- Precision medicine will mature. In conjunction with this, the pace of discovery and implementation of targeted therapies will accelerate. “While oncology has experienced the most significant shift in practice because of personalized therapies, we should expect to see a shift in prescribing patterns for chronic disease,” Foster says. “In the past, medication selection and dosing were based on broad, population-based studies.”
Soon, rather than starting a medication at a dose based on population averages, providers will have the ability to select a medication and dose based on patient-specific genomic factors. “This should improve patient outcomes and medication adherence rates,” he says.
The promise of precision medicine will force health plans and health systems alike to rethink formulary management strategies. “Although additional research will be needed in order to determine which genomic variations translate to meaningful outcomes, developments in this space are promising,” Foster says.
- Ongoing emphasis on social determinants of health (SDoH). SDoH, which the CDC defines as “conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes,” will continue to move to the forefront as a major issue in managed care pharmacy.
“SDoH have been obvious to healthcare providers for many years, but the concept hasn’t been a focal point in the total care of the patient until more recently,” Bizzaro says. “There’s a growing recognition that not only do you need to treat physiology for disease management and prevention, but you also need to identify whether members need help with social care that can affect their well-being and clinical outcomes—including those related to pharmacotherapy.”
When it comes to managed care pharmacy, health plans that are investing in addressing SDoH will likely see a positive impact in areas such as medication adherence, Bizzaro maintains. For example, getting members to medical appointments is important, so increasingly, health plans and other organizations are paying for ride share services when members have transportation challenges.
“This type of intervention means members see their providers for regularly scheduled visits, ensuring they obtain needed prescriptions,” Bizzaro says. “Their physicians are also able to monitor drug therapy, to ensure it’s effective and that members aren’t encountering issues with adherence or side effects. By viewing members and their situations holistically, medication therapy is more effective and clinical outcomes improve.”
- Pharmacists emerge as primary care providers. More pharmacists are functioning as primary care providers, whether they are giving vaccinations at retail pharmacies or hospitals, are certified in diabetes care, or in some states, are empowered to prescribe and order laboratory tests. “In 2020, we can expect to see an expansion of pharmacists and other non-physician healthcare professionals providing this type of care,” Bizzaro says. “This approach allows pharmacists and physicians to practice at the top of their licenses; doctors can concentrate on sicker patients.”
Orsula Knowlton, PharmD, MBA, co-founder and president, Tabula Rasa HealthCare in Moorestown, New Jersey, which provides medication risk mitigation technology, also foresees pharmacists taking on more primary care provider responsibilities, by playing a larger role in advising care, managing treatment, and taking responsibility to prevent adverse drug events, the third leading cause of death.
“Traditionally, pharmacists and physicians have worked separately from one another. However, as a new model of patient care emerges, more hospitals and health systems will integrate pharmacists alongside physicians and nurses before prescribing decisions are made,” Knowlton says.
There are multiple reasons for this change in the care team structure. First, while multiple players can be involved in decision making for a patient, none except the pharmacist have the unique education required to holistically assess medication regimens for effectiveness and safety. “Together, pharmacists and physicians can make impactful interventions that can lead to reduced hospitalizations and unnecessary healthcare costs associated with medication mismanagement,” Knowlton says. In addition, collaborative practice agreements are becoming more common, which is a proven model in the Veterans Health Administration clinical pharmacy program.