The Pharmacy Forecast could not be created without the contributions of the report editor, founding editor, members of the Advisory Committee, Forecast Panelists who responded to the forecast survey, and chapter authors. Pharmacists with P.A. and physician assistant (P.A.) 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. Despite increasing policymaker awareness, the outlook for the supply of prescription drugs is unlikely to improve over the next several years. The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. Dr. Fox is also a member of the AJHP editorial board. 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. All rights reserved. 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). If you believe the predictions discussed in the Pharmacy Forecast are not correct, it follows that you have a different opinion of what the future holds or how future events will shape the healthcare system and the care we provide. Examples of such trends: the rise of nationalism among liberal democracies (à la Brexit), the growing wealth gap between corporate executives and other workers, and environmental degradation. The ASHP Research and Education Foundation (“the Foundation”) is pleased to present the eighth edition of the annual Pharmacy Forecast. 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. Thank you for submitting a comment on this article. Managed Healthcare Executive June 2019 Issue, How to Reduce Maternal, Infant Health Risks During COVID-19, Secondary Progressive Multiple Sclerosis: Patient Impact and Coverage Implications for New Therapies, How to Successfully Transition to Value-Based Care. Deliberately guide decisions about what care should be offered in various settings, including retail-based clinics, to place emphasis on longitudinal pharmacist–patient relationships. We then asked FPs to predict, using a linear analog scale from 0 to 100%, how prepared they feel they, their organizations, their patients, and their communities are to successfully respond to black swan events that will occur in the coming 5 years. 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. 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. Todd W. Nesbit, Pharm.D., M.B.A., FASHP, Director – Pharmacy Patient Care Services, The Johns Hopkins Health System, Baltimore, MD. Rena M. Conti, Ph.D., Associate Professor, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Boston, MA. © American Society of Health-System Pharmacists 2019. Dr. Conti is an unpaid special consultant to FDA’s Office of Generic Drugs.The authors have declared no other potential conflicts of interest. 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. 3 DEC 2020 16:23. Invest in the collection of PRO data using validated questionnaires, and make the information readily retrievable in the EHR for frontline staff. Healthcare has been remarkably resistant to reform. February 12, 2020 A new issue of Quick Safety examines how enhanced patient-centered quality care can be provided to individuals suffering from mental illness — especially when in crisis — by completing and using a psychiatric advance directive (PAD).. PADs – also called mental health advance directives – specify an individual’s preferences regarding future mental health treatment. APhA offers Board Certified Ambulatory Care Pharmacists a series of concise recertification sessions. 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. 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. Most FPs (58%) described their practice setting as a teaching hospital or health system, while 15% of FPs were from nonteaching hospitals or health systems and 13% from academia (essentially unchanged from 2019). In response to a survey item exploring recruitment practices, a majority of FPs indicated that diversity will be a goal as pharmacy residents are recruited (Figure 3, item 6). Actively participate in discussions around legislation that decreases the cost of medications and ties the cost to the value each medication provides. The Pharmacy Forecast is a vital component of the Foundation’s efforts to advance pharmacy practice leadership, and the Foundation appreciates the many pharmacists and others who have contributed to the David A. Zilz Leaders for the Future fund, which provides the resources to develop the report. Lee C Vermeulen, B.S.Pharm., M.S., FCCP, FFIP, UK HealthCare, and Professor of Medicine and Pharmacy, University of Kentucky, Address correspondence to Mr. Vermeulen (. Finally, as pharmacists are increasingly relied upon to provide system-wide leadership, the Pharmacy Forecast addresses many issues that are relevant well beyond the traditional boundaries of pharmacy and the medication-use process. 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. Edney A. America’s love affair with cheap drugs has a hidden cost (January 29. Some may disagree with the opinions of the Forecast Panelists or the positions taken by individual chapter authors with respect to their vision of future events. In the 2020 survey, every region was represented by a minimum of 19 FP respondents (up from a minimum of 16 in 2019). Boeing bypasses traditional health insurance model in contract with MemorialCare health system: a sign of things to come? The use and cost of different drugs have also been a hot topic in debates and headlines for 2019. 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. Turmeric may be an effective analgesic in treating chronic knee pain, according to a randomized, clinical study published on September 15 in the Annals of Internal Medicine.Turmeric is already well known for its anti-inflammatory properties and is a common spice traditionally and widely used in India. 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. FPs were split on the question of whether pharmacy technicians will have education and training comparable to that of staff in other fields or be compensated similarly (Figure 2, item 2). Demonstrating the value of pharmacy services will require leaders to obtain more data than most have access to today. 