future of pharmacy practice
TRANSCRIPT
Future of Pharmacy
Things to consider when starting a career in
community practice
David Holdford, RPh, MS, PhD
Professor, School of Pharmacy
Virginia Commonwealth University
There are few guarantees in life
Every choice you make is a gamble
Your chances improve by understanding
the healthcare market and major trends
influencing it
Knowledge helps you distinguish
opportunities from threats
What is my future in community pharmacy?
Opportunities
Personal & professional
growth
Work that doesn’t feel like work
Threats
Obsolescence
Drudgery
Is this how you
want to feel about
your pharmacy
career?
Isn’t this more
like it?
You may not be able to change the
future, but you can prepare yourself to
adapt to it
This presentation will…
Describe major trends influencing community pharmacy practice in the US
and Worldwide
Identify potential futures for community pharmacists
Suggest strategies to thrive in a dynamic pharmacy business environment
Where we are today
Community Pharmacy Practice is under pressure
The current business model is facing…
Shrinking dispensing fees
Lower product reimbursement
Higher performance expectations
Reasons for pressure on community pharmacy
Tightening healthcare budgets
Greater competition
Evolving channels of distribution and finance
Changes in consumer demand
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18 cents of every dollar in
America is spent on healthcare
instead of transportation,
education, food, housing, leisure,
and other consumption. Only 7
cents was spent in 1970.
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No other industrial country in the
world spends more than 12
cents of every dollar on
healthcare.
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And they get better health
outcomes.
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HEALTH CARE REFORM?
Reasons
Tightening healthcare budgets
Greater competition
Evolving channels of distribution and finance
Changes in consumer demand
CVS, Walgreens, & Express Scripts
account for almost half of all prescription
revenues in 2017
The top 15 companies account for 72% of market
Source: DrugChannel.net
The big companies keep getting bigger.
Small chains and independents have to work hard to
keep up with the big players.
And new pharmacy businesses keep
trying to disrupt the market
Reasons
Tightening healthcare budgets
Greater competition
Evolving channels of distribution and finance
Changes in consumer demand
Te
leph
arm
acy
https://www.scriptpro.com/blog/2014/10/08/hrsa-awards-grants-for-telepharmacy-and-more-in-rural-areas/
http://www.rethinkrobotics.com/baxter/
AT
M D
isp
en
sin
g &
Robo
ts
Instymeds.com
Moby is a solar-powered store on wheels. It uses artificial intelligence, drone delivery, is open 24 hours, and needs no staff.
Pharmacy?
Reasons
Tightening healthcare budgets
Greater competition
Evolving channels of distribution and finance
Changes in consumer demand
The aging population
Unmet demand for primary care practitioners = more opportunities
Healthcare is moving from hospitals to the community
Specialty drugs are becoming a larger portion of spending
Adherence and persistence with medications is still a problem
Interprofessional care is more accepted
Uninsured and underinsured is likely to increase with most recent healthcare reform proposals
Margins eroding on generics
Consolidation in the healthcare industry
Trend toward limited pharmacy networks
Po
sitiv
e T
ren
ds
Ne
ga
tive
Tre
nd
s
Possible futures
Indentured Servitude
Retail Hub
Pharmacy Phactory
Gig Economy
Relational
Transactional
Production Line
Approach to Service
Empowerment
Approach to Service
Indentured Servitude
Retail Hub
Pharmacy Phactory
Gig Economy
Relational
Transactional
Production Line
Approach to Service
Empowerment
Approach to Service
The future is based upon
probabilities. These are 4 futures
proposed in the literature. One,
none, or several of these may
come to pass.
The question is, “Which one are
you preparing for?”
Indentured Servitude: Pharmacists are trapped in
contracts serving their PBM Overlords
Pharmacy Phactory Pharmacists work in assembly line
conditions like mail order--dispensing
drugs, not providing healthcare
The Gig Economy – Pharmacists work PRN
Pharmacists get individual gigs using a website or mobile app that helps to match
them with customers or temporary employers. Gigs are of limited duration. They
can be very brief or months long like with a employment service contract.
