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Emerging trends in managed care pharmacy: A mixed-method study.

T Joseph Mattingly1, Laura E Happe2,3, Laura Cranston4,5

  • 1Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City.

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Managed care pharmacy is evolving due to AI, new therapies, and policy changes. Experts predict increased AI use, data breaches, and new drug approvals within five years.

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Area of Science:

  • Managed Care Pharmacy
  • Health Informatics
  • Health Policy

Background:

  • Managed care pharmacy has been significantly influenced by the COVID-19 pandemic, advancements in generative 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 trends, enabling organizations to strategically plan and adapt.

Purpose of the Study:

  • To identify and analyze emerging trends within managed care pharmacy.
  • To forecast potential developments and their impact on organizational strategies.

Main Methods:

  • A sequential mixed-method study involving a multidisciplinary advisory panel to develop a survey.
  • Thematic analysis was used for qualitative data from advisory panel meetings.
  • Descriptive and exploratory bivariate statistics analyzed survey results, assessing relationships with demographics and likelihood predictions.

Main Results:

  • A survey of 201 participants identified key anticipated trends in managed care pharmacy over the next five years.
  • Most likely scenarios include increased use of glucagon-like peptide-1 receptor agonists, a major data breach, numerous orphan drug approvals, and widespread AI application in prior authorization.
  • Key organizational impacts are expected from federal/state policy changes, cell and gene therapies, AI in operations, and evolving payment models.

Conclusions:

  • The study highlights critical emerging trends in managed care pharmacy, emphasizing the opportunities and challenges presented by AI integration and specialty therapeutics.
  • Areas with limited consensus underscore the need for careful strategic planning within managed care organizations.
  • Anticipating these trends is crucial for proactive strategy development in the evolving landscape of managed care pharmacy.