Joseph T. DiPiro, Pharm.D Associate Vice President, Faculty Affairs Virginia Commonwealth University

Pharmacy Forecast: Paradigm Shifts in Breakthrough Therapeutics Will Challenge Existing Payment Models Interview with:

Joseph T. DiPiro, Pharm.DAssociate Vice President, Faculty Affairs Virginia Commonwealth University

Dr. DiPiro

Joseph T. DiPiro, Pharm.D
Associate Vice President, Faculty Affairs
Virginia Commonwealth University
Dr. DiPiro is an editor for Pharmacotherapy: A Pathophysiologic Approach What is the background for this study?

Response: The ASHP/ASHP Foundation Pharmacy Forecast Report is constructed from a survey of health-system pharmacy leaders who were asked to rate the likelihood of events, scenarios, and trends occurring in the next five years. The purpose is for health-system pharmacists and pharmacy leaders to inform their strategic planning efforts. The Pharmacy Forecast is not intended to predict future events. Rather, the report is intended to be a provocative stimulant for the thinking, discussion, and planning that must take place in every health system. Leaders must be informed of potential developments to help position their organizations to care for patients, enhance population health, and improve medication outcomes. What types of medications and/or procedures are considered ultrahigh cost?

Response: Typically gene and cellular therapies (Hemginex, Adstiladrin, Carvykti, Elevidys, Kymriah, Luxturna, Roctavian, Skysona, Yescarta, Zynteglo and Zolgensma).

Specific products were not addressed in the Forecast report. How do/will these costs impact overall care provided by health care systems? (ie currently expensive drugs for hemophiliac patients currently experiencing a bleeding episode can cost a hospital hundreds of thousands of dollars, necessitating cost cuts elsewhere)?

Response:  Some of these therapies completely transform the treatment paradigm because they result in cure of the condition rather than requiring lifelong supplemental therapy, such as for hemophilia. Some of the treatments considerably prolong or extend life where no current therapy exists or the current treatments are low cost, but minimally effective, as is the case for Duchenne muscular dystrophy and sickle cell disease. We expect that there will only be a few organizations who will be offering these treatments since the conditions are rare and it will take a certain amount of infrastructure and resources to be able to provide these products. How should single high-cost therapeutics (ie gene therapies) be paid for, as a single patient can raise the price of health insurance for all those covered?  This is especially true for small to medium size employers.

Response:  How the drugs should be paid for is out of the scope of the report. We mention this as a concern in the manuscript and we know this will be a challenge to our existing healthcare payment models in the US. What should readers take away from your report?

Response: The institutional planning and actions that come from using this report will likely differ among institutions based on their unique environment, finances, opportunities, and priorities. Given the broad range of topics in the report it may prove helpful to place some issues on the pharmacy leader’s radar screen.

Citation: ASHP and ASHP Foundation Pharmacy Forecast 2024: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems was published in the American Journal of Health System Pharmacy on Dec. 4.

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Last Updated on December 9, 2023 by Marie Benz MD FAAD