When one gig is over, pharmacist must find another. Sometimes, full time pay
requires juggling multiple jobs at once.
https://www.bls.gov/careeroutlook/2016/article/what-is-the-gig-economy.htm
Gig example: Working at home at low pay & unpredictable
hours serving customers at ATM dispensing machines
Wellness products &
services
Medication Therapy
Management
Coordinating with health
care providers
Managing insurance &
financing
Diagnostics & point-of-care
testing
Retail Hub
Sourc
e: P
wC
Health R
esearc
h Institu
te, “T
he c
om
ing
plu
g-a
nd
-pla
y h
ea
lth
eco
syste
m,”
20
15
.
Wellness products &
services
Medication Therapy
Management
Coordinating with health
care providers
Managing insurance &
financing
Diagnostics & point-of-care
testing
Retail Hub
Sourc
e: P
wC
Health R
esearc
h Institu
te, “T
he c
om
ing
plu
g-a
nd
-pla
y h
ea
lth
eco
syste
m,”
20
15
.
Community pharmacists are at
the center of a retail ecosystem
of health care, diagnostics,
wellness, and financing.
Retail Hub
In this future, pharmacies provide a platform or “health hub” that serves
customers. The retail pharmacy hub can link employers, local health system,
pharmaceutical companies, diagnostics companies, insurers, and other
healthcare stakeholders to help patients get and/or stay well.
Sourc
e: P
wC
Health R
esearc
h Institu
te, “T
he c
om
ing
plu
g-a
nd
-pla
y h
ea
lth
eco
syste
m,”
20
15
.
Sourc
e: P
wC
Health R
esearc
h Institu
te, “T
he c
om
ing
plu
g-a
nd
-pla
y h
ea
lth
eco
syste
m,”
20
15
.
Community pharmacies can compete
In very large markets as hubs
Retail Pharmacies have an advantage
They are…
• Convenient
• Efficient
• Technologically advanced
• Omnichannel
• Have highly trained healthcare experts on site
But they need to change
Doing the same old thing will likely lead to a bleak future for the profession
htt
p://inve
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om
Pharmacy chains like CVS and Walgreens are moving toward a hub model
Future for Pharmacists in
Community Pharmacy
Opportunities in community
pharmacy hinge in part on the
answer to the following question…
Will technology or other
substitutes replace
pharmacists?Answer:
Probably some, but not all
The median salary of community
pharmacists in the US in 2016 is
$120,000
Not counting benefits
https://www.bls.gov/oes/current/oes291051.htm
High performing community pharmacists
will generate value that exceeds their
cost of employment…
…On complex tasks that humans are better at doing
https://www.bls.gov/oes/current/oes291051.htm
Low performing pharmacists who do not
add value are likely to be replaced by
lower cost substitutes like robots
empxtrack.com
empxtrack.com
Technology is more likely to replace
average & below average
pharmacists
Pharmacists who fail to add value to healthcare are
at risk
Are you planning on being an above
average pharmacist?
If so, what is your plan?
What skills will you need to actively
participate in the new community
pharmacy market environment?
More skills are
needed
These are some of the skills
that are likely to be important
for successful pharmacists in
the futureSkills & Training
Needed in pharmacy
Clinical Skills
Practice Management
Oral & Written Communi-
cations
Assess & Add to Evidence
Base
Working in Teams
Automation & Technology
Diagnostics
Epidemiology & Pharmaco-economics
Pharmaco-genomics
The future is uncertain
Pharmacy students and pharmacists can increase their opportunities by observing
major trends and adapting to them
Adapting requires learning things like
• how to build business plans and
• marketing pharmacist services
References
https://www.pwc.com/us/en/health-industries/health-research-
institute/publications/pharmacy-of-the-future.html
https://www.atkearney.com/health/ideas-insights/article/-
/asset_publisher/LCcgOeS4t85g/content/the-future-of-community-pharmacy-in-
england/10192 (note: the article focuses on England but the insights are equally
applicable to the US)
http://drugtopics.modernmedicine.com/drug-topics/news/future-community-
pharmacy?page=full