A different type of black swan hit hospitals in 2017 with the arrival and rapid adoption of 2 CAR-T therapies for various leukemias and lymphomas in adults and children.b At a cost of up to $475,000 per patient, and with a lag in insurance coverage and an absence of alternative therapies, many hospitals had to initially absorb this expense.c In 2019, a gene therapy for spinal muscular atrophy in children less than 2 years oldd hit the market at a cost of $2 million for a single patient—an astonishing figure that few institutions and payers were prepared for. Healthcare has been remarkably resistant to reform. Edney A. America’s love affair with cheap drugs has a hidden cost (January 29. Examples of black swans (which can have either negative or positive implications) include the 9/11 terrorist attacks on the United States, the 2008 meltdown of worldwide financial systems, and the rise of the Internet. The University of Utah Drug Information Service (UUDIS) has a contract to provide Vizient (a group purchasing organization) with drug shortage information. 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. The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. Current Hot Topics United States Pharmacopoeia (USP) and PA State Board of Pharmacy At the October 22, 2019 Pennsylvania State Board of Pharmacy (Board) Meeting, the Board discussed issues related to USP’s decision to delay implementation of the revisions to chapters <795> and <797> pending resolution of appeals. See below for the archived webinars. Perry Cohen is an editorial advisor for Managed Healthcare Executive and is Chief Executive Officer, The Pharmacy Group. 2019 FDA drug approvals (1) Mullard A. The authors have declared no other potential conflicts of interest. Approximately half of FPs believe that a publicly accessible hospital charge master will provide value to consumers (Figure 6, item 5). More than 30 years ago, the term patient-centered care was coined to shift the focus of healthcare providers and health systems from diseases back to patients, and a movement was born.1 Concepts regarding patient activation (knowledge, skills, and confidence in managing one’s own health) and codesigned care are emerging to emphasize a higher level of integration of patient beliefs, values, and preferences in clinical decision-making at both the bedside and in health policy.2–4 As the pharmacy enterprise expands across the continuum of care, there is opportunity for pharmacists to lead the way in establishing new patient-centered care models.5. 3 DEC 2020 16:40. The top pharmacy trends for 2020 and the year that was While these analyses are increasingly used by private insurers and Medicaid programs in some states, they are not used by traditional Medicare to determine coverage or reimbursement. Develop and implement programs that do not necessarily increase fee-for-service–based revenue but leverage the recognized skills of pharmacists in reducing inefficiency and improving quality as important contributions in value-based payment models. Pharmacy practitioners, on the other hand, were perceived by FPs as generally having difficulty in taking black swans in stride (Figure 8, item 2). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. While FPs did not feel it is likely that insurers will restrict their beneficiaries from having prescriptions filled at pharmacies where they receive their care (Figure 7, item 6), it seems a likely possibility given similar trends seen in specialty pharmacy, where insurers and manufacturers drive the care of patients away from their health-system providers, leading to inefficiency and higher risk. When using the Pharmacy Forecast, it is recommended that planners review at least 1 or 2 past editions in addition to this new report; many of the observations and recommendations that are 1 or 2 years old remain important to consider. Their novelty lies in entering into contracts with health systems that guarantee access to drug supplies over longer periods than are offered in typical group purchasing organization contracts. In this section of the Pharmacy Forecast, drivers of reform are examined. Lead your institution to proactively develop data systems that support the development of validated AI applications, providing the opportunity to redeploy human resources to other unmet patient care needs. Many pharmacy departments are organized by setting of care. Nat Rev Drug Discov, doi: 10.1038/d41573-020-00001-7. Purchase pharmaceutical products produced in the United States or European Union whenever possible. However, the increasing cost of medications is an ongoing issue affecting patients and payers, and government action is required to capitalize on saving opportunities presented by lower-cost agents. In 2018, ASHP established the Technician Forum to provide a home for these essential practitioners and serve as the collective voice for pharmacy technicians by supporting their advancement and professionalization. Despite widespread recognition that healthcare is too expensive, impersonal, and inaccessible and produces the worst outcomes in the developed world, no consensus has emerged on how to improve it. 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?”. 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. 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. degree holder than a pharmacist without the ability to diagnose and prescribe. 