Trying to predict the future of pharmacy practice is a challenging endeavor. What our profession will look like in the coming months and years will likely be determined by the interplay of many factors, only some of which are within our control or even on our radar. Regardless, determining where we are headed and what factors may shape the road ahead is valuable in order to adequately prepare for that future, as well as assessing whether there may be anything we can change to control.
To that end, insights like the Pharmacy Next: Health Consumer Medication Trends survey commissioned by Wolters Kluwer can provide a valuable guide to what we can expect in the near future based on consumer demand and the evolving pharmacy landscape. The data reflects a dramatic shift toward the role of the pharmacy becoming the site for primary care, as well as providing clarity on some of the tradeoffs consumers are willing to make for more affordable and personalized care.
Expanding pharmacy and pharmacist services
Not surprisingly, 97% of Americans say a pharmacist should have a responsibility to inform them about the safety and/or effectiveness of their medication. A little more surprising may be that, according to the survey, 61% of Americans believe that 5 years from now, most primary care services will be provided by pharmacies, retail clinics and/or pharmacy clinics rather than primary care providers. office. Similarly, 72% of Americans said they would be open to receiving medication prescribed by a specially trained pharmacist rather than a physician.
Movement in this direction is already taking place across the profession, and has been for many years. There are already more than 3000 retail health clinics in North America, And business acquisitions of some of the larger retail pharmacy chains in 2022 suggest these numbers and services offered at these sites will continue to expand. Additionally, pharmacists are critical providers of vaccines in all 50 states, and in more than 20 states, pharmacists have either direct prescribing authority or authority under a collaborative practice agreement to prescribe in response to rapid diagnostic test results for diseases such as COVID-19, influenza, and strep. Many states authorize pharmacists to initiate hormonal contraceptive or pre-exposure prophylaxis treatment for HIV prevention. Using consumer sentiment as a guide, these pharmacy service offerings will likely continue to expand.
However, although many Americans say they are not concerned about the safety of receiving medication instructions from someone other than their physician (such as a pharmacist and/or nurse practitioner/care staff) at a clinic, issues such as pharmacy staffing and medication safety still cause some consumers to pause. Specifically, 51% of survey respondents said they were concerned about potential problems with their prescriptions due to understaffed pharmacies.
Adequate training and support of pharmacists is critical to the success of these efforts, without causing excessive burnout to expand pharmacist responsibilities and pharmacy services. Respondents cited concerns about more traditional pharmacy services when additional services are added, with half of consumers worried about wrong dosages, wrong medications or wrong directions. While some of these concerns can be addressed through improvements to understaffing problems in pharmacies, these concerns highlight challenges that can be at least partially overcome through technology and workflow improvements.
Tradeoffs to reduce health care costs
Another important concern of respondents is the cost of medication. According to the survey, more than 2 in 5 Americans (44%) have chosen not to fill a prescription in the past few years due to cost. Furthermore, the number of patients avoiding medication due to cost was higher (56%) among those without health insurance. Medication non-adherence is a complex problem that needs to be addressed by many stakeholders, including providers, pharmacists, pharmaceutical companies, payers and patients. The data highlight the potential extrinsic role that consumption may play in these adverse health behaviors.
In fact, between July 2021 and July 2022, more than 1200 medicines saw price increases that exceeded the rate of inflation (8.5%), with an average increase of 31.6% for these products. The Inflation Reduction Act of 2022 aims to limit drug prices and keep price increases under control, but some of those measures don’t kick in for years, and more will likely be needed for meaningful price controls. Some pharmacies, such as Mark Cuban’s CostPlus Online Pharmacy, are even looking at a cash-only system that bypasses insurers and pharmacy benefit managers.
Not surprisingly, consumers seem eager to explore ways to save on healthcare costs. More than half of respondents (56%) often ask their doctor about less expensive options and 43% ask their pharmacist about less expensive options. Meeting this need for information will require additional training for pharmacists, and access to tools that can help make safer recommendations that also address patient concerns about cost.
Other considerations raised to reduce costs include increasing interest in accepting prescriptions by mail if it means lower costs, seeing alternative providers or making more prescription drugs available over the counter. While some of these changes are already in place—such as the growth of mail-order pharmacies in the past decade—others may bring important safety trade-offs to consider.
Meeting the rise of personalized medicine
Some of these security considerations stem from the lack of visibility of patient health information in decentralized care settings. With the rise of personalized medicine and tailored prescribing, interoperable health records represent a significant hurdle to overcome. However, thanks to the rise of mainstream genomic testing like Ancestry.com or 23andMe, patients are showing interest in using these insights to inform their medications.
Despite the availability of specific published guidelines for more than 160 drug-gene combinations, the use of genomics, also known as pharmacogenomics, to inform prescribing is still limited. When given an overview of pharmacogenomics, more than 70% of Americans would provide a blood sample for genomic analysis if it meant they would receive more personalized medical care. Similarly, more than 4 in 5 Americans would provide a sample for genomic testing if it meant their prescriptions would be safer or more effective, and 88% see an incentive for health insurance plans to cover the costs of genomic testing if it helps avoid wasteful spending. . Ineffective or unnecessary medication.
It is important to note that pharmacogenomics represents only one aspect of efforts to personalize patient drug therapy. Avoiding hazards such as dangerous drug interactions, duplicative therapy, drug-disease interactions, or allergies may be more valuable than using genomics to determine guidelines. To that end, more than 4 in 5 (85%) respondents said they would make their medication history more accessible to an extended care team if it improved the safety and/or relevance of their prescribed medication. It’s clear that more education is needed for patients so they can inform other providers about personal health conditions that may affect their care—for example, nearly two-thirds (65%) of respondents don’t know that things like their kidney health may actually be what they’re prescribed. Change the dose of the medicine.
Pharmacist responsibilities are sure to change in 2023 and beyond. While some of this will likely be driven by continued shifts in pharmacies and retail clinics offering more and expanded services, consumer concerns about drug prices and safety are also important drivers. These changes represent significant opportunities for pharmacists to offer services that many patients have been clamoring for for decades.
As drug experts and one of the most respected and accessible healthcare professionals, pharmacists are well positioned for the extended care responsibilities that consumers increasingly seek. At the same time, it is imperative that these decentralized clinical sites provide adequate staffing, training, and other support so that these efforts fully realize the benefits to individual patients as well as the broader health care system.
About the author
Daniel S. Streetman, PharmD, MS, Manager of Referential Drug Interactions and Pharmacogenomics, Clinical Effectiveness Wolters Kluwer.
At Rebelo. Pharmacy Next: Health Consumer Medication Trends. Walters Kluwer. December 7, 2022. Accessed January 24, 2023. https://www.wolterskluwer.com/en/news/us-survey-signals-big-shifts-in-primary-care-to-pharmacy-and-clinic-settings