'Pharmacy Forecast' identifies growing societal challenges expected to impact care

Societal issues—including the growth in ultra-high-cost treatments, the epidemic of mental health and substance use disorders, climate change, and the rise of artificial intelligence (AI)— could alter how health systems serve their communities within five years, according to the latest annual ASHP/ASHP Foundation Pharmacy Forecast Report. The 2024 Pharmacy Forecast, released at the ASHP Midyear Clinical Meeting & Exhibition, drew its findings from a survey of more than 250 pharmacy leaders from across the United States on key topics impacting health systems.

The Pharmacy Forecast is published online ahead of print and will appear in print in the January 15, 2024, issue of American Journal of Health-System Pharmacy.

"This 12th annual Pharmacy Forecast contains topics of broad health care importance underscoring societal challenges that will likely drive profound changes to health care delivery, including not only our practices as pharmacists, but even the future structure of our health systems," said ASHP CEO Paul W. Abramowitz, PharmD, ScD (Hon), FASHP. "As health care evolves at an unprecedented pace, pharmacists' engagement is crucial to ensuring safe and effective care for all patients."

Ultra-high-cost drugs

The rise of innovative and ultra-high-cost new treatments, which often come with complex delivery systems, provide new hope for preventing, curing, and treating devastating diseases. These treatments, which can cost millions of dollars per patient, may fundamentally alter how health systems deliver care.

More than three-quarters of survey respondents indicate formulary and policy decisions for ultra-high-cost drugs will be made by payers or service-line stakeholders, weakening the scope of the pharmacy and therapeutics committees, which have led the selection of drugs provided by health systems for decades.

In addition, 77% of survey respondents believe that it is somewhat to very likely the cost and complexity of new treatments will result in the termination of service lines within some health systems.

The report recommends pharmacy leaders collaborate with health-system finance experts to assess the financial risk associated with the provision of ultra-high-cost drugs to ensure long-term program feasibility and sustainability.

Mental health and substance use disorders

In the 2024 survey, 71% of participants noted pharmacists are well prepared to initiate and modify medication treatment plans for individuals with substance use disorders. Pharmacy Forecast authors recommend health-system leaders integrate the expertise of pharmacists into innovative strategies to bridge gaps in treating substance use and mental health disorders.

"An 'all-hands' approach is needed so that everyone involved in direct care increases their skills and knowledge in mental health," said Joseph T. DiPiro, PharmD, editor of the Pharmacy Forecast. "To do this, we need health systems to develop additional infrastructure and support. Providing mental health first-aid training to health care workers should be as common as CPR training."

Public health emergencies

Survey participants expect the frequency of public health emergencies related to climate change to double in coming years, affecting health systems and the communities they serve. Pharmacy departments should continue to engage in the emergency response of health systems by taking part in routine assessments of disaster preparedness. Pharmacists' knowledge and abilities are essential to managing supply chain disruptions, contingency staffing, and coordination with local public health and community groups.

Artificial intelligence

The growth of AI in health care is a double-edged sword, bringing potential rewards and risks. Most survey respondents (86%) believe AI technology can provide automated drug dosing adjustments based on things like kidney function, weight, and age; and more than half of respondents believe advanced technologies, including AI, will help close the gap on health care disparities.

At the same time, respondents agree it is crucial to balance patient safety, equity, and security in the implementation of these rapidly advancing technologies. A full 80% expect that a high-profile failure of AI that causes patient harm will accelerate government regulation of AI technology.

"As AI progresses, it is imperative to ensure that the models used in health care are unbiased and benefit a diverse population," said DiPiro. "Health systems should establish AI as a strategic priority and engage pharmacists' expertise to optimize its safe, ethical, and equitable use."