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. James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, Chief Patient Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN. 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. Tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite Pharma). 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. Related article: Top 6 Pharmacy Challenges of 2019. A critical requirement for successfully creating crowd-based knowledge is establishing a systematic method of combining individual beliefs into a collective opinion—the Pharmacy Forecast uses a survey of carefully selected pharmacy leaders to derive our environmental scan. Assure the development of pharmacist expertise related to genomic testing, creating infrastructure and developing policies and practices that address the appropriate clinical and ethical use and interpretation of such testing. APhA offers Board Certified Ambulatory Care Pharmacists a series of concise recertification sessions. In order for data from validated PRO tools to be integrated into daily, frontline practice, pharmacy leaders must allocate resources for infrastructure to collect this information directly from patients. The editorial staff of AJHP has provided substantial support for this publication, and we appreciate their assistance. aBased on 2010 U.S. Census population data (estimated). Among the challenges facing health-system pharmacy over the next 5 years are drivers of the cost of medications, the specialty pharmacy market, and delivering care supported by advances in technology. Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH. Sixty-five percent of FPs were optimistic about the vacancy rate for pharmacy positions that require specific expertise in sterile compounding and drug distribution (Figure 2, item 1). 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. Founded in 1897, Pharmacy Times, a full-service pharmacy media resource, reaches a network of over 1.3 million retail pharmacists. Within each section of this report, the results of each survey question are summarized in detail. As the cost and use of pharmaceuticals is now on the front page of newspapers and a top priority for employers, government, and individuals, some people think that this is a new phenomenon. The purpose of this report is to encourage and support active, deliberate strategic planning in hospitals and health systems. (Drivers of Healthcare Reform). Patients (Figure 8, item 5) and the communities in which they live (Figure 8, item 6) were downgraded by FPs with respect to their capacity to adapt to unpredicted disruptive events. The stability of the supply chain is of critical importance, and recommendations for focused strategic planning are provided. The 2020 Pharmacy Forecast includes a number of topics related to the role of evidence in the emergence of new practices and their impact on health systems. Those changes are unlikely in the near future. Those health systems already involved in specialty pharmacy programs should collect, analyze, and disseminate patient outcome data that demonstrate the value of services, thus differentiating their organizations from national providers. 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). The pace of this change varies by region—regions with dominant payers are moving more slowly toward full capitation. An important pharmacy-specific example of a black swan relates to Hurricane Maria in September 2017, which decimated pharmaceutical manufacturing capacity in Puerto Rico, thereby creating a crisis for U.S. hospitals. These teams should be incentivized to establish partnership outside of the health system as well, such as collaboration with postacute care facilities. 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. 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. This is inconsistent with national trends and attention to the preparation of these medications. This shortage of programs and the increasingly high debt load of new graduates may decrease interest in residency training somewhat, but health systems will continue to require completion of residency training as a requirement for employment. Strategic plans should be reviewed frequently, allowing for tactical adjustments in course over time as trends (those discussed in this report and others that were not predicted) emerge. As you plan for 2020 and beyond, here are some key questions to consider: 1. Who is the customer for pharmaceuticals and pharmacy services? The evolution of the 21st century organization. [Nature: News Article] Hot Topics: Cryo-EM structure of a selective T-type calcium channel blocker bound to the Cav3.1 voltage-gated calcium channel Jörg Striessnig, University of … Recent books and media attention regarding the poor quality of active pharmaceutical ingredients (APIs) and finished drugs have prompted discussions regarding the merits of incentivizing United States–based manufacturing.4–6. 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. 