Karen Appold

An estimated 80% of Americans will be infected with human papillomavirus (HPV) at some point. For many people, the infection will clear on its own without causing symptoms; for others, it can cause cancer later in life.

Pharmacists are highly trained and conveniently positioned to advocate for and administer vaccines. “As highly accessible healthcare professionals, pharmacists are equipped to identify patients who should receive the HPV vaccine and increase vaccination rates to assist with disease prevention,” said Katelyn Johnson, PharmD, MS, BCACP, assistant professor of pharmacy practice and community pharmacist at University of Cincinnati James L. Winkle College of Pharmacy and Kroger Health in Cincinnati, Ohio.

Community pharmacists are among the most accessible health care professionals; more than 90% of Americans live within 5 miles of a pharmacy, noted Deanna Tran, PharmD, BCACP, an assistant professor of pharmacy practice and science at the University of Maryland School of Pharmacy in Baltimore. These providers interact with customers who are picking up their medications, getting an OTC recommendation, or just passing by while buying something else. “Through these regular interactions, pharmacists are uniquely positioned to provide education on HPV and HPV vaccines, debunk myths associated with the vaccine, and administer the vaccine at the pharmacy,” she said.

Furthermore, young adults, including those in the age group indicated for the vaccine, often seek out convenient health care. Community pharmacists can provide that convenience, Tran said. Pharmacies may be open later than a traditional medical office or clinic practice, and pharmacists can administer vaccines with minimal wait times or without appointments. Community pharmacists can also play a vital role in rural or underserved areas, where a primary care provider may not be as easily visited.

Pharmacists who work in an ambulatory care clinic or in a hospital also can help boost vaccination rates. As medication experts, they often review medications and screen patients for necessary vaccinations, Tran said.

HPV vaccination helps prevent new HPV infections. It does not prevent progression of HPV infection to disease, decrease time to clearance of HPV infection, or treat HPV-related disease.

The Advisory Committee on Immunization Practice (ACIP) recommends that the HPV vaccination series be started at age 11 or 12 years, although it can be initiated as early as age 9. Catch-up is recommended for all individuals through age 26 who weren’t adequately vaccinated previously.

For unvaccinated patients aged 27 to 45 years, vaccination can be considered based on shared clinical decision-making between the provider and patient. “Although transmission is most likely to occur in adolescents and young adults, some people may have specific behavioral or medical risk factors that increase their risk of HPV infection,” said Danielle C. Mayer, PharmD, BCACP, an assistant professor in the Department of Pharmacy Practice at Thomas Jefferson University’s Jefferson College of Pharmacy in Philadelphia, Pennsylvania. Currently, HPV vaccines aren’t licensed for use in adults older than 45.

“Vaccine effectiveness is lower in this older age group because these individuals may already be exposed to HPV, so a discussion with a provider would be beneficial,” Tran added.

The vaccine is not recommended for pregnant women. If a woman has not been fully vaccinated for HPV, Mayer recommends starting or finishing the series in the postpartum period. The vaccine can be administered to a woman who is breastfeeding.

Gardasil 9 is the only HPV vaccine currently distributed in the United States. For patients aged 9 through 14 years, Gardasil 9 can be administered using a 2- or 3-dose schedule. For the 2-dose schedule, the second dose should be given 6 to 12 months after the first dose. If the second dose is administered less than 5 months after the first, a third dose should be given at least 4 months later. For the 3-dose schedule, Gardasil 9 should be administered 2 and 6 months after the first dose. Study results have shown that in patients aged 9 through 14 years, the 2-dose schedule, with at least 6 months between doses, provided an antibody response as good as or better than that of the 3-dose schedule.

For patients aged 15 through 45 years and for immunocompromised patients, including those with HIV infection, Gardasil 9 should be administered using a 3-dose schedule at 0, 2, and 6 months.

Existing vaccines cover only a limited number of the more than 100 HPV types, according to Zvi Loewy, PhD, professor of pharmaceutical and biomedical sciences, associate dean of research, and immediate past dean at Touro College of Pharmacy in New York, New York. The Merck vaccine covers high-risk HPV types (16 and 18) and those that cause genital warts (6 and 11). A vaccine made by GlaxoSmithKline covers oncogenic, or high-risk, types (16 and 18) exclusively. Another vaccine in development covers 9 types of HPV.

