Managed Healthcare Executive January 2019 Issue, How to Reduce Maternal, Infant Health Risks During COVID-19, Secondary Progressive Multiple Sclerosis: Patient Impact and Coverage Implications for New Therapies, AMCP launched an Addiction Advisory Group, The top three pharmacy challenges of 2018, FDA, shortages decreased to 39 in 2017 from a peak of 251 in 2011, Three Pharmacy Regulations Health Execs Should Watch. It is up to PBMs and plans to decide which benefit should cover specialty,” Lutz says. As a solution, he recommends developing a strong, proactive pipeline management system anticipating costs and ensuring the right indication, right drug, and right person are aligned. Efforts focused on PBMs feature prominently in President Trump and Secretary Azar’s Blueprint for Drug Cost Reduction. Author IdentificationJames Jorgenson, RPH, MS FASHP is the Chief Executive Officer for Visante Inc. 101 E. 5th Street, #2220, St Paul, MN firstname.lastname@example.org(317) 997-2004. Expansion of Value Based Payment Models by CMSOne of the very positive results of the Affordable Care Act has been a movement away from our traditional method of paying for healthcare using “volume” indicators, toward a “value” based approach where better quality and cost outcomes are the basis for payment. Lucio makes technology sound like a necessary evil when he says it is expensive but enables the pharmacy industry to work more safely and effectively. Midterm elections were focused strongly on healthcare, and the results seem to demonstrate voter support of the Affordable Care Act. “Specialty medications are responsible for churn and volatility because they can be covered under both medical or pharmacy benefits but require a high-touch model because of side effects, changes in dosages, and comorbidities. As part of its proposed payment regulation for hospitals under the Outpatient Prospective Payment System (OPPS) for 2019, CMS proposes continuation of the 30 percent payment reduction for Part B drugs implemented earlier this year for certain hospitals in the 340B drug pricing program, and further proposes to extend the payment reduction to drugs provided in non-excepted off-campus hospital outpatient departments (HOPDs) that are subject to reduced "site neutral" payments. Skills in healthcare: pharmacy challenges in the UK The challenges today’s pharmacists face Pharmacists in the UK are expected to take on a broader role than ever before under the ongoing shifts within the NHS and there's a clear consensus among the clinical community that much more can be done in patients' own communities to keep them healthy. • Hospital Pharmacy Transformation Plans (HPTP) offer an opportunity for pharmacists and pharmacy services to gain greater recognition at board level within the hospital. “We want pharmacists to operate a patient-safe environment, but a business model doesn’t exist to enable that but with so many products and technologies that can cause problems,” says Norman Tomaka, BS, Pharm, MS, clinical consulting pharmacist based in Melbourne, Florida. Feature: Challenges facing pharmacy. The new year, however, brings some additional challenges to the fore and further complicates the challenges the industry already faces, as outlined by industry experts. Copyright © 2021 Becker's Healthcare. The three biggest challenges hospital and health system pharmacy teams are facing include drug shortages, drug diversion, and drug utilization. But capturing and recording that event in the pharmacy benefit, which is needed to execute the VBC model, is hampered by the segmentation of the two benefits. © Copyright ASC COMMUNICATIONS 2021. It has also been a stated goal of CMS to move at least 90% of ambulatory payments to an ACO or bundled payment type arrangement over the next 10 years. Clinical Pharmacist 5 FEB 2010. Shortages of some drugs have also presented a challenge to the industry-something Lucio partially attributes to natural disasters such as Hurricane Maria in Puerto Rico, and to low margins on certain drugs which force manufacturers to stop production. Looking into 2021 and beyond, here are six major challenges … 4 minute read Article Overview: Of late, the NHS faces a lot pressure for a host of economic, social and political reasons. At the same time that USP standards are in process, State Boards of Pharmacy are also actively working on enhancements to their regulations as well as continuing to elevate the training around sterile compounding compliance for their inspectors. Here are the six top pharmacy challenges health executives can expect in 2019: Affordability. Antimicrobial Resistance. But, before you embark on this journey, you need to know everything from opportunities to challenges surrounding it. The biggest issues confronting pharmacists in 2017 are lack of recognition as healthcare professionals, low wages and declining PBS income, according to an AJP poll. 1. Hospitals are faced with increasing challenges as their bottom lines continue to be squeezed by lower medical reimbursements, healthcare reform, and double-digit prescription rate increases. • Hospital Pharmacy Transformation Plans (HPTP) offer an opportunity for pharmacists and pharmacy services to gain greater recognition at board level within the