Emerging trends in managed care pharmacy: A mixed-method study | JoVE Visualize

Area of Science:

Pharmacy and Pharmaceutical Sciences
Health Policy and Management
Health Informatics

Background:

Managed care pharmacy has been significantly influenced by the global pandemic, advancements in artificial intelligence (AI), Medicare drug price negotiation policies, and major therapeutic developments over the last five years.
Collective intelligence methods offer a framework for anticipating future practice developments, enabling organizations to strategically plan and adapt.

Purpose of the Study:

To identify and analyze emerging trends within managed care pharmacy practice.
To forecast potential future developments and their impact on managed care organizations over the next five years.

Main Methods:

A sequential mixed-method study involving a multidisciplinary advisory panel to develop a survey with five domains: information technology, therapeutics and diagnostics, payment models, pharmacy operations, and public policy.
Thematic analysis was used for qualitative data from advisory panel meetings, while descriptive and exploratory bivariate statistics analyzed quantitative survey results from 201 participants.
Respondent opinions on the likelihood of future events were assessed by comparing 'likely' and 'unlikely' responses.

Main Results:

The survey identified increased use of glucagon-like peptide-1 receptor agonists, a major data breach, numerous orphan drug approvals, and widespread AI application in prior authorization reviews as highly probable scenarios within five years.
Key issues anticipated to impact managed care organizations include federal and state policy changes, the rise of cell and gene therapies, AI's operational impact, and evolving payment models.
A total of 53 potential scenarios were evaluated by 201 survey respondents, yielding a response rate of 16.2%.

Conclusions:

The study highlights key emerging trends in managed care pharmacy, emphasizing the transformative potential of AI and specialty therapeutics.
These trends present both significant opportunities and challenges for managed care organizations, necessitating strategic planning.
Areas lacking consensus among experts underscore the need for careful consideration in strategic decision-making.