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Try out PMC Labs and tell us what you think. Learn More. The ASHP Foundation Pharmacy Forecast has been a valuable source of insight and guidance about our profession as it is influenced by or influences external factors in our environment. The staff of AJHP has provided substantial editorial support for this publication, and we appreciate their assistance. Zilz Leaders for the Future fund, which provides the resources to develop the report.

The Foundation is also grateful to Omnicell for their support of the Zilz fund, which has made the Pharmacy Forecast possible. ASHP and the Foundation are indebted to those individuals who have helped make the edition a success. Over the past 8 years, the Pharmacy Forecast has provided insight into emerging trends and phenomena that have impacted the practice of pharmacy and the health of patients in health systems. The value of the report is determined by its value to health-system pharmacists and health-system pharmacy leaders as they use the report to inform their strategic planning efforts.

The Pharmacy Forecast is not intended to be an accurate prediction of future events. Rather, the report is intended to be a provocative stimulant for the thinking, discussion, and planning that must take place in every hospital and health system in order for those organizations to succeed in their mission of caring for patients and advancing the profession of pharmacy. Some may disagree with the opinions of the FPs or the positions taken by individual chapter authors with respect to their vision of the future.

That is acceptable and desirable. Also, the report reflects a consensus of the national direction and may not reflect what is likely to occur in your geographic region or state. We welcome your comments on this new edition of the Pharmacy Forecast. Joseph T. Address correspondence to Dr. DiPiro ude. An underlying assumption supporting the need for the Pharmacy Forecast is that many factors influencing our profession and pharmacy services are not directly under our control, yet we can take actions that enhance the likelihood of favorable outcomes within this environment.

Those influencing factors may be as a specific state or national policy or regulation, or as nebulous as the trend toward globalization or anti-globalization. Within that context, then, we have greatest control over the scope of our pharmacy enterprise and the workforce within that enterprise, and some control over those factors where we can advocate to the decision makers such as health-system administrators, legislators, and government agency officials. The perspective gained from reading the Pharmacy Forecast is most effectively used within the process of strategic planning as part of environmental scanning or when identifying strengths, weaknesses, opportunities, or threats SWOT.

This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. 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.

The 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. That list was then expanded and refined through an iterative process, resulting in a final set of 7 themes, each with 6 focused topics on which the survey was built. Each of 42 survey items was written to explore the selected topics and was pilot tested to ensure clarity and face validity.

Nominations were limited to individuals known to have expertise in health-system pharmacy and knowledge of trends and new developments in the field. The size of and representation within the Forecast Panel were intended to capture opinions from a wide range of pharmacy leaders.

The Pharmacy Forecast survey instructed FPs to read each of the 42 scenarios represented in survey items and consider the likelihood of those scenarios occurring in the next 5 years. They were asked to base their response on their firsthand knowledge of current conditions in their region, not on their understanding of national circumstances.

The panel was carefully balanced across the census regions of the United States to reflect a representative national picture. 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.

This year we chose to present in related articles in this issue of AJHP additional insights on Pharmacy Forecast topics in the light of major societal factors, the U. William Zellmer was invited to reflect on the developing political environment after our national election and how it could impact healthcare. Therefore, it is important to understand the composition and characteristics of the panel. A total of FPs were recruited to complete the forecast survey. Responses were received from an The remainder of FPs included leaders and practitioners at varying levels and with varying titles.

Overall, the composition of the Forecast Panel was similar to that in years. As shown in Table 1 , the percent of total responses from each U. In the survey, every region was represented by a minimum of 15 FP respondents. Each section of the report provides a summary of the survey findings, assessment and perspective of the chapter author, and strategic recommendations. While the individual survey items focus on a specific projection of the future, the full breadth of discussion in each chapter is broad and links related items when appropriate.

The first chapter, by Erin Fox and Aron Kesselheim, focuses on the global drug supply chain. A generally accepted assumption is that the world at large and the United States will likely experience calamities such as the COVID pandemic and breaches in cybersecurity that could disrupt the availability or reduce the quality of medications. What can and should we do within health systems to prepare for these possibilities? While access to healthcare has always been an issue, it has received greater visibility and urgency as our nation struggles with racial equity. The emergence of new communication technology provides greater opportunity to expand access to underserved populations.