State laws differ regarding a pharmacist’s ability to give the vaccine. Of 50 states and the District of Columbia, 40 have laws expressly granting pharmacists the authority to administer the HPV vaccine, Loewy said; 22 have laws that authorize pharmacists to vaccinate preadolescents aged 11 or 12 years, the age group recommended by the CDC. Pharmacists have prescriptive authority in just 5 states.

More than 12 years of monitoring data and research demonstrate that the HPV vaccine is very safe, Tran said. Similar to other vaccines, the HPV vaccine can cause injection site reactions such as pain, redness, or swelling, as well as nausea and headache.

Fainting after receiving any vaccine is more common among adolescents, and dizziness or fainting may be more common with the HPV vaccine. Johnson suggests having patients sit or lie down for 15 minutes of observation after getting the vaccine. Patients may minimize potential pain by relaxing their arm during administration and moving their arm around afterward.

Ask the experts: human papillomavirus. Immunization Action Coalition. October 10, 2018. Updated March 1, 2020. Accessed June 29, 2020. 

www.immunize.org/askexperts/experts_hpv.asp

Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. 

Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the Advisory Committee on Immunization Practices. 

CDC recommendations for patients 9-26 years of age. Merck Vaccines. June 2020. Accessed June 29, 2020. 

https://www.merckvaccines.com/gardasil9/cdc-recommendations-hpv-vaccination/

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Pharmacists should counsel patients on how taking steps now can prevent certain cancers later.

Communicating Facts Can Help Boost HPV Vaccination Rates

Americans are desperate to be well. Being well, however, is not the business model of modern medicine, according to Kathy Campbell, PharmD, clinical community pharmacist and CEO/owner of Dr Kathy Health, LLC, and Medicap Pharmacy in Owasso, Oklahoma. The American health care system is structured to respond to a patient’s diagnosis, not prevent disease.

The $40 billion supplement industry,1 which includes vitamins and nutraceuticals, represents Americans’ willingness to spend money to be healthy. “Pharmacists are perfectly positioned and trained to understand the chemistry of supplements and foods, and as well as drugs and diseases,” Campbell said. “They can assist customers by recommending appropriate supplements. Sales of these products can also benefit a pharmacy’s bottom line.”

Bowe Craine, PharmD, co-owner and pharmacist in charge at Okie’s Pharmacy II Inc., in Blaine, Tennessee, agreed, and said that pharmacists should be at the forefront of not only selling supplements, but that they should also educate patients on OTC products that may not be FDA approved.

When looking to grow business with supplement sales, pharmacists should first educate themselves. “Research the most common products in various categories, and then analyze which ones fit your community’s needs,” Craine said. For example, if you have a large patient population with inflammatory conditions, such as irritable bowel disease or arthritis, then you should start with products like turmeric, fish oil, or cannabidiol (CBD) oil.

“Get out from behind the counter and talk to customers,” Craine said. “Ask how they feel about their current therapies and if they’re sufficient. Be confident in your ability to make recommendations about products that can improve quality of life. Not only will you increase your sales and profit margins, but you will also create loyal customers and build trusting relationships.”

Campbell recommended attending an 8-hour continuing education course from the National Community Pharmacists Association and Dr Kathy Health, Creating Health-Pharmacist-led Lifestyle and Weight Management, which teaches supplementation basics and foundational training in assisting patients with health.

When researching supplements, Craine uses UpToDate, PubMed, or the Dietary Supplements Labels Database to study their safety, efficacy, and various uses. National Center for Complementary and Integrative Health’s website is also recommended to get a better understanding of the usefulness and safety of supplements with evidenced-based research, advises Dipan B. Ray, MPharm, MS, PhD, RPh, senior director of experiential education at Touro College of Pharmacy in New York, New York.

Nina Chhabra, PharmD, a natural medicines specialist at Northwell Health/Vivo Health Pharmacy in New Hyde Park, New York, subscribes to reputable databases, such as the Natural Medicine Database, which provides detailed information regarding supplements like their level of effectiveness, safety information, dosing information, and possible drug interactions. ConsumerLab.com provides third-party testing results. The National Institute of Health’s website shows if any clinical trials were conducted to support a particular product’s usage, she said.

By far, the most popular supplement Craine sells are multivitamins. “Consumers take them mainly to avoid vitamin deficiencies which can lead to problems such as osteoporosis, muscle cramps, and fatigue,” he said.

Hemp-derived CBD topped Chhabra’s list in 2019. Patients use this product to help manage anxiety and stress, for insomnia or to support sleep, and for different types of pain related to fibromyalgia, headaches and migraines, and muscle and joint pain.

