Ask the Experts: The Future of Health System Pharmacy—Part 2

By: Barbara Giacomelli and Adrienne Donaldson

Read time: 4 minutes

In part 2 of this informative Q&A series, experts Barbara Giacomelli and Adrienne Donaldson discuss the future role of health system pharmacy in healthcare.

When it comes to the future of healthcare, health system pharmacists have an important part to play. Their roles have grown exponentially since the pandemic, and as issues arise with staffing shortages, supply chain disruptions, and formulary management, pharmacists are on the front line addressing the major challenges facing health systems.

Read our latest Q&A to learn more about important issues facing pharmacy schools, the changing business of health system pharmacy, and how health systems can work toward profitability. Check out Part 1 of the discussion with experts Craig Dolan and Josh Jang.

Q: What adjustments are being made in pharmacy to keep up with labor shortages and unprecedented patient demand?

A: Barbara Giacomelli, Pharm.D., MBA, FASHP VP, Advisory Services, McKesson RxO

The labor shortages have primarily impacted the pharmacy technician role in pharmacies whether it be inpatient, clinic, or retail pharmacy settings. To meet patient care needs, pharmacies are offering more flexible schedules, adjusting hourly wages, allowing work from home when possible, and using pharmacists to complete some of the duties normally done by technicians. In addition, hospital pharmacies are buying pre-mixed IV and IVPB solutions and unit dose whenever possible, even if it is more costly. Also, pharmacies are looking at on-line training programs and coursework to assist in training pharmacy technicians so they can join the workforce sooner.

Q: What are some important issues that pharmacy schools could address to help pharmacists who are just coming into the industry?

A: Barbara Giacomelli

There are so many different career paths today for pharmacists entering the workforce. Traditionally there were 3 tracks for pharmacists: hospital, retail, or pharmaceutical research. But today there are many other opportunities such as working for a PBM or healthcare insurance company, infusion centers, healthcare provider officers, vaccination clinics, health care education, law, nuclear pharmacy, informatics, or healthcare innovation. Pharmacy schools should address these opportunities through guest lecturers and offering a broad variety of externship sites. They should also offer joint educational opportunities for students to obtain their pharmacy degree while pursuing other advance degrees such as law or MBAs. Another opportunity for a pharmacist is to gain experience through a pharmacy residency.

Q: How is the business of health system pharmacy changing?

A: Adrienne Donaldson, RPh., MSLIT Director, Business Intelligence

The future of health system pharmacy is more diverse. There has been a shift away from focusing only on inpatient care and controlling drug expenditures. It now includes retail and specialty operations, as well as the expansion beyond the hospital walls with oncology clinics, and hospital-owned infusion centers. This growth helps patients flow through the continuum of care while also providing health systems with revenue opportunities.

Along with this comes greater complexity. Pharmacies had previously been measured and held to a drug spend or expense budget. Historically, the primary thought was “How can I save money?” While controlling expenses is still required, it is no longer the primary focus of pharmacy business. The most expensive drug option may ultimately be most profitable, depending on the always changing PBM preferences, or may have better patient outcomes. With new areas of business, a different and more complete clinical and financial analysis is required to determine profitability and best business practice, which includes an understanding of value-based care drugs across the spectrum.

Q: What are some of the complexities that pharmacists in health systems may face?

A: Adrienne Donaldson

On the inpatient side, health systems face complexities with formulary management and care pathway standards that tie into patient outcomes. It is important to understand which drugs are being prescribed by whom and for what diagnosis to assess the cost per episode of care and variances in patient outcomes. For example, associating utilization of the higher cost medication used to induce labor with a decreased cesarean section rate may justify higher drug costs in favor of improved patient outcomes. Another example is monitoring the impact of new drugs being used to treat severe COVID patients.

Regarding outpatient oncology and infusion clinics, the formulary may be smaller, but they utilize high-cost, complex, drug molecules. It is important for health systems to understand the billing and reimbursement challenges they may encounter which differ from the inpatient side of the business. As it relates to specialty drugs and biosimilars, health systems need to understand how drugs are purchased, where they are being administered, the per patient cost by diagnosis, and the variability of payer reimbursements.

It is imperative that health systems can track and monitor how drugs move through their health system in all facets of their business. This includes the purchase, usage, and reimbursement across all lines of business (inpatient, outpatient, and retail/specialty). In addition, supply chain expenses, drug pricing fluctuations, and the impact of new drug treatment indications should be closely monitored. To maintain full line of sight into all these factors, drug purchasing should be connected to patient utilization which then needs to be connected to payer reimbursements.

Q: How can health systems continue to work toward profitability?

A: Adrienne Donaldson

Without a view across business lines, it is difficult to maintain a profitable health system pharmacy business. Understanding trends in payer reimbursements and how to optimize drug procurement is critical to maximizing margins. Pharmacies also need to understand and analyze profit and loss reporting to identify the most profitable drug or alternative therapy within a biosimilar grouping or diagnostic class (Rheumatoid Arthritis, Ulcerative Colitis, Crohn’s, etc). With this level of data, a multidisciplinary team including supply chain, clinical pharmacy, revenue cycle, and finance have greater line of sight into how their specific area can impact the business and the rationale behind key decisions.

To learn more about how health system pharmacists have taken on leadership roles in healthcare, watch our latest video from the pharmacist’s perspective.

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