As pharmacy services and healthcare in general have become more data-complex, effective and ethical use of data has become ever more important. Jannet Carmichael and Joy Meier discuss the implications of data use to develop more efficient and consistent models of care, and also the ethical issue of privacy in systems that have access to a greater extent of patient and employee data. Healthcare financing, a persistent topic for past Forecast editions, is addressed by Thomas Woller and Brian Pinto and includes a wide scope of topics from pharmacy benefit manager transparency to contracts with online distributors and value-based contracts.

The tax-exempt status of health systems is another topic of discussion in the chapter as requirements for the charity-care requirement are under scrutiny by federal and state governments. Patient safety is addressed in the chapter by James Hoffman and David Bates and continues the discussion from editions of Pharmacy Forecast. They also address the role of the pharmacists as patient safety leaders and the roles of pharmacy and therapeutics committees. They tie in staff resilience and well-being to patient safety. We are all aware that the scope of the pharmacy enterprise in health systems has grown and changed substantially in the past decade.

John Armitstead and Dorinda Segovia discuss expansion of access to pharmacists in primary care settings as well as the potential for pharmacist redeployment from traditional acute care positions. They also discuss institutional credentialing processes and likely changes in the extent and documentation of pharmacy services.

Along with changes in the pharmacy enterprise, there have been and will continue to be changes in our pharmacy workforce, and these issues are addressed by Melanie Dodd and Mollie Ashe Scott. Among the issues that have been before us for years are pharmacist provider status and prescribing authority. They also discuss the opportunity to enhance pharmacist roles through automatic verification of medication orders and expanded roles of technicians.

Finally, the pharmacist workforce, including resident recruitment, could ificantly be impacted by a reduction in the of pharmacy graduates across the country. The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence us over months and years and not on day-to-day situational dynamics.

The edition of the Pharmacy Forecast differs from past editions by inclusion of new, timely topics while continuing the discussion of topics that have remained important from years. The report 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.

This is the most appropriate level of focus for strategic planning. As the process of strategic planning should involve pharmacy staff at all levels, the Pharmacy Forecast provides guidance to anyone participating in health-system strategic planning activities, and it is recommended that the report be reviewed by all involved. 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.

Those organizations involved in education or training should consider the use of the Pharmacy Forecast as a teaching tool. 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. Finally, as the pharmacy workforce is 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.

The content of the report should inform the broadened scope of responsibility that many pharmacists now take. The Pharmacy Forecast should be shared with other senior health-system leaders and executives as a resource to help them understand the challenges facing pharmacy and to help them recognize the way emerging healthcare trends will affect many other areas of health systems. Erin R.

Fox, Pharm. Aaron S. Kesselheim, M. Fox ude. Drug shortages are not new to healthcare providers in the United States, and the SARS-CoV-2 pandemic has highlighted the fragility of the global medication supply chain. The of ongoing and active drug shortages increased from in to in , with many of the shortages in exacerbated by the current pandemic. Primary management of shortages falls mainly to pharmacists. In the early days of the SARS-CoV-2 pandemic, as hospitals were struggling with allocation of personal protective equipment and ventilators, the crisis standards of care that states generated helped provide some clarity and transparency to the process.

Bioethics researchers such as those at the Hastings Center and the Berman Institute are also suggesting guidance for allocating scarce resources. Most health systems suffered substantial financial shortfalls from fewer patient encounters and cancelled procedures during statewide shutdowns. Since , FDA leaders have been advocating for such a system to reduce the likelihood of shortages and encourage low-performing manufacturers to improve.

Unfortunately, cases of quality problems, including with angiotensin II receptor blockers and metformin, have continued in recent years, sometimes also contributing to shortages. Despite several drug shortage provisions in the Coronavirus Aid, Relief, and Economic Security Act CARES Act , 5 such as requiring manufacturers to provide FDA with more information regarding reasons for and durations of shortages and asking manufacturers to establish contingency plans relating to supply disruptions, a method to rate the quality of medications was not included.