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. Dr Alexander is past chair of the Food and Drug Administration’s Peripheral and Central Nervous System Advisory Committee, has served as a paid advisor to IQVIA, is a cofounding principal and equity holder in Monument Analytics (a healthcare consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation), and is a member of OptumRx’s National P&T Committee. The demand for postgraduate training programs continues to increase each year, with demand outpacing supply; however, 64% of FPs felt it was unlikely that health systems would offer nontraditional residency programs (Figure 2, item 4). It will be difficult for health-system SPs to compete with market-dominating SPs. For example, you need to focus on lowering drug costs by having a “state of the art” fraud, waste, and abuse program. Those organizations involved in education or training should consider the use of the Pharmacy Forecast as a teaching tool. The customer is changing from a physician-centric to a patient-centric world.Â. 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. As many of those new ventures will likely arise in the ambulatory care setting, pharmacy leaders should expand their understanding of operational and financial nuances of that setting. 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. As patients pay more of the cost of these expensive therapies, drug companies are trying to develop value-based contracting ties to outcomes to address the cost problem. 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. 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. Most SPs and other stakeholders, such as manufacturers and payers, are invested in providing quality service (today defined by process indicators such as time to fill; adherence; outcomes specific to certain therapies, such as hepatitis C; or patient service indicators, such as abandoned-call rates). A majority of FPs felt health systems will have a large portion of their revenue at risk in the future (Figure 7, item 4). Just last month LexisNexis Risk Solutions hosted its annual Pharmacy Partner Summit. All of these challenges are made more acute in the absence of a robust, deliberately developed and maintained strategic plan. The emergence of health system–based specialty pharmacy programs is an example of ventures that many institutions have implemented to create new revenue streams. These results are interesting, but simply disclosing prices will have little effect on accessibility to medications. While large health systems with the capability to achieve high volume, as well as health systems with access to 340B pricing, will have fewer challenges, many SPs will struggle to be profitable. Our latest podcast episode discusses how pharmacies can tap technology to boost vaccination programs for COVID-19 vaccines and others. In these scenarios, if FPs believed that individuals or entities tend to be well equipped for responding to black swans, the charts would be skewed to the right (i.e., toward 100% resilience in dealing with an unpredicted disruptive event). The cost and effort associated with achieving designation will be difficult to justify while the benefits of designation are uncertain. Although this seems overly optimistic for the general market, it is possible in health systems with strong formulary controls and active clinical programs. 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. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. Many of the FPs hold the title of chief pharmacy officer or director of pharmacy (13% and 16% of FPs, respectively). Hospital pharmacy departments were forced to divert attention from previous priorities to compounding sterile i.v. (Healthcare Marketplace). 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. Meghan D. Swarthout, Pharm.D., M.B.A., Division Director, Ambulatory and Transitions of Care Services, Department of Pharmacy, Johns Hopkins Health System, Baltimore, MD. The 2020 Pharmacy Forecast is intended to assist with strategic planning efforts by health-system leaders. Fragmented finance structures lead to fragmented care delivery. (June 20. 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. For example, Kentucky recently joined California and a few other states in expanding the pharmacist scope of practice, granting independent prescribing authority (to be exercised in collaboration with physicians) under approved protocols for a wide range of conditions, including acute infections, tobacco cessation, and opioid use disorder.1. (The Black Swan). 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?”. Pharmacy Tech Topics™ provides quality continuing education for pharmacy technicians. John Kotter, a leading authority on change leadership, has noted that traditional hierarchies and management processes are rarely equipped to identify important opportunities or hazards quickly, formulate effective responses nimbly, and implement them speedily.3,4 He has recommended that organizations create a volunteer strategy-accelerator network—to complement their operating systems—for pursuing big strategic initiatives.3,4. (Evidence-based Pharmacy Practice). Suggestions for future forecasts can be sent to any of the forecast editors through the Foundation’s Pharmacy Forecast website at http://www.ashpfoundation.org/pharmacyforecast and will be considered for future editions. An audio interview that supplements the information in this article will be available at www.ajhpvoices.org. Routine communication and collaboration on quality improvement projects will yield efficiencies, helping to financially justify the added time needed for this work. Redesign departmental organizational structures to place greater emphasis on continuity of care for