NACDS TSE 2024: Shaping the Future of Pharmacy

Session One

Presenters:

• Scott Biggs, Director, Supplier Services, IQVIA
• Doug Long, Vice President, Industry Relations, IQVIA

Summary: What was discussed

This popular annual session provided an in-depth analysis of the latest trends and market dynamics in the pharmacy industry. Long addressed many of the major challenges facing the broader healthcare industry today, including the recent announcement of the new Medicare prices for the first 10 drugs negotiated under the Inflation Reduction Act (IRA), the upcoming implementation of the Drug Supply Chain Security Act (DSCSA), drug shortages, increased prescription abandonment, growth of biosimilars covered under the pharmacy benefit, reimbursement challenges, staffing shortages, store closures and the impact these factors have on pharmaceutical companies, pharmacies and patients.

Key takeaways

• Long shared slides on IQVIA’s “The Use of Medicines in the U.S. 2024” report, highlighting that elective procedures still haven’t fully recovered from the COVID-19 pandemic. Health screenings are down despite increased availability at retail pharmacies.^[1]The Use of Medicines in the U.S. 2024: Usage and Spending Trends, and Outlook to 2028. IQVIA Institute for Human Data Science, April 2024.
• Notable medication trends in 2023 include the growing use of immunology treatments, rising use of GLP-1 therapies, antibiotic use and rising antimicrobial resistance, drug shortages impacting patient care, and changing patterns of contraceptive use.^[2]The Use of Medicines in the U.S. 2024: Usage and Spending Trends, and Outlook to 2028. IQVIA Institute for Human Data Science, February 2024.
• More than half of new prescriptions for novel medications go unfilled, and only 31% of patients remain on therapy for a year.^[3]IQVIA Libraries — Quality of Access Library, Dec. 2023.
• Spending on specialty drugs (54%) is outpacing traditional (46%). Net spending on the immunology and oncology specialty classes have increased since 2018. In traditional, net spending is up in the diabetes and respiratory classes.^[1]The Use of Medicines in the U.S. 2024: Usage and Spending Trends, and Outlook to 2028. IQVIA Institute for Human Data Science, April 2024.
• 26 new drugs have launched so far this year, as of June 2024 – with immunology, digestive and infectious disease leading as the top therapeutic areas. Long noted there are fewer launches, they’re relatively small and 70% were in specialty.^[4]National Sales Perspective; Launch Center of Excellence, IQVIA; publicly available information from the FDA.
• 89% of all prescriptions dispensed are unbranded generics, which only accounts for 7.3% of the sales (in percentage of dollars).^[5]IQVIA National Sales Perspective, National Prescription Audit, June 2024.
• Drug shortages have slowed in 2024 but 57.8% of the shortages have been going on for more than two years and 27.5% for 1-2 years.^[6]U.S. Food & Drug Administration, FDA Drug Shortages, data pulled July 31, 2024. 84% of the drug shortages over the last six years are generics.^[7]FDA Drug Shortages Database, IQVIA National Sales Perspective, Jun 2023; IQVIA Institute, Oct 2023.
• 5,300 retail pharmacies have closed over the last six years^[8]Store count data reflective of the stores in the IQVIA Rx Universe as of June 2024. – heightening concerns about pharmacy deserts. A recent study in the journal Health Affairs Scholar found that 15.8 million people, or 4.7% of the U.S. population, now live in a pharmacy desert. The study shows this is disproportionately affecting rural and historically marginalized communities, which are already significantly impacted by social determinants of health.^[9]Wittenauer R, Shah PD, Bacci JL, Stergachis A. Locations and characteristics of pharmacy deserts in the United States: a geospatial study. Health Aff Sch. 2024;2(4):qxae035. Published 2024 Mar 16.
• Biggs shared a slide that referred to the GLP-1 pipeline as the "obesity gold rush" as, according to IQVIA’s data, there are over 120 different products for weight loss currently being developed by 60+ companies – 65 intravenous or subcutaneous, 41 oral and 17 undisclosed.^[10]Scott Biggs, Aug. 19, 2024, NACDS TSE, 2024 Pharmacy Trends, Issues and Forecasts.
• The role of the pharmacist continues to expand – Long shared data from NACDS that showed examples of services authorized by U.S. states, including administering vaccines (authorized in all 50 states, to some degree), covering services like tobacco cessation (authorized in 20 states), testing and initiation of treatment (authorized in 20 states), naloxone dispensing (authorized in all 50 states), initiating and dispensing hormonal contraception (authorized in 21 states), HIV prevention (authorized in 13 states) and tuberculosis testing (authorized in 4 states).^[10]Scott Biggs, Aug. 19, 2024, NACDS TSE, 2024 Pharmacy Trends, Issues and Forecasts.

The industry call to action

The session shows the need for pharmacies to adapt to these trends by leveraging data and analytics, enhancing patient engagement and fostering collaborations within the healthcare ecosystem. By doing so, pharmacies could position themselves as key players in the evolving landscape of healthcare delivery.

Session Two

Presenters:

• Adam Chesler, PharmD, MBA, Senior Vice President, Strategic Initiatives, VillageMD
• Anita Patel, PharmD, MS, Vice President, Pharmacy Services Development, Walgreen Co.

