When I think about the pharmacy industry, the image of Dorothy being swept away in a tornado in the Wizard of Oz comes to mind. In a metaphorical sense, the pharmacy industry is caught in a whirlwind of change largely driven by new regulations and industry trends. Hopefully these changes will lead to improved patient care and outcomes just as the tornado that hit the farmland in Kansas led to Dorothy discovering the magical Land of Oz. It’s the idea that something good eventually emerges from moments of uncertainty.
To me, uncertainty is the right word to describe today’s regulatory landscape. There are multiple pending or expected regulations coming down the pike that will determine key opportunities for the pharmacy industry. In addition, 36% of Americans say healthcare is the top issue facing America today, according to a recent poll.1
Just last month LexisNexis Risk Solutions hosted its annual Pharmacy Partner Summit. The Summit convenes some of the brightest minds across the industry. Our keynote speaker, Joel White, President of Horizon Government Affairs, delivered an insightful presentation outlining five dynamics that he believes will shape the pharmacy industry in 2020 and beyond:
Universal Patient Identifier
The inability to accurately match patients to their medical record is a foundational barrier to progress on cost, quality, and safety. Having a universal patient identifier would enable accurate exchange of prescription data and other critical health data. Although the House of Representatives lifted a federal ban on using taxpayer dollars to develop or use a universal patient identifier, the Senate vote has been postponed.
Various regulations have sought to improve transparency related to pharmaceutical prices and transactions, lower patients’ out-of-pocket costs, and ensure accountability to taxpayers. Most recently, House Speaker Nancy Pelosi, D-Calif., issued a proposal to negotiate prices annually for the top 250 most expensive drugs on the market that don’t have at least two competitors. The proposal also includes a $2,000 out-of-pocket cap on prescription drugs for Medicare beneficiaries and the disabled.
The shift toward value-based payments means pharmaceutical companies must deliver products that demonstrate real, measurable value. This requires a new mindset in terms of how these companies market and price their products.
There are many reason for non-adherence; however, social determinants of health—particularly financial stability and health literacy—play a particularly important role. We’ll likely see more efforts to not only reduce costs but also to improve packaging, synch medications, refine patient education, send patient reminders, and more—all with the goal of increasing medication adherence to ultimately reduce overall medical spending.
There are efforts underway to refine the use and exchange of health data so pharmacy companies can glean actionable insights. Technology and data will be a key part of success in the market, and pharmacy companies must choose their vendor partners wisely.
How will the winds of change continue to uproot the pharmacy industry as we know it? Only time will tell.
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To learn more about how to navigate the ever-changing landscape, including how to solve for patient record matching, mitigate compliance risk and perform due diligence when filling prescriptions, click here.