Vitamin D is the most popular supplement currently used. It helps the body absorb calcium in order to increase bone density and therefore reduces the risk of developing osteoporosis, especially in women and the elderly, he said.

In addition to serving as a resource on which supplements to take, pharmacists should make customers aware of possible adverse drug reactions.

A general myth is that most supplements are safe because they’re derived from natural sources. “The truth is that a majority of herbal supplements interact with other drugs and can have significant adverse effects,” Ray said.
	
	For example, Chhabra noted that turmeric, curcumin, and fish oil supplements can thin blood. If a patient takes a blood-thinning agent such as aspirin or warfarin, she warns them to stop taking these supplements before surgery or any medical procedure that could affect their clotting time.

Chamomile, often used as a sleep aid, interacts with birth control, Craine pointed out. Ginger, which prevents nausea and vomiting, can lower blood sugar and interact with blood thinners if high doses are taken. Yohimbe may aid with erectile dysfunction, but it can raise blood pressure and heart rate and cause tremors.

Consumers should understand the importance of selecting the most appropriate products depending on their medical histories and current medication use. “Before using any such products, patients should share their current medications and over-the-counter products with their physicians and pharmacists so they can counsel them about any potential risks and benefits,” Ray said. “I encourage patients to report any side effects to physicians or pharmacists immediately.”

Because the kidneys and liver break down supplements just as they do prescription drugs, Chhabra asks customers if they have any issues with these organs. “Supplements can cause interactions for patients who take prescription drugs because they can compete with the same pathway,” she said.

Craine aims to ensure that customers buy products from reputable companies. For example, he’ll recommend a multivitamin with the United States Pharmacopeia (USP) seal of approval. “This seal means you can trust that the bottle’s contents contain exactly what the label states,” he noted.

Craine asks patients for feedback as well. “I want to know if a product helped or if it had side effects, so I can relay that to other patients,” he said.

The most frequent questions Chhabra gets from patients is if a product is safe and if it works. “I emphasize that safety is our primary concern, however it is hard to find robust clinical evidence about efficacy,” Chhabra said. “This is simply because large trials that can show this are rarely performed. Unlike prescription drugs, supplements are considered safe unless proven otherwise.”

Currently, Chhabra also receives many questions about hemp-based CBD products. “Although CBD appears to be safe, it is relatively new and we’re still learning its exact uses,” she said. “I recommend patients start taking low doses and slowly increase the dosage every 2 to 3 days until they feel an effect. But I caution them to only use products that provide third-party testing results, which can help ensure it’s a quality product and reveal its CBD content as well as any contaminants such as heavy metals, pesticides, and bacterial growth.”

The most frequently asked question consumers ask Ray is, “How much should I take?” He pointed out that all vitamins need to meet a certain Recommended Daily Allowance (RDA) as stated on the label to achieve desired benefits.

Supplements, Vitamins, and Nutraceuticals: What’s the Difference?

The best way to describe the differences between vitamins, supplements, and nutraceuticals is to consider supplements as the main category that these agents fall into.

The Dietary Supplement Health and Education Act of 1994 (DSHEA) defines dietary supplements as “a product intended to supplement the diet that bears or contains 1 or more dietary ingredients, including a vitamin, mineral, herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combination of any of the aforementioned ingredients.”2

Nutraceutical products are generally derived from food sources intended to be used for health benefits, whereas vitamins are organic compounds that are needed from external sources, such as food, because the body can’t make them, explained Chhabra.

“If someone can’t obtain enough of a necessary vitamin from a food source alone, they may use a supplement that contains that specific vitamin,” Chhabra said. “Vitamins are essential for bodily functions, whereas nutraceuticals are used to supplement the diet and are typically food or food sources and are used for a specific health benefit.”

1. Statista. Total US dietary supplements market size from 2016 to 2024. https://www.statista.com/statistics/828481/total-dietary-supplements-market-size-in-the-us/.
	2. National Institutes of Health, Office of Dietary Supplements. Dietary Supplement Health and Education Act of 1994 Public Law 103-417 103rd Congress. https://ods.od.nih.gov/About/DSHEA_Wording.aspx#sec3

When looking to grow business with supplement sales, pharmacists should first educate themselves.

Growing Your Business With Supplements

The opioid crisis continues to be one of the worst public health crises that the United States has ever seen. Opioids- mainly synthetic opioids (other than methadone)-are currently the main driver of drug overdose deaths. According to the CDC, opioids were involved in 47,600 overdose deaths in 2017 or 67.8% of all drug overdose deaths. Approximately 2.1 million Americans live with opioid use disorder.