service lines and populations, eliminating traditional divisions based on setting of care. In early 2018, in the midst of the flu season, basic i.v. FPs might have had a tendency to be more optimistic about issues “closer to home” than about topics less subject to control or influence by pharmacy practice leaders. In addition, 36% of Americans say healthcare is the top issue facing America today, according to a recent poll. We are again pleased to disseminate the Pharmacy Forecast through AJHP, providing readers with easy access to the report. While the intent of pricing transparency is commendable, challenges in establishing a common charge master format and standardizing pricing information make it unlikely that the current proposals will provide meaningful information that could assist patients in making better decisions regarding their care. 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. Develop and implement policies and procedures that protect all staff involved in the handling of hazardous medications, including appropriate education, training, and certification of personnel, regardless of the health status of the individual employee. 8 DEC 2020 15:33. Thank you for submitting a comment on this article. While 18% of FPs indicated that their primary organization was not a hospital (down from 24% in 2019), 63% of FPs were employed by hospitals with 400 or more beds (up from 61% in 2019), and 19% of respondents were from hospitals of less than 400 beds (similar to 18% in 2019). Fifty-four percent of FPs felt that such federal action will occur in the future (Figure 5, item 2). The customer is changing from a physician-centric to a patient-centric world. This year, it was held virtually due to the ongoing coronavirus pandemic. Healthcare Executive, Ridgewood, NJ. They were asked to base their response on their firsthand knowledge of current conditions in their region, not based on their understanding of national circumstances. Whether or not a fully realized single-payer system is achieved, broadening access to efficient care—particularly outside the acute care setting—is essential. Welcome to Hot Topics in Pharmacy Practice which features a variety of episodes covering emerging trends, key topics and areas across medicine. The remainder of FPs included leaders and practitioners at varying levels and with varying titles. Changes in state laws and regulations to require higher levels of pharmacy technician education and training must occur before pay scales for pharmacy technicians will be comparable to those of other ancillary healthcare providers. 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. The Foundation is indebted to those individuals who have helped make the 2020 edition a success. Two out of three FPs indicated they do not believe health systems will assign pharmacists to provide education and support to parents who are uncertain about vaccinating their children (Figure 1, item 6). The existing regulatory landscape frequently results in confusion for patients and conflicts for healthcare practitioners. Substance Use … 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. 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. It is also important to note that not all violence is physical—verbal and emotional abuse must also be recognized and addressed. The duties a technician can perform will be nonjudgmental; however, they will continue to take on additional tasks that will necessitate additional education, training, and credentials. Most FPs (63%) believed that in many health systems, departments other than pharmacy will have primary responsibility for the management of these treatments (Figure 4, item 5). The content of the report should inform the broadened scope of responsibility that many pharmacists now take. In the 2020 survey, every region was represented by a minimum of 19 FP respondents (up from a minimum of 16 in 2019). Medicare for All? Using information technology can enable timely communication. They were asked to provide a top-of-mind response regarding the likelihood of those conditions being very likely, somewhat likely, somewhat unlikely, or very unlikely to occur. 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). The concept of a “black swan” a—a rare event (widely deemed improbable) that has massive consequences—was popularized by a 2007 book (updated in 2010) by Taleb.1 After a black swan event, explanations often emerge that make the event seem predictable (although few had seen it coming). According to U.S. News & World Report, physician assistants made a median salary of $104,860 in 2017; the top quartile made $124,200 that year, while the lowest quartile made $87,980.4. 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). Address correspondence to Mr. Scott (bruce-scott@comcast.net) or Mr. Sheehy (frsheehy@gmail.com). A majority of FPs agreed that pharmacy leaders will continue to be expected to bring innovative strategies to bear in their departments (Figure 3, item 2). Unpaid volunteer member of the total budget for UUDIS diagnose and prescribe shifting and consolidating contract.... Varying levels and with varying titles long been an issue, most likely. Course, the outlook for the Medi-Cal program for UUDIS not all violence is and! About key metrics necessary to assess the success of their health systems would an... 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