Drug development and innovation could render the current specialty pharmacy model obsolete in 20 years.
What will the world of specialty pharmacy look like in 20 years? All signs point to the growth of specialty spending well into the foreseeable future. Now, one must wonder what these therapies will look like in 2036?
As with any technology, drug development will continue to push the boundaries of innovation. The question then becomes: when do drug therapies or genetic engineering become so advanced that the clinical roles that specialty pharmacies provide are no longer needed?
Drug innovation is the backbone of the specialty pharmacy industry and has changed millions of patients' quality of life. Advancements are occurring so rapidly that there are new research and developments published every day.
At this rate, when will the innovations become so significant that they will reduce the need for specialty pharmacies? For example, 10 years ago, patients with hepatitis C virus (HCV) had severe side effects and a low cure rate.
Now, therapies have cure rate percentages in the 90s and very minimal side effects with simplified dosing. With this success, specialty pharmacies may no longer be needed in this disease state.
Treatments will continue to get more patient friendly regarding dosing, side effects, and cure rates. The incidents of HCV is likely to be dramatically lower in 10 years. When a patient does need treatment for HCV, it may be a single treatment that can be administered in the provider's office.
With these simplified drug regimens, the specialty pharmacy is cut out. This same logic can be applied to almost any disease state, which begs the question, what diseases will even be left for specialty pharmacies to monitor?
HIV is another disease state that utilizes all aspects of specialty pharmacies. Pharmacies ensure compliance, side effect counseling, and promote safe sex practices, all of which are necessary to improve patient care.
In the future, what are HIV treatments going to look like and will specialty pharmacies still be part of the treatment team? Several companies are currently working on HIV vaccines and will begin to see their approval shortly.
This could be the start of an HIV-free generation once these vaccines get into vaccine protocols. Could this lead to a cure? There is a high likelihood that there will be a cure for HIV during this lifetime.
The combination of curative treatments and early vaccinations can lead to a world free of HIV. If this disease once thought of as incurable could become almost obsolete, then how many diseases will remain?
Orphan and ultra-orphan diseases may be the only space where specialty pharmacies have a long-term future. Even then, with gene therapy and genetic engineering, how many of those diseases can be cured even before a baby is born?
If treatment at this level is possible, how do specialty pharmacies integrate themselves into this process? These treatments will need to undergo extensive engineering and personalization.
This is the future of specialty pharmacies and pharmacists; they will ultimately go back to the roots of individual compounding. Pharmacists will be more like engineers, rather than clinicians.
This will alter the way pharmacists are educated. The traditional education model backed by clinical knowledge and business acumen will be so outdated and inferior, in just a few short years.
The knowledge set that will be needed in the future will be drastically different than it is currently. Pharmacy schools might not exist when these therapies hit the market.
Biomedical engineers may substitute the traditional role of pharmacists. This would be quite the paradigm shift. In 2016, the realization must be made that pharmacists' professions might not even be recognizable in the very near future.
The only one constant moving forward is that prices will increase. If prices have continued to skyrocket for years, how long can this continue?
The current trend of prescription price increases will continue, but eventually this increase must come to a standstill. There will be a breaking point soon that will more than likely require government intervention.
This intervention may be in the form on a single payer system that could become a reality in the United States. It will be highly contested, but the price of health care is not sustainable, and the fragmented landscape is in desperate need of repair. This change alone could minimize the amount of specialty pharmacies that are utilized.
The future of health care in the United States is completely unknown, but there are a few trends that can shed some light. The simplification of drug regimens and curative treatments will be part of the future.
How these treatments are dispensed and prepared is the unknown, but these will all minimize the role of specialty pharmacies. The future of specialty pharmaceuticals will have incredible outcomes that will change the world forever.
The idea seems impossible that specialty pharmacies and pharmacists may not exist one day, did anyone ever think that Kodak would not be around in 2016?
Disruptive innovation is the future, and we must be prepared for what it brings. The world will see the eradication of diseases in the future, and with that, the specialty pharmacy industry will no longer exist, or be in a form that is completely alien to us today.
About the Author
Anthony Mazzarese is a graduate of The University of Pittsburgh School of Pharmacy. He received his MSPBA, a 12-month, executive-style graduate education program designed for working professionals striving to be tomorrow’s leaders in the business of medicines, from the University of Pittsburgh in 2016. He is the Pharmacist-in-Charge at Giant Eagle Specialty Pharmacy. His practice is focused on improving medication compliance and overall well-being in the areas of HIV, auto-immune disorders, oncology and organ transplantation.