Some small signs of improvement have come to light. Opioid prescribing has declined since 2012, and July 2019 data from the CDC demonstrated a 5.1% decline in overdose deaths for the first time since 1990.

 “These numbers are provisional and positive, but improvement is minimal and slow,” Jim Lichauer, PharmD, BCPS, FASHP, program director for Pharmacy Performance Improvement Collaboratives at Vizient, a health care performance improvement company, said. “Increased awareness, appropriate education regarding opioid risks and benefits, and education on non-pharmacologic and non-opioid alternatives have improved prescribing practices.”

The federal government continues to address the crisis with new regulations, said Katharine Van Tassel, JD, MPH, visiting professor of law, Case Western Reserve University School of Law. In the summer of 2019, the FDA issued new draft guid- ance, “Opioid Analgesic Drugs: Considerations for Benefit-Risk Assessment Framework,” which describes the application of the benefit-risk assessment framework that the agency uses in evaluating applications for opioid analgesic drugs.

“Normally, when deciding whether to approve a new drug, the FDA only looks at the risks and benefits to patients who take it as directed, not risks to everyone else,” Van Tassel explained. “Under its new proposal, the FDA will consider whether a new opioid works better than other painkillers-opioid and non-opioid-that are already on the market. Officials will also analyze a new drug’s potential impact on public health.” For example, does it have characteristics that might tempt people to misuse it, such as it being very potent, or easy to crush, dissolve, and inject.

On another front, the Drug Enforcement Administration (DEA), which is responsible for keeping controlled substances from being diverted for abuse and sets a quota for how many opioid pills drug makers are allowed to produce in the United States along with input from the FDA and drug manufacturers, is proposing that appropriate quota reductions be made only after estimating the potential for pills to be sold illegally. Under the proposal, the diversion potential would be based on rates of overdose deaths and abuse, as well as the overall public health impact related to specific controlled substances.

Furthermore, the FDA is using its authority under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act of 2018 to mandate short-duration packag- ing for outpatient dispensing of certain solid, oral dosage forms of immediate-release opioid analgesics to treat acute pain and require manufacturers to develop technologies such as mailback pouches to dispose of unused opioid medications, Van Tassel reported

The FDA also plans to announce changes to strengthen the Risk Evaluation and Mitigation Strategy for transmucosal immediate-release fentanyl medicines, and issue updated guidance to promote the development of non-opioid drugs to treat pain, Van Tassel added.

Finally, the FDA is focused on securing the legitimate supply chain and doing more to hold distributors responsible. Under the Drug Supply Chain Security Act (DSCSA), manufacturers, re-packagers, wholesale distributors, and dispensers-which are all mainly pharmacies-are all required to have systems and processes in place to quarantine and investigate suspect and illegitimate medications, Van Tassel said.

“The FDA plans to ensure that entities responsible for maintaining the supply chain take measurable steps under the law to appropriately track and trace opioid medications as these products move through the supply chain, and to respond to incidents involving illegitimate products to protect the public health,” Van Tassel said.

States also issue their own laws regarding drugs, which generally address limiting initial prescription quantities, requiring prescribers to query the state’s prescription drug monitoring program prior to prescribing, requiring provider education or training as well as patient education, and requiring co-prescribing of naloxone, the opioid reversal agent, Lichauer said.

Regarding states’ rules, Lichauer said that limiting initial prescription quantities will reduce the potential for leftover pills, which can fall into the wrong hands and be misused, and can lower the risk of long-term opioid dependency. A CDC study correlated higher initial prescription quantities with a greater risk of continued use at 1 and 3 years.

 The same study also demonstrated an increase in continued use at 1 and 3 years for patients who received a third prescription refill of their initial opioid pain medication.

Upon dispensing in most states, pharmacists are required to query a patient’s history in the prescription drug monitoring program (PDMP) database. “Pharmacists need to know their state regulations on prescription quantities and refills as well as requirements for patient education,” Lichauer said

Pharmacists should be sure that their entire staff is registered for their state’s PDMP and that they check it every time a controlled substance medication is dispensed, said Andrew Smith, PharmD, BCPS, BCCCP, assistant professor and PGY-2 emergency medicine residency program director, Touro College of Pharmacy. Furthermore, since pharmacies are required to send data to the state for this reporting program, finding ways to streamline the reporting process will help decrease their perceived workload burden.