Many clinicians were concerned that drug shortages would increase due to manufacturing closures in China or that some nations would halt imports to reserve supplies for their people. A list of potentially affected products was challenging to prepare due to the proprietary nature of much drug manufacturing information, including the source of raw materials and site or name of the manufacturer.

As more patients came down with COVID in the United States, drug shortages increased, but those shortages were due to an increased demand resulting from high patient volumes rather than global causes. Despite this reality, politicians moved to bolster U. The U. Inexpensive generic drugs are among the most cost-effective healthcare interventions, and prices of some older, off-patent medications have been increased substantially, leading to increased healthcare system spending and lack of access for patients.

Importation of prescription drugs has been proposed for decades, but prior presidential administrations were reluctant to push for more vigorous implementation of importation in the face of opposition by the pharmaceutical industry. While importation of single-source brand-name drugs may not be feasible, FDA may develop pathways for responding to generic drug shortages or price hikes by facilitating the regulatory approval of overseas manufacturers of those products. Forty percent of generic medications without production competition in the United States had approved versions made by independent manufacturers outside of the United States, and importation could therefore help ensure lower prices.

Collaborate with other health systems and local and state agencies to plan for pandemic-related surges or distribution of scarce resources such as vaccines. Establish information-sharing systems to ensure level loading between organizations. Insist on receiving publicly reported quality measures when ing drug acquisition contracts, and ensure that contracts ed on behalf of health systems also include a measure of quality. Encourage public policy advocates within your circle of influence e. Marie Chisholm-Burns, Pharm.

Christopher K. Finch, Pharm. Christina Spivey, Ph. Marie Chisholm-Burns ude. Barriers to healthcare threaten the health of those in front of the closed doors—and the health of everyone. Advances in technological adaptability will and have paved the way for this to occur. In fact, we have already witnessed a considerable growth in telehealth during the COVID pandemic, with patient consultations being conducted remotely. Nevertheless, use of telehealth, including telepharmacy Figure 2 , item 2 , for services such as transitions of care and medication therapy monitoring and recommendations will likely continue to grow due to its convenience, efficiency, accessibility, and cost-effectiveness.

Seventy-one percent of FPs believe that pharmacy technicians will be actively engaged with patients and interprofessional care teams in identifying, assessing, and resolving barriers to medication access Figure 2 , item 3. An interprofessional care team, which included pharmacy technicians, worked with patients to identify, assess, and resolve medication access barriers; increase medication access; and ificantly improve therapeutic outcomes and patient quality of life.

It is incumbent upon pharmacy leaders to assess the roles pharmacy technicians can play, as extending their scope of practice may improve care and reduce costs to institutions and the patients they serve. While having seamless transitions from one setting to the next as they relate to medication therapy would be ideal, the reality of having a perfectly aligned formulary is rife with logistical challenges, including:.

Given these challenges and many more, the realization of a community or regional formulary will continue to face obstacles and likely not be fully supported in the near future. For example, since cannabis use is illegal under federal law and because hospital accreditation occurs through the Centers for Medicare and Medicaid Services, health systems that provide access to cannabis put themselves at ificant risk, as cannabis use could result in violations, loss of federal funding, or other substantial penalties.

The t Commission weighed in on nonhospital medications with standard MM. In addition, if inpatient settings began dispensing non-FDA-regulated products, added problems would no doubt materialize in the form of lack of inventory control and formulary management. All of these pose opportunities for error, increased cost, and breaches in safety for the patient.

Build on the expanded use of telehealth during the coronavirus pandemic to implement, permanently, telepharmacy that will enhance the medication-related outcomes of all patients in your health system, including those in underserved areas.

Assess how pharmacy technicians in your pharmacy enterprise can be engaged more broadly and effectively by patient care teams to improve medication access; enhance technician training and roles accordingly. Evaluate with other pharmacy leaders in your state the desirability and feasibility of making permanent any expanded pharmacy scope of practice that was implemented in response to the coronavirus pandemic or other public health emergencies. Pursue with the pharmacy leaders of other health systems in your region the prospect for greater harmonization of formularies and the formulary decision-making process.

Initiate a process within your health system of examining and revising if necessary existing policies related to use of non-FDA-regulated therapies. Jannet M.

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