Pharmacy Forecast 2020

Deaconess Health System

Landon Russell, PharmD; Lauren Wathen, PharmD

 Objectives

1. Summarize results from the ASHP Pharmacy Forecast

2020

Discuss ways to implement these best practices at

Deaconess
 Patient-Centered Care
➔ Engagement
Patient ownership in their healthcare
➔ Continuity of Care
Increasing pharmacy responsibility
➔ Patient Cost-Sharing
Tailoring a therapy plan to meet patients’
financial means
 ● 57% of respondents believe
Patient the health status of the US
Engagement population will decline from
patients’ increased burden of
engaging in their own care

● Concern for overwhelming

patients with healthcare
information

● Balanced with belief that

patients “may be willing to
embrace complex self-care
management”
 Continuity of Care
Almost 70% of respondents
believe pharmacists will have
increased comprehensive
responsibilities for patients in
outpatient, inpatient, and
transitions of care roles.
Recommendation
“Redesign departmental
organizational structures to
place greater emphasis on
continuity of care for service
lines and populations”
Patient Cost-Sharing
Patient Cost-Sharing, cont.
Cost continues to be a huge barrier
for patient care

Essential for pharmacy to tailor therapy plans

with cost for patients in mind

Shared decision making with patients

 Pharmacy Education and
Workforce
➔ Pharmacy Technicians
Increasing education and training
➔ Non-Traditional Residencies
Expanding training opportunities
➔ Salary Premiums
Hazard pay
 Pharmacy Technicians

~50%
of respondents believe that pharmacy technicians will
have similar education, certification, and licensure as
other technical staff and be compensated similarly
 Pharmacy Technician Trends

21 states require 6 states allow

certification (ie PTCB) pharmacy technicians
for licensure to immunize patients

In Indiana, pharmacy
technicians can administer
flu vaccines and transfer
prescriptions
1. Pharmacy Technician Certification Board. State regulations and map.
2. Walmsley L, et al. Pharmacy technician role in immunization administration. February 18, 2020; National Harbor, MD.
3. 856 IAC 4-1-1 Pharmacist vaccinations administered via protocol authority.
4. 856 IAC 1-32-5 Electronic transfers.
 Non-Traditional Residencies
What is a Non-Traditional
Residency?
Although residency programs ➔ “Residency that can be
completed while a pharmacist
are growing dramatically, remains in active practice”
~70% of respondents DO
NOT believe that 25% of ➔ Currently ~35 programs in the
country
health systems will offer a non-
traditional residency

1. National Matching Service, Inc. Participating PGY1 Programs. 2020 ASHP Match.
 Hazard Pay

73%
believe pharmacy will need to offer salary premiums
(“hazard pay”) for “pharmacists and technicians who work
with hazardous medications to attract and maintain staff”
 Pharmacy Leadership
➔ Pharmacy Value
Proving our worth through data
➔ Entrepreneurial Skills
Business opportunities to make and save
money
➔ Expanding Influence
Increasing pharmacy leadership over other
departments
➔ Diversity
 Pharmacy Value
89% believe pharmacy will have consistent, ongoing processes
for evaluating the value of their department

Value-Based Reimbursement Data Collection

➔ Based on outcomes ➔ Documentation

and performance ➔ Optimizing technology
rather than volume ➔ Building new services
from data collected
 Entrepreneurial Skills and Expanding Influence

Increasing costs with limited revenue Sharing resources and experiences

reimbursement → business opportunities to across multiple departments
make and save money
Diversity
 Evidence-based Pharmacy
Practice
➔ Artificial Intelligence
Clinical decision making technology
➔ Performance Metrics
Focus on patient outcomes
➔ Genomic Testing/Genetic Modification
What is pharmacy’s role?
➔ Medical Cannabis
Managing medical cannabis both inpatient
and outpatient
Artificial Intelligence

➔ Predictive analytics

➔ Drug development

➔ Tracking drug adherence

Performance Metrics
 Genomic Testing

➔68% of respondents believe that health systems will

develop policies about the ethical use of genomic testing

Psychiatry

Cardiology Oncology

ID
 Genetic Modification

➔63% of respondents believe departments other than

pharmacy will have responsibility for technology
pertaining to genetic modification

What is our
role?
 Medical Cannabis
➔64% of respondents believe the federal government will remove
marijuana and medical cannabis from the list of controlled substances

CBD vs THC
 Medical Cannabis, cont.

Medical Cannabis Law: Only CBD products < 0.3% THC

Recreational: Illegal

Medical Cannabis Law: Only CBD products < 0.3% THC

Recreational: Illegal

Medical Cannabis Law: Completely legal

Recreational: Legal

1. IN Code 35-48-4-11 (2017).

2. 302 KAR 50:020 (2020).
 Pharmaceutical Supply
Chain
➔ Shortages
57% increase in medication shortages from 2017 to 2019

➔ Innovation
Developing businesses with missions to improve supply

➔ Drug Pricing
Price reduction plans are a hot topic with the federal
government

➔ Value
Value is rarely used when discussing prices of medications
 Shortages

● Increased incentives for

domestic API production
● Essential medication lists
● Buy USA/EU products when
available
 Innovation in
Supply Chain

● New developing
businesses with missions
to improve supply
● Goals are to outsource
production to contract
manufacturers
Medication Pricing
● Advertising prices are
unlikely to decrease
medication costs
● Price controls on some
products will have minimal
impact on high cost of
medications
 Value

● Institute for Clinical and

Economic Review (ICER) are not
commonly used for Medicare to
decide coverage
● Continue trend towards value-
based reimbursement
Healthcare Marketplace
➔ Biosimiars and Generics
Two areas that have significant contributions to
medication prices

➔ Specialty Pharmacy
Shifting and consolidating pharmacies

➔ Health System Price Transparency

Can price transparency help reduce drug prices?

➔ Delivery of Care in Rural Areas

Delivery to rural areas is important and necessary
 Biosimiars and
Generics
- 91% of panelist believe that
biosimilars will represent
25% of the market in the
next five years
- Federal regulations to stop
patent manipulations are
unlikely
Specialty
Pharmacy
- The market is consolidating
- Four organizations control
70% of the specialty market
(CVS, Cigna, Walgreens, and
UnitedHealth)
- 77% of panelists believe
health system pharmacies
could provide better care
 Price Care in Rural
Transparency Areas
● 50% of panelists believe
publishing hospital ● Telemedicine can help reach rural
charges will provide value areas that are underserved
to patients
 Healthcare Reform
➔ State Initiatives

➔ Disruption and Integration

➔ Bypassing Insurers

➔ Future of Capitation

➔ Universal Healthcare Coverage

Healthcare Reform
● 181 million individuals have
employee-sponsored health
insurance
● Average of $15,000 per employee
Healthcare Reform
● Joint ventures are being
developed to reduce costs for
the companies
● Contracts with health care
systems
● Movement to value-based
reimbursement
● Election may decide
possibility of universal
healthcare
 Black Swans
➔ Black Swans in Pharmacy

➔ Preparing

➔ Strategic Planning
Black Swan Events
Black Swan
Black swan events can and will
happen
Examples: 2017 Puerto Rico
hurricane, 2018 IV fluid
shortage, 2017 new CAR-T
therapies
Preparing
Panelists report health care
systems tend to not be prepared
for black swan events
Planning
Recommend probe of
pharmacy team for “what if”
discussions
Increase attention needed for
long-term strategic issues
Black Swan Events
What questions
do you have?
Pharmacy Forecast 2020
Deaconess Health System

Landon Russell, PharmD; Lauren Wathen, PharmD