Pharmacists need to review their state laws and figure out what their roles can be to help their communities. “If naloxone is available as a standing order under state law, pharmacies should be sure to have an adequate supply and they should train their pharmacists and interns to counsel patients and be candid about the risks of even a short course of opioids for patients,” Smith said. Furthermore, pharmacies should become more familiar with medication-assisted treatment (MAT) as more emergency physicians begin initiating treatment in the emergency department as a bridge to long-term treatment with an addiction medicine specialist. MAT will grow over time as more patients get the help they need.

Van Tassel said that pharmacists are stepping up to address the opioid crisis by playing an active role in stewardship programs to prevent opioid misuse. These programs are designed to promote appropriate use of opioids, improve patient outcomes, and reduce the misuse of opioids.

Pharmacists are also participating in opioid stewardship programs through clinical education and guideline generation, and by using PDMP database searches to track prescribing practices and patient behavior that can drive opioid abuse, Van Tassel said. Pharmacists are monitoring prescribing practices to identify outliers among providers, to assess the appropriate use of clinical decision support, to impose restrictions on specific opioids and doses, and to provide daily feedback to prescribers.

Most hospitals assign pharmacists to play pivotal roles in drug therapy management. Pharmacists do so by assessing therapeutic drug levels, patient outcomes, laboratory results, and adverse drug events to track potential opioid abuse, Van Tassel concluded.

Ahmad FB, Escobedo LA, Rossen LM, et al. Provisional drug overdose death counts. National Center for Health Statistics. 2019. 

https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm?mod=article_inline

Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use – United States, 2006-2015. 

http://dx.doi.org/10.15585/mmwr.mm6610a1external icon

The opioid crisis continues to be one of the worst public health crises that the United States has ever seen.

Addressing the Opioid Crisis in 2020

Technology use in healthcare is growing with the increased use of electronic health records and health informatics, and pharmacy is no exception. Pharmacists should embrace the innovations technology can offer in order to enhance patient engagement, improve workflows, increase patient safety, and simplify communication. 

One of the biggest challenges consumers face is incorporating complex and multiple medication regimens into their daily lives. “It’s important to design behavioral and therapeutic interventions that engage patients throughout their journey from their first prescription fill through refill,” says 

, co-founder and chief executive officer, Medisafe, a medication management platform. Today, various platforms assist with dosing, how to take specific medications such as injections, and how to mitigate adverse effects. 

For example, Shor recommends designing interventions for selective serotonin reuptake inhibitor patients in the beginning of treatment that reinforce adherence, since patients may not initially feel a medication’s effects because it takes time to titrate. Interventions might include digital messages, reminders, or even surveys through the company’s app to understand a patient’s needs. Equally important is educational content about medication applications, such as how to properly inject medications, connections to care support, and condition-related measurement trackers.

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Another technology gaining popularity is the central fill automation machine, which can fill medicines in high volumes in lieu of a technician or pharmacist, says 

 chair and associate professor, Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York. 

Central fill automation machines are especially beneficial for medication refills: Based on the first fill of a medication, subsequent fills are automatically filled for verification and dispensing. In addition to lowering operating costs and reducing dispensation errors, this can save significant time for pharmacists, allowing them to work on more clinical aspects of medication dispensing, such as patient counseling or medication therapy review. 

Automation isn’t only for pharmacists, however. Machines can now dispense medicines for patients, similar to vending machines. Instead of waiting at the pharmacy window for a technician or pharmacist to hand over a bag of medicine, a patient can access a machine inside the pharmacy, Unni says. Pharmacy personnel scan and load filled medicine bags into the machine. 

If a patient is interested in using the machine, they are registered within the pharmacy and given a unique pin number to access their medication bag and pay electronically for their medicine. Before receiving their medication, a patient must accept or decline counseling by the pharmacist. If counseling is requested, the patient can pick up a phone located on the machine and be connected to a pharmacist. “These machines can make prescription dispensing windows less crowded and allow patients to pick up their medications at their own convenience, as long as the store is open, even when a pharmacy is closed,” Unni says. 

In a hospital setting, automated dispensing cabinets are used to increase workflow efficiencies and patient safety, Unni says. Unit dose medicines are prepared and stored in these cabinets, which a nurse can access after a pharmacist verifies the prescription order entered by a physician. 

Pharmacies are using the large amount of data they generate in a variety of ways. The current pharmacy management systems used through pharmacy benefit managers have information about each patient’s prescriptions and prescription pick-up habits, Unni says. Several health insurance companies use this data to flag patients who haven’t picked up their medicine in recent months-an indication of medication non-adherence. This provides an opportunity for the pharmacist to either call or speak with the patient about the necessity of taking their medicine as prescribed.