hospital. Jonathan Gavras, MD, senior vice president and chief medical officer of Prime Therapeutics, a PBM headquartered in Eagan, Minnesota, believes it is important to anticipate what’s coming down the pipeline, especially high-cost specialty drugs; develop appropriate policies around cost to be affordable for payers and patients; and keep ahead of drug approvals, many of which are fast tracked. In the second model the same basic quality and cost targets are present but there are enhanced levels of payments, however these come with a “down-side” risk of reduced payments if the targets are not reached. Some are used in surgeries, while others are needed to bring a person back to stability after an accident. When an employee at a self-insured hospital uses an outside pharmacy, the hospital can expect to pay their PBM anywhere from $25 to upwards of $100 per prescription. Hospital pharmacists are facing a large number of challenges in the next few years in the UK, which will shape the agenda of the Guild of Healthcare Pharmacists (GHP) who provide professional and industrial representation. Drug shortages. 7 Challenges Facing Hospitals and Their Outpatient Pharmacies. Hospital pharmacy transformation programmes (HPTP), the meltdown of A&E services with an undercurrent of financial pressures and low morale owing to workplace pressures are some of the issues facing hospital pharmacy. According to the FDA, shortages decreased to 39 in 2017 from a peak of 251 in 2011. In today’s health care ecosystem, the pharmacist is a trusted, critical, and—often—underutilized resource. As of this publication there are well over 200 drugs in shortage situations. • Hospital pharmacy is under the spotlight, the traditional model of a pharmacy department will change and this presents challenges and opportunities. Jim’s top 10 issues facing hospital & health system pharmacy in 2019. As the pharmacy industry increases its use of enabling technologies, pharmacists may find themselves at a professional crossroads: either grow their role’s scope and value or face potential disintermediation. Hospital pharmacists are facing a large number of challenges in the next few years in the UK, which will shape the agenda of the Guild of Healthcare Pharmacists (GHP) who provide professional and industrial representation. There are two basic approaches to ACOs and value-based payment. The major challenges described for the clinical pharmacy services include lack of support from hospital management, absence of clearly defined roles and responsibilities for the clinical pharmacists, and shortage of pharmacy workforce and staff turnover. Escalating Drug CostsThis year the total prescription drug spend is expected to exceed $460B and projections are that by the end of 2019 that total will be at half a trillion dollars. Prescription drugs now represent approximately 17% of the total US healthcare spending. With medications representing the fastest growing element of US healthcare spending and the primary treatment modality for the majority of patients, pharmacy can play a significant role in addressing these challenges. One, the rising cost of drugs, and two, lack of human and financial resources to perform the growing number of responsibilities placed on the pharmacy. When that activity meets a real or perceived need, it makes money for the innovator. Lucio is looking forward to potential biosimilars-especially in oncology-entering the marketplace in 2019 to help mitigate costs through competition. That is nine more than record-breaking 2017, which had the highest number of approvals in more than two decades, according to an April 12, 2018 Health Policy Report in the New England Journal of Medicine. © 2021 MJH Life Sciences™ and Managed Healthcare Executive. In addition, 36% of Americans say healthcare is the top issue facing America today, according to a recent poll. Topics include early identification of target medications or clinicians, medication adherence, automated assessment of the current situation and action plans to manage … On the positive side, about 85% of people with commercial insurance pay less than $20 a month out of pocket. Challenges in the Pharmacy. From next year, and for the following three years, it will be cut. There are multiple pending or expected regulations coming down the pike that will determine key opportunities for the pharmacy industry. The continued evolution of antimicrobial resistance remains a top threat worldwide. 1. Apr 10, 2019 | Uncategorized. We also see the introduction of new terminology with companies like Ventegra now branding itself as a Pharmacy Services Administrator (PSA) as opposed to a traditional PBM and offering a fully transparent approach and a greater emphasis on 340B and specialty pharmacy options along with enhanced medication therapy management programs. Rising drug costs pose a financial challenge to hospitals for inpatients, but high cost drugs are also an opportunity for the hospital’s outpatient business. Change comes when someone does something different. At present, 34 U.S. states recognize pharmacists as “providers or practitioners,” reported the Drug Channels Institute report. Many hospitals rely heavily on sterile compounds. 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