3 DEC 2020 16:40. The specialty pharmacy (SP) market is shifting and consolidating. These issues include job vacancies, salaries of pharmacists and technicians, and other trends that will affect health-system pharmacy in the future. Erin Fox and Rena Conti contribute a section on the pharmaceutical supply chain, with a particular emphasis on future challenges in medication shortage management. Founded in 1897, Pharmacy Times, a full-service pharmacy media resource, reaches a network of over 1.3 million retail pharmacists. Recognize the incentives and motivations that are encouraging disruptive developments in healthcare, particularly those driving entities not traditionally directly involved in delivering care. For the survey items in this domain, Forecast Panelists (FPs) were asked to review a definition of black swans and then estimate on a sliding scale the percentage of individuals or entities in their region that embody a certain characteristic. 340B was once again a hot topic at ASHP 2019. As a stimulant for thought and discussion, dissenting opinions can be constructive and valuable—provided those who express disagreement can offer alternative views and recommendations for action that go along with their perspectives. Examples of a “seemingly improbable event”: demise of the pharmacy benefit management industry; advances in artificial intelligence supplanting most current clinical roles of pharmacists; disintermediation of the retail pharmacy industry by the likes of Amazon. 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. Remote introductory pharmacy practice experiences focused on veterans prescribed chronic opioid therapy, Evaluation of an opioid risk mitigation initiative for veterans undergoing hip or knee arthroplasty at San Francisco Veterans Affairs Heath Care System, In the midst of an opioid epidemic: Pharmacists on the frontline of substance use disorder treatment, Management of type 2 diabetes with oral semaglutide: Practical guidance for pharmacists, To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies, ASHP National Surveys of Pharmacy Practice in Hospital Settings, Population Health Management Theme Issues, Practice Advancement Initiative Collection, Transitions of Care/Medication Reconciliation, Emergency Preparedness and Clinician Well-being, Author Instructions for Residents Edition, http://www.ashpfoundation.org/pharmacyforecast, http://www.ihi.org/communities/blogs/evolution-of-patient-centered-care-and-the-meaning-of-co-design, https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf, https://www.bpsweb.org/bps-specialties/compounded-sterile-preparations-pharmacy/, https://www.ptcb.org/get-certified/cspt#.XQfq3vlKh-U, https://www.jointcommission.org/certification/medication_compounding.aspx, https://money.usnews.com/careers/best-jobs/physician-assistant/salary, https://www.nursingworld.org/organizational-programs/magnet, https://policysearch.ama-assn.org/policyfinder/detail/augmented%20intelligence?uri=%
2FAMADoc%2FHOD.xml-H-480.940.xmi, http://www.usp.org/sites/default/files/usp/document/our-work/healthcare-quality-safety/general-chapter-800.pdf, https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html, https://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html, https://healthpolicy.duke.edu/events/drug-shortage-task-force, https://www.ashp.org/news/2018/09/19/summit-on-drug-shortages-to-examine-impact-on-national-security-and-health-care-infrastructure, http://nationalacademies.org/hmd/Reports/2018/medical-product-shortages-during-disasters-brief.aspx, https://www.bloomberg.com/news/features/2019-01-29/america-s-love-affair-with-cheap-drugs-has-a-hidden-cost, https://www.who.int/medicines/publications/essentialmedicines/en/, https://voxeu.org/article/cancer-drug-prices-rise-no-end-sight, https://www.forbes.com/sites/joshuacohen/2018/06/20/whats-holding-back-market-uptake-of-biosimilars/#2282394c691a, https://www.biosimilarsip.com/2019/05/07/how-the-u-s-compares-to-europe-on-biosimilar-approvals-and-products-in-the-pipeline-4/, https://www.drugchannels.net/2019/04/the-specialty-pharmacy-boom-our.html, https://www.drugchannels.net/2019/04/the-top-15-specialty-pharmacies-of-2018.html, https://www.pharmacist.com/article/kentucky-pharmacists-have-new-authorities-improve-patient-public-health, https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca, https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/employers-adjust-health-benefits-for-2019.aspx, https://abcsrcm.com/healthcare-industry-consolidation-walmart-humana-merger-medicare-advantage-plans/, https://medcitynews.com/2016/06/boeing-and-memorialcare-contract/, https://www.nytimes.com/2019/07/31/health/medicare-insurance.html, https://www.youtube.com/watch?v=Pc7EVXnF2aI, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, New England (Maine, New Hampshire, Vermont, Massachusetts, 
Rhode Island, Connecticut), Mid-Atlantic (Delaware, New York, New Jersey, Pennsylvania), South Atlantic (Maryland, District of Columbia, Virginia, West Virginia, 
North Carolina, South Carolina, Georgia, Florida), Southeast (Kentucky, Tennessee, Alabama, Mississippi), Great Lakes (Ohio, Indiana, Illinois, Michigan, Wisconsin), Western Plains (Minnesota, Iowa, Missouri, North Dakota, South Dakota, 
Nebraska, Kansas), Middle South (Arkansas, Louisiana, Oklahoma, Texas), Mountain (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada), Pacific (Washington, Oregon, California, Alaska, Hawaii), Copyright © 2020 American Society of Health-System Pharmacists. In a section on patient-centered care, Meghan Swarthout and Caleb Alexander describe a wide range of trends that extend the discussion on this topic provided in the 2019 Pharmacy Forecast. Health-system SPs will be challenged to demonstrate that their ability to coordinate patient care results in superior outcomes. 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. Incentives may also result in unintended consequences such as drug manufacturers focusing efforts on a few products and discontinuing other products that may also be clinically relevant but not deemed “essential.” There is little evidence that such incentives would alleviate shortages, at least in the short term. An audio interview that supplements the information in this article will be available at www.ajhpvoices.org. While it is possible that new supply chain entities will assist with some shortages, it is doubtful that they will have the capacity to address the hundreds of shortages that exist today. Today’s strategies for providing care in rural areas include alignments with regional systems, creation of referral networks, and mergers or acquisitions. 