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. 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. 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. This podcast series will feature lively discussions from subject matter experts and members. The results for survey items 3 and 4 (Figure 8) are worrisome because they suggest that both health-system pharmacy departments and health systems as a whole tend not to have a strategic planning process that is well suited to dealing with black swans. Fragmented finance structures lead to fragmented care delivery. 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. 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). 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. This is inconsistent with national trends and attention to the preparation of these medications. A majority of FPs indicated they believe this is a likely occurrence in many departments (Figure 3, item 3). A majority of FPs (78%) believe price disclosures will be required in future direct-to-consumer advertising (Figure 5, item 4), but just over half of FPs believe that price controls will be enacted for some essential medications, such as insulin (Figure 5, item 5). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 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. 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). Approximately half of FPs believe that a publicly accessible hospital charge master will provide value to consumers (Figure 6, item 5). Integration across these service lines should entail the development of new expertise and the development of strong partnerships with existing subject matter experts (e.g., cell therapy laboratories). 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. In the United Kingdom, the National Institute for Health and Care Excellence provides guidance and utilization decisions based on clinical evidence. Address correspondence to Dr. Fox ( 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. Data from the University of Utah Drug Information Service show a 57% increase in ongoing and active drug shortages, from 176 in 2017 to 276 in 2019. While the responses indicate a concern regarding the impact that such burden could have, patients may be willing to embrace complex self-care management.6,7 The responses may also reflect confidence that individual- and health system–level factors can mitigate potential burdens. 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. 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. It will be difficult for health-system SPs to compete with market-dominating SPs. Within each section of this report, the results of each survey question are summarized in detail. Unless Congress acts to reform coverage and reimbursement rules, Medicare will continue to pay for all drugs with FDA-approved indications and selected off-label indications, without regard to cost-effectiveness standards. Nominations were limited to individuals known to have expertise in health-system pharmacy, knowledge of trends and new developments in the field, and the ability to think analytically about the future. They did not consider where drug products were made, perhaps assuming sufficient geographic dispersion so that a single natural disaster could not significantly disrupt supplies. 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. 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 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. (Evidence-based Pharmacy Practice). Health systems must work towards policies for the ethical use of this potentially very large volume of data.7 A majority of FPs agreed that development of such policies in health systems was likely (Figure 4, item 4). This process is particularly valuable when addressing phenomena that are not well suited to quantitative predictive methods. Hospitals are integrating with medical practices, … 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. From specialty medications to the use of technology to speed up the development of drugs, this year was all about innovation and breakthroughs for the pharmaceuticals industry. 1199 W. Shoreline Lane, Suite 303 Boise, Idaho 83702-9103 (208) 334-2356 (208) 334-3536 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. Similarly, pharmacologic effects of medical cannabis include the potential for adverse effects and drug interactions and will be more common with increased use. Adopt practices that support occupational risk levels for handling of hazardous drugs in accordance with the ALARA principle while pursuing research that explores the validity of risk assessment and the effectiveness of risk mitigation, particularly as they relate to regulations. Expand on organizational policies and procedures focused on preventing and managing workplace violence, partnering with security staff to implement training and drills specific to pharmacy space and staff. Although this seems overly optimistic for the general market, it is possible in health systems with strong formulary controls and active clinical programs. 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). 2020. 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