank Sheehy, B.A., M.B.A, Michael J Melby, B.S.Pharm., M.S, Mark A Lantzy, James M Hoffman, Pharm.D., M.S., BCPS, FASHP, Scott Knoer, M.S., Pharm.D., FASHP, William A Zellmer, B.S.Pharm., M.P.H, ASHP Foundation Pharmacy Forecast 2020: Strategic Planning Advice for Pharmacy Departments in Hospitals and Health Systems, American Journal of Health-System Pharmacy, Volume 77, Issue 2, 15 January 2020, Pages 84–112, https://doi.org/10.1093/ajhp/zxz283. 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. A majority of FPs felt health systems will have a large portion of their revenue at risk in the future (Figure 7, item 4). This podcast series will feature lively discussions from subject matter experts and members. They used this role to âmanageâ the cost of the pharmacy benefit while simultaneously creating new ways to create profits for themselves. As senior leadership teams become smaller in order to reduce labor costs, pharmacy leaders may be asked to take on additional responsibilities. Pharmacists on the Frontlines: A Pandemic Response to COVID-19-Nayan Patel, PharmD,an expert in community pharmacy, will discuss effective pandemic preparedness strategies for healthcare providers. As long as you articulate those differing opinion in the context of your own organization’s strategic planning process and chart a course for your organization that is consistent with your beliefs, then the Pharmacy Forecast has met its objective of encouraging planning efforts of health systems. It is critical that leaders pursue opportunities to advocate for reasonable regulations based upon evidence. Treatment Updates and Specialty Pharmacy Controversies in Atopic Dermatitis Recording from June 10, 2020 with CE credits available until July 1, 2021. Improving the quality of your practice environment is a top priority for APhA. Health systems should collaborate with colleges and schools of pharmacy to develop a range of training options for pharmacists to ensure an adequate supply of staff capable of meeting the future needs of the healthcare system. While drug shortages had long been an issue, most pharmacists likely believed that the pharmaceutical supply chain was fundamentally secure. Pharmacists and technicians who complete additional training and/or certification may qualify for higher salaries, but this would be based on additional credentials, not necessarily the compounding of hazardous medications. Lee C. Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, Chief Efficiency Officer, UK HealthCare, and Professor of Medicine and Pharmacy, University of Kentucky, Lexington, KY. , pharmacies will be posting throughout the week, pharmacy hot topics 2020 health system–owned or not-for-profit.... The contract represents less than 5 % of Americans say healthcare is the value of new drug coverage will. That change daily, the outlook for the brain discussed and analyzed for decades departments organized. New ventures seek to address current data shortfalls drug. ” outside of the flu season, basic i.v of are. 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