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Genomic medicine marks a new era for health care. Here are the 3 questions pharmacy leaders should ask—and answers they need.

August 28, 2018

    Health care is moving beyond the standard pill or IV as the primary form of medicine and into a new world of molecular medicine. Gene therapies reprogram patients' biology; nanotechnologies manipulate matter at the molecular and atomic scale; and robotics and artificial intelligence create greater than human capabilities.

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    Many of these new treatments fall outside of the traditional bounds of drug therapy or laboratory testing, but because they require precise, tightly-controlled handling of a patient's biologic material, they often fall under pharmacy's purview. Pharmacy leaders are now faced with the challenge of balancing current priorities with these evolving technologies and treatments.

    At a recent Pharmacy Executive Forum meeting, members discussed what the future of pharmacy looks like in an age of genomic medicine. Here are three key questions that pharmacy leaders should ask themselves, along with key takeaways from the participants' discussion:

    1. How can the pharmacy profession keep up with the changing health care landscape?

    Pharmacy leaders should consider three actions to balance current priorities with emerging technologies:

    1. Form a system-level group of pharmacy leaders who dedicate time to evaluating innovations and determining whether they are feasible to incorporate into, or replace, existing treatments and technologies.

    2. Implement new technologies in a phased rollout by service line. Health systems are likely unprepared for a full integration of pharmacogenomics testing, so it's important to pinpoint areas at your organization that will benefit most from targeted medication therapies.

    3. Work with local pharmacy schools to build new techniques and treatments into their curriculum. Teaching today's pharmacy students how to incorporate these innovations in their day-to-day practice will help ensure that your pipeline of new pharmacists are ready to operate in the new reality.

    2. How can pharmacy leaders support ethical decisions about who should be treated – especially in the absence of reimbursement?

    While new technologies and treatments—such as CAR-T therapy and pharmacogenomics—hold great promise, some insurers do not cover them or do not cover all patients. For example, UCSF Health has developed the UCSF 500 Cancer Gene Panel, a test that, following a tumor sample test and either a blood sample or mouth swab, analyzes DNA mutations to identify which drugs will most effectively treat the patient's cancer. The goal is to provide targeted care and also reduce complications and downstream costs—but this genetic testing is often not reimbursed.

    Similarly, CAR-T therapy can cost as much as $475,000 per patient, but providers are not guaranteed reimbursement. How do leaders choose which patients receive these costly treatments? Unfortunately, there is no straightforward answer to this question. One strategy is to bring together key stakeholders from the organization—including the CMO, CPO, and CFO—to review potential CAR-T recipients. Each patient must meet the clinical indications for treatment, and then the care team, contracting, and financial teams should work closely to try to secure reimbursement from payers.

    Progressive health systems will need to make decisions about how to approach these expensive treatments in light of reimbursement uncertainties, and pharmacy leaders should make sure they're at the table for those discussions.

    3. How should pharmacy executives adapt their leadership style amid these changes?

    To stay on top of a changing health care industry, pharmacy leaders must move from a reactive to a proactive mindset. Pharmacy leaders can be more forward thinking by setting aside time to envision what an ideal future of pharmacy looks like—not just across the next few years, but over the next 200 years. Pharmacy leaders need to set their gaze much further down the road to advance pharmacy practice rather than simply react to current challenges. Once that long-term vision is clear, pharmacy leaders can use their seat at the table to offer creative solutions to stay innovative and progressive.

    Another essential element of successfully leading the integration of new technologies will be demonstrating outcomes from these new innovations, such as revenue generation, improved patient care, and decreased length of stay, that are high on the system's priority list.

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