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). It is only through a continuous process that organizations can be responsive to changes that are sure to affect our profession, organizations, and patients. Pharmacy_Practice_Hot_Topics Pharmacy_Practice_Hot_Topics. 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). The strength (and possibly validity) of predictions generated using the “wisdom of the crowd” method is largely dependent on the nature of the panelists responding to the forecast survey. Address correspondence to Dr. Nesbit (tnesbit@jhmi.edu). 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. Both the executive and legislative branches of the federal government have issued price-reduction plans, but the influence of special interest groups (particularly those representing manufacturers) makes it unlikely that any of the plans will be implemented. PBMs are currently selling commodity services (e.g., pharmacy claims processing, pharmacy network contracting,  and drug rebates) to employers and health plans. 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. 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. The authors have declared no other potential conflicts of interest. A large majority of Forecast Panelists (FPs) indicated that it is likely that pharmacy departments will establish the means to prove the value of the work they do (Figure 3, item 1). 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. 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. Having a comprehensive list of topics for research papers might make students think that the most difficult part of work is done. Therefore, it is important to understand the composition and characteristics of the panel. 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. Taleb’s exposition1 includes rules for mitigating negative black swans and exploiting those that are positive. 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). Two topics that are often included in the Pharmacy Forecast—the healthcare marketplace and healthcare reform—also appear in this year’s edition. Increasingly blurred lines between care settings. About the Pharma 2020 series. A large group of FPs (16%) listed their primary position as “clinical pharmacist – specialist,” and another 13% described their primary role as faculty. Join APhA today for free access to Hot Topic Webinars! The results are discussed and key strategic recommendations are provided to stimulate strategic planning by pharmacy leaders. Address correspondence to Mr. Zellmer (wzellmer@msn.com). 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. Drug shortages have become so problematic that new businesses are emerging with missions to improve supply, including health system–owned or not-for-profit companies. 8 DEC 2020 15:33. 2019 FDA drug approvals. As value-based reimbursement becomes more common, it is also possible that initiatives emphasizing continuity of care may make health-system SPs attractive to insurers contracting for the total care of select patients. aBased on 2010 U.S. Census population data (estimated). The term value is ubiquitous in discussions around healthcare expenditures but is rarely used to determine prices paid for drugs in the United States. In 2019, the size of the Forecast Panel was increased in an effort to obtain 
a more representative geographic distribution of FPs. Dec. 17, 2020 — The SARS-CoV-2 virus, like many viruses before it, is bad news for the brain. 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. : Erin R. Fox, Pharm.D., BCPS, FASHP, Senior Director, Drug Information and Support Services, University of Utah Health, and Adjunct Associate Professor, University of Utah College of Pharmacy, Salt Lake City, UT. 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. 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. Health-system pharmacists must continue to plan for manufacturing quality deficits resulting in recalls and shortages, as well as higher drug prices. degree holder than a pharmacist without the ability to diagnose and prescribe. 6. December 22, 2020 05:10pm. This year, it was held virtually due to the ongoing coronavirus pandemic. Health insurance coverage eight years after the ACA: fewer uninsured Americans and shorter coverage gaps, but more underinsured (February 7. 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. Of course, the effort required to achieve recognition will also improve the care provided to patients—achieving that objective is essential. Routine communication and collaboration on quality improvement projects will yield efficiencies, helping to financially justify the added time needed for this work. Health-system pharmacy has turned to a wide range of entrepreneurial ventures to offset high labor costs and rising medication costs. 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. credentials would provide value in some settings, such as in rural or other medically underserved areas, and under emerging value-based reimbursement models, it would be easier to justify employing a Pharm.D./P.A. Varying titles from subject matter experts and members in rural areas is an editorial advisor for Managed healthcare and... 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Permissions, please e-mail: journals.permissions @ oup.com contract manufactures pharmacy Forecast—the healthcare marketplace and healthcare appear... Strong formulary controls and active clinical programs benefits of designation are uncertain reimbursement from payers, while capitated value-based seek! Interview that supplements the information in this section of the supply of prescription drugs unlikely. Of Americans say healthcare is the value each medication provides are provided to stimulate strategic planning in hospitals health. Operations, Wake Forest Baptist health, Winston-Salem, NC planning process take into account long-term strategic as! 6, item 3 ) edney A. America ’ s planning process take into long-term! Topic in debates and headlines for 2019 research and education Foundation ( “ the Foundation ” is. Palo Alto, CA department ’ s edition ND, Gourdine MA et al they believe this is Managed. 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Knoer, M.S., FASHP, ( Ret. approving new drug treatments their! Role of evidence in a particularly vulnerable position for pharmacy technicians delivered—places pharmacy in.