3 key forces shaping the future of pharmacy

The future of pharmacy care is arriving every day

Does that make you excited, or worried? Both reactions have merit. Medical science is continuing to produce treatments and technologies that were unthinkable not long ago. The way we deliver care is also changing for the better. Technology plays a role there, too.

But the challenges are real. These miraculous treatments won’t pay for themselves. Consumers and plan sponsors alike are left wondering how they will ever manage these accelerating prices.

There’s an old saying that advises, "Be for the future. There’s more of it." At Optum Rx, we are not only embracing the future. We are actively working to create it through leading-edge systems, tools and expertise.

To give you a glimpse of this exciting new world, we have identified four big trends that will make a difference. These trends include a focus on keeping medicines affordable, an expanded role for pharmacists, rising consumer expectations and the rapid advance of medical science.

Given that the impact of many of these trends is still ongoing, it is reasonable to assume the rapid pace of evolution seen in pharmacy care services is likely to persist for the foreseeable future.

1. An increased focus on affordability

Any assessment of the future of pharmacy must begin with accounting for whether people needing medicines will be able to afford them. As drug costs have continued to rise in recent years, this question has become less rhetorical. A recent survey found 47% of people now acknowledge they have skipped a medication or refill due to cost.¹

With this need in mind, we are creating tools that help minimize barriers to care for members.

A recent survey indicated 70% of consumers have shopped around for the best drug price.² Launching early in 2023, Optum Rx Price Edge is designed to help consumers find the best price, whether on or off the pharmacy benefit. For a given drug, this innovative offering compares a member’s on-benefit cost-share with the prices available via discount cards. It then adjudicates to the lower cost in real time. For drugs not covered under the pharmacy benefit, Price Edge offers direct-to-consumer discounts. These savings improve the member experience and reinforce the value of the pharmacy benefit, all at no program cost to clients or members.

For people with chronic conditions, even a short interruption of therapy can have a significant impact on health outcomes. Drugs contained within the Optum Rx Critical Drug Affordability modules have a maximum member cost share of $35 per month supply. By limiting member out-of-pocket expenses, these modules help sever the link between rising member cost share and lower medication adherence.³

Affordability is also a future concern for plan sponsors. Optum Rx has a broad spectrum of clinical programs that plan sponsors can leverage to achieve substantial savings and safeguard the benefit.

One recent innovation is the Optum Rx® Polypharmacy Value Management Program. Using analytics to identify potential instances of medication overload, our pharmacists perform comprehensive medication reviews with eligible members. Then, with their consent, pharmacists contact their provider to evaluate opportunities to stop using medications based on member response and other clinical information.

This consultative approach can help prevent side effects and potential adverse drug events for members. It also lowers costs from unnecessary medicines for plan sponsors.

These are but a few of the many ways we are building the capabilities and services necessary to make sure clients and members can afford the medications of tomorrow.

2. The expanded role of the pharmacist

The nation’s more than 320,000 pharmacists have long been at the forefront of healthcare. Data indicates patients interact with pharmacists almost twice as often as they do with a physician.⁴

As the tools of pharmacy continue to evolve, so too will the role of the pharmacist. Pharmacy automation is expected to more than double by 2030. This use of automation will allow pharmacists to spend more time on virtual and physical patient care.

This expanded role will include initiating therapies and having greater flexibility in deciding which drug to dispense. For example, in July 2022, the U.S. Food and Drug Administration revised the Emergency Use Authorization (EUA) for Paxlovid™ (nirmatrelvir and ritonavir), to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients, under certain conditions.⁵

With the potential designation as a healthcare provider, pharmacists will play an expanded and more active role treating patients in a holistic manner. This new role may also help offset a looming shortage of physicians.⁶ An expanded role for pharmacists will also be welcomed by patients, with more than 80% of patients already considering them an integral part of their healthcare team.⁷

Therefore, pharmacists are uniquely positioned to prevent medication adverse effects. For example, a study found that a pharmacist-managed anticoagulation service had significantly fewer adverse events than the comparison group. This resulted in $3,700 overall cost savings per patient.⁸

Additionally, engagement with pharmacists drives medication adherence. A study found that effective use of pharmacists resulted in a 30% improvement in medication adherence.⁹

Pharmacists can also play a leading role in educating patients about less expensive medications. This will increasingly include biosimilar options for biologic drugs.

Taken together, these actions show how pharmacists are poised to improve the affordability and sustainability of pharmacy benefits and reduce the total cost of care for patients and payers.

3. Rising consumer expectations

From the patient perspective, visible seams have long existed between the medical, behavioral, wellness, and pharmacy facets of their care. This has resulted in inefficiencies and potential gaps in care.

Consumer expectations have evolved in the era of mobile devices and ubiquitous e-commerce. They now expect a seamless, omnichannel experience to find and access high-quality, affordable medication options. For PBMs and healthcare providers, meeting these expectations means investing in the digital tools necessary to offer simplified, frictionless access to prescription medications for patients.

One prime example of how the drive to a more consumer-centric future has accelerated in recent years is the increased adoption of telemedicine, as seen during the pandemic. Going forward, more than 40% of adults indicate that they would like to continue to use telemedicine services post-pandemic.¹⁰

From now on, all aspects of healthcare will be more seamlessly integrated as consumers demand easier ways to navigate and support their care. This better integration and more holistic care coordination will especially benefit those with chronic diseases.

Take for example diabetes, where unhealthy behavior and lifestyle choices can result in poor adherence to diabetes medications and poor health outcomes. To combat this, the Optum Rx Diabetes Management Program features an integrated approach. It pairs member engagement, education and weight loss support with case management provided by certified diabetes educators from Optum Rx. The result is clinical improvement, higher member satisfaction and medical cost savings.

Conclusion

It’s important to remember that these trends aren’t happening in isolation. Rather, these and other factors will overlap and combine to define how much pharmacy changes for payers and patients alike in the years ahead.

To make the most of these future forces, Optum Rx believes that collaboration with payers, providers and members alike is essential. Talk to your Optum Rx partner to learn more ways we can work together to help you prepare for the future of pharmacy care services.