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With the tumultuous election behind us, our thoughts turn to a new year and the challenges that lie ahead. These changes should be beneficial for the economy while also creating new opportunities and challenges for the pharmacy industry.
Finding and implementing solutions regarding specialty pharmacy is taking on increased importance, as these products account for a growing percentage of the annual healthcare spend. According to the Express Scripts 2016 Drug Trend Report, based on 2015 data: “Today 37.7% of drug spend is for specialty medications, with the number expected to increase to 50% by 2018 and continue to grow from there.”
Pharmacists are increasingly facing new challenges with managing and dispensing controlled substance medications. Market and regulatory changes have been taking place with controlled substances, including the new opioid guidelines, electronic ordering of CIIs using the Drug Enforcement Administration’s Controlled Substance Ordering System (CSOS), and increased availability and utilization of prescription drug monitoring programs (PDMPs).
Yesterday was my 80th birthday. Several times I said, “Thank you for the first 80 years — they have been great. I am looking forward to the next 80. There is still much to do.” However, this is also a time to look back on what has gone on since 1936. What follows are a few of the things that have impressed me.
We absolutely know you don’t have time to have your head in the clouds, envisioning a future scenario where technology allows you to morph your practice into another unanticipated level. We also fear that many of you are spending most of your waking moments in the weeds of survival in your practice, while changes are afoot that can dramatically impact your business.
It seems that you can’t go a day without seeing or hearing something about the opioid epidemic, whether in trade publications or mainstream media. Now that everyone is paying attention to it, what happens? While we wait for Congress, or maybe, instead of waiting for them, there are steps that the healthcare industry can take today.
The difficulty arises when we make measurable things important rather than make important things measurable. What a pharmacy benefits manager’s (PBM’s) drug trend report reveals is interesting, but what it conceals is essential.
The healthcare space continues to evolve, partially in response to the increasingly numerous and glaring shortfalls patients experience in terms of poor outcomes. Possibly an even greater driver to the changes you are experiencing in your practice is the continually rising cost of care. A single healthcare dollar can be divided into an array of expense areas, including inpatient hospital stays, nursing home and home healthcare costs, administrative fees, and physician and clinic services. Did we forget medications?
We will review the types of performance networks and the different strategies employed to drive measurements designed to improve patient outcomes.
Pharmacies are now competing on so many fronts — to be in payer networks, to offer additional services, to achieve high-quality metrics to retain patients — it is a challenge to evaluate all of the options and determine the best approach to be successful.