Summary: What was discussed

This discussion explored the pivotal role pharmacies can play in the value-based transformation of healthcare, emphasizing the need for meaningful collaborations with payers and providers, innovative service delivery models and enhanced data interoperability. The speakers highlighted how pharmacies, through strategic partnerships and operational reforms, can not only improve health outcomes for high-risk populations but also drive significant cost reductions within the broader healthcare ecosystem, while simultaneously generating potential revenue from expanded pharmacy services.

The only way that we can take the fragmented health system and improve it is through partnerships and data.

Anita Patel, PharmD, MS

Vice President, Pharmacy Services Development, Walgreen Co.

Key takeaways

• Pharmacies can play a crucial role in value-based care, especially with managing the complexities of a fragmented healthcare system marked by high costs and limited primary care access. Pharmacists can help to address pressing issues like an aging population and the prevalence of chronic disease.
• The convenience and accessibility of pharmacies make them an ideal point of care for many patients – particularly helping to care for the 20% of the population that causes 80% of the healthcare spend.^[11]Robertson TM, Lofgren RP. Where population health misses the mark: breaking the 80/20 rule. Acad Med. 2015;90(3):277-278.
• As pharmacists take on new tasks, such as blood pressure checks, their role can be seen as a supplement that leads to better health outcomes for patients.
• Pharmacists can’t code to clinical records, which Chesler says is an “untapped opportunity.” Pharmacists can help with more accurate patient risk rankings that drive value-based care payment.
• Pharmacies can be a key player in driving medication adherence and improving star ratings through activities like medication reconciliation for high-risk patients.
• Data is essential in value-based care, from identifying patient needs to measuring outcomes and demonstrating cost savings.
• Effective scaling of these new initiatives requires changes in workflow and stronger collaborations with payers and providers.

The industry call to action

Pharmacists can become key players in patient support by playing a more collaborative role in the patient journey – ultimately enhancing health outcomes.

Session Three

Presenters:

• Jill Blanchard, President, Client Solutions, Advantage Solutions
• Rachel Marler, Chief Customer Officer, Haleon
• Stephen Corrou, Executive Sales Director, Alcon U.S. OTC Business

Summary: What was discussed

The session featured insights from quarterly 2024 Advantage Outlook reports, which Blanchard described as offering “a forward-looking pulse” on the pharmacy industry. These reports examine the sometimes-contrasting perspectives between direct-to-consumer initiatives from manufacturers and retail pharmacies. The panelists discussed delivering value to consumers, innovation strategies, managing theft-related shrinkage, omni-commerce priorities and differentiation as a winning strategy.

80% of manufacturers and retailers have a plan to win… the ones that are winning, that will ultimately win, are the ones that are truly finding ways to differentiate.

Jill Blanchard

President, Client Solutions, Advantage Solutions

Key takeaways

• While everyone is looking for a deal, value means different things to different consumers. 66% of manufacturers are shifting towards value via more promotions, while 75% of retailers are focusing on private label.^[12]Advantage Sales Manufacturer Outlook Study February 2024 (Base 62) and Retailer Outlook Study February 2024 (Base 32).
• Manufacturers are focused on innovative line extensions targeting the mainstream and premium price tiers. However, retailers are looking for value-priced innovation, since consumers are unwilling to pay for premium pricing right now, unless there is clear value and differentiation.^[13]Advantage Sales Manufacturer Outlook Study July 2024 (Base 54) and Retailer Outlook Study July 2024 [Base 40).
• Theft-related shrinkage remains a consistent problem without a clear solution. Consequently, many retailers are considering no longer carrying high-shrink items, especially the more expensive smaller packaged items.^[14]Advantage Sales Retailer Outlook Study April 2024 (Base 20). Addressing stolen and counterfeit goods sold on e-commerce platforms poses a significant challenge.^[15]Rachel Mailer & Stephen Corrou, Aug. 19, 2024, NACDS TSE, Industry Outlook: Challenges, Opportunities & Strategies Corrou and Marler emphasized the necessity of broadening stakeholder engagement to the federal, state and local levels to more effectively combat this issue.
• Regarding omni-commerce, both manufacturers and retailers’ top priorities are optimizing digital shelf content and retail media investments. Retailers are also increasing promotional and coupon activity.^[16]Advantage Soles Manufacturer Outlook Study July 2024 (Base 54) and Retailer Outlook Study July 2024 (Base 38).
• Almost 80% of manufacturers are planning for volume growth this year, with innovation and expanded distribution as the top drivers.^[17]Advantage Sales Manufacturer Outlook Study February 2024 (Base 62 | 42).
• Corrou noted that an area of opportunity for retailers and manufacturers is to continue to raise awareness that consumers can use their HSA (Health Savings Account) and FSA (Flexible Spending Account) for many over-the-counter (OTC) items.

The industry call to action

The session underscored that differentiation is key to success in a rapidly evolving market. As economic pressures continue to shape consumer behavior, retailers need innovative strategies that address both immediate challenges and long-term opportunities.