The Future of Pharmacy

by Phil Walls, RPh
Chief Clinical Officer

myMatrixx has been conducting drug regimen reviews on injured patients for almost five years. Increasingly the requests for those reviews are coming from payers who are not yet utilizing our PBM services. I was recently asked; if I wrote a drug regimen review on a claimant, but never processed or dispensed a prescription for that claimant, would I consider him or her to be my patient? My immediate answer was “Yes”! I was a little taken aback by the question, especially because the individual that asked has been in the business of pharmacy for many years (although not a pharmacist). But then I remembered that a few short decades ago, my colleagues were considered druggists, and they had customers not patients.

Gradually, pharmacists were recognized as healthcare professionals (this was actually a very recent realization for the state of California). Because we have a duty of care as well as a liability for the treatment of our “customers”, the pharmacist-patient relationship has finally evolved. However, the traditional role of the pharmacist, either compounding or dispensing a medication, is still inseparable from the image of what pharmacists do. In actuality, the dispensing function is where most pharmacists spend the least amount of their time. I know pharmacists today that have a thriving pharmacy practice but never dispense drugs.

So what are pharmacists currently doing, and what will they be doing in the future? Well, here is my list of predictions:

  • The dispensing function will be entirely replaced by automation. This may be multimillion dollar robotics like the ones used by large mail service pharmacies today (one location in Nevada dispenses millions of prescriptions per week via a robotic system) or it may be smaller scale operations that one may see in a local pharmacy. Or high security, prescription kiosks or vending machines may become commonplace.
  • Electronic prescriptions or e-prescribing will finally deliver what we have been hearing about for over a decade – and many functions handled by the retail pharmacists will be shifted to the already over-worked physician. Functions such as drug utilization review and formulary compliance must be completed before an electronic prescription is ever sent to the pharmacy. Busy physicians will employ a pharmacist much the same way they work with nurse practitioners today.
  • Pharmacists will gain prescriptive authority. Physicians will diagnose and then consult with a pharmacist as to the appropriate medication regimen.
  • States will require prescribers to consult the individual state’s prescription drug monitoring program (PDMP) database prior to prescribing any controlled substance. Pharmacists are a likely conduit to this information.
  • Prescription drugs will be tracked via a variety of developing technologies – just like GPS is used in your automobile today. Pharmacosurveillance will become commonplace to ensure that patients take their medication as prescribed.
  • Pharmacogenomics – or the application of genetics to drug responses – will completely change the pharmaceutical industry. The day of the blockbuster drugs with sales in the billions of dollar range each year could be over, and instead drugs designed for a specific genotype may be developed for a relatively small number of individuals. As a result, we will have many more drugs but each drug will only serve a limited population. The genetic pharmacist may have a new use for the old role of “right drug to the right patient”.
  • Finally, the traditional pharmacy will still exist – in order to compound those medications that cannot be made commercially, and 2020 may not look that different from 1920 when one passes by the window of an apothecary Show globes were used as displays in the front windows of Victorian drug stores. It was said that if you entered a town with red water in the globe, that meant there was a spreading disease present, so enter with caution. If it was filled with green water, it meant everything was normal.