Additionally, some pharmacies and health insurance companies are using big data to predict the risk of medication non-adherence, Unni says. This medication adherence prediction model is based on several variables, such as patient demographics, the number of medications a patient takes, out-of-pocket costs for medications, and past refill habits. When a patient is identified as high-risk for medication non-adherence, a pharmacist provides them with additional counseling to reduce the possibility of non-adherence. They focus on educating the patient about the importance of adherence, the need for the medicine, what to expect for treatment outcomes and side effects, cost concerns, and so forth. 

In clinical pharmacies, in collaboration with physicians, big data is now used to develop algorithms to predict treatment outcomes or medication errors. Based on past outcomes and medication errors with various patient and condition characteristics such as age, gender, duration of disease, and severity of disease, risk models are developed to determine treatment outcomes and medication errors, Unni says. 

Medisafe’s AI technologies are based off of machine learning analyzing more than 2 billion managed doses. The company leverages this data to identify persona types based off of behaviors such as reasons for non-adherent behavior, demographics, digital profiles, and therapeutic needs. “Once patients match persona types, then the power of AI guides patients through their personalized journey in their medication management needs,” Shor says. For example, periodic surveys or interventions check in with patients to assess their progress. If needed, persona-based management designs will change to meet patient’s needs.

Pharmacists are also using AI to monitor and prevent opioid abuse. “Incorporating AI can remove some of the burden from healthcare providers and improve patient safety,” says Rachael Fisher, PharmD, senior clinical implementation analyst, Wolters Kluwer, Health, which provides evidence-based health information and technology. Nationwide databases and prescription history can be used alongside AI to identify patients at risk for opioid misuse or patients who are doctor shopping, which could be an indicator that they are obtaining multiple controlled substance prescriptions illegally. Also, AI can identify physicians who overprescribe opioids, so education can be recommended.

Many state-specific laws have been created in response to the epidemic. “Pharmacists can use AI to assess compliance of local laws in addition to national recommendations from organizations such as CMS and CDC,” Fisher says. “The environment is ever changing; AI can help providers be more vigilant, effective, and improve overall opioid monitoring and safety.”

Looking ahead, technologies will continue to transform the pharmacy industry in positive ways.

Fisher expects pharmacy dispensing to become more automated in the next decade. With electronic prescribing becoming the norm, pharmacists will no longer need to manually interpret prescription data or enter it. “As dispensing machines and systems become smarter, the whole process will be mostly automated with minimal clinical oversite,” she says. 

This will force pharmacists to evolve. They will need to embrace their place in clinical roles, such as medication therapy management programs, patient education, or health information technology. “Pharmacists can make a huge impact on drug costs and patient education, which impacts overall compliance and healthcare outcomes,” Fisher says. As technology evolves, programs will accurately target the most needy and costly patients.

, senior vice president, Research and Innovation, American Pharmacists Association Foundation, which is focused on patient-centered, team-based care, has predicted that through new technology innovations medications will be customized to an individual patient’s genome, health status, and point-of-care needs via 3D printing. This may even include all-in-one pills for some patients. 

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The supporting technologies for this revolution are already in place. Hard work from clinicians on data aggregation and standards that support individualized care is ongoing through the Clinical Pharmacogenetics Implementation Consortium (CPIC), Bluml says. Technology companies are also working on innovations that will increase the variety of medications available for 3D printing. “The challenges for moving this innovation to scale are significant, but the combination of human and artificial intelligence at the point-of-care will undoubtedly contribute to its eventual reality,” he says.

Finally, with many grocery stores containing pharmacies and with a focus toward lifestyle management for chronic disease conditions, a new technology that could emerge in the next decade is linking an individual’s shopping habits to their prescriptions. “By using store loyalty cards, consumer shopping habits can be captured, which can be connected to their prescriptions for point-of-buying suggestions,” says Unni. For example, if a patient has a prescription for cholesterol-lowering medicines and is buying red meat, the technology (in the form of a mobile app) could inform the individual about red meat’s fat and calorie content and could make recommendations about the appropriate use of that food, even including healthy recipes. 

Pharmacies are making the most of tech from automation to big data.

Author | Karen Appold

Articles

Communicating Facts Can Help Boost HPV Vaccination Rates

Growing Your Business With Supplements

Addressing the Opioid Crisis in 2020

How Pharmacists are Embracing New Technologies