Mohamed A. Jalloh, PharmD

Every pharmacist dreams of a great purpose in their pharmacy career. However, many often feel frustrated with the current employment market.

According to a 2019 US Bureau of Labor Statistics report, the projected employment of a pharmacist is purported to decrease by 3% within the next 10 years.

 Unfortunately, the days of receiving a generous starting bonus, working at the same pharmacy job for the next 25 years, or starting at $120,000 are gone. Therefore, to remain competitive in the future employment environment, experts recommend gaining career skills that would likely complement the upcoming trends in the pharmacy profession.

Below are some key trends that could impact future employment opportunities.

Direct-to-Consumer Health Care and Specialty Pharmacies

The DTC model is one of the fastest-growing health care models and represents a $700 billion industry. Averill Gordon, PharmD, the group vice president for hims & hers, a telemedicine company, said that many health start-up companies are investing in creating their own pharmacies and will likely recruit pharmacists to help launch them internally. In addition, many of such pharmacies are adopting the mail-order model for servicing such DTC patients, said Kathleen Wong PharmD, a former Alto Pharmacy manager and current Modern consultant. 

However, she suspects that many such pharmacies will use courier-like medication delivery services to prevent patients from being limited to delays due to UPS or FedEx logistical issues.

Many community pharmacists can volunteer under their current pharmacy managers to the skills and process
in obtaining the proper legal and operational requirements to open or manage a pharmacy. Such pharmacists can master the processes ranging from how to purchase medication-related inventory to how to facilitate home delivery services legally.

Dtx are defined as software therapeutic interventions that are able to directly prevent, manage, or treat a medical disorder.

 The Dtx market is purported to grow 21% annually, with over 300,000 new digital health start-ups in the current market.

Julie Fishman, MPA, RPh, a digital health executive, said pharmacists need to know how such Dtx interventions could affect medication therapy. For example, she claims that there are digital therapeutics used for pain, and providers may need to adjust pain medications for patients to effectively correspond with the “dose” of the Dtx interventions. Pharmacists can lead the adjustments of such pain medication regimens to provide truly personalized pain medication recommendations.

In addition to providing treatment recommendations, pharmacists may help pharmacy benefit managers (PBMs) integrate Dtx onto formularies like what Express Scripts has already done.

 Many managed care pharmacists already have the experience of evaluating interventions to clarify whether they should or shouldn’t be included in a formulary. Therfore, many Dtx companies would value the input of a pharmacist to learn how to demonstrate the efficacy, safety, and financial viability of their Dtx to managed care organizations.

Many pharmacists can visit websites such as the Digital Therapeutics Alliance to learn more about digital health and Dtx. Pharmacists should also practice helping to make formulary decisions by volunteering to work with PBMs or working with local physicians to help develop their in-clinic injection or immunization formularies.

Pharmacogenomics is the study about how DNA may significantly affect how patients might respond to medications. Experts suspect that the pharmacogenomics market will grow 8.6% by 2024 and generate $10.2 billion in market value.

With the advent of companies such as 23andme, patients have become motivated to learn how their genetic code and habits can significantly affect their health.

According to Gordon, pharmacists may need to learn how to evaluate a patient’s genomic profile, in context with their pharmacogenomic profile, to provide a truly personalized medication review. “Imagine if you can now aggregate everything about yourself, go to a doctor’s office with a report that says what will probably what will work for me from a personalized medication perspective,” he said. “A pharmacist should learn to be able to account for all of those data points to help guide pharmacotherapy therapy.”

The University of Florida has an entire online curriculum of certificate programs in topics ranging from “implementing pharmacogenomics into clinical practice” to learning about “pharmacogenomic implementation, testing, and reimbursement.”

 Pharmacists may want to consider getting a sufficient amount of continued education to gain the skills of providing pharmacogenomic recommendations.

Value of Health Informatics and Data Science

Health informatics is considered the use of computer sciences and health care information sciences to help in the management of information. Data science is considered the use of scientific methods to gain further insight from organized or disorganized data.

Both market areas are projected to grow over 20% over the next 5 years as health organizations have seen greater value in using machine learning and artificial intelligence.

 Kim (Frey) Jacoby, PharmD, MSHI, a senior clinical expert for the digital health start-up Komodo Health, claims that any data science skill is important. According to her, pharmacists will make a greater impact of querying and evaluating data due to understanding the context of the health data versus data science professionals without any health care knowledge.

Jacoby says that pharmacists can learn different areas of data science such as using engineering model development, creating different types of machine learning algorithms, or even learning a programming language like “R” or “Python.” However, before jumping into data science, pharmacists can learn basic terminology by reviewing websites such as practice RxNorm. Pharmacists can also take any online data science courses from Coursera from Johns Hopkins University and use public health datasets to practice what they learn. Finally, pharmacists can visit the RxNav, RxMix, SNOMED websites to learn to codify medication information and large aggregate datasets to analyze and practice using the knowledge to apply in your current setting.

Due to the ever-changing health care landscape, pharmacists have greater opportunities to integrate or create new roles by continuing to adapt their skills.

Occupational outlook handbook. Pharmacists. U.S. Bureau of Labor Statistics. Updated October 13, 2020. Accessed November 30, 2020. 

https://www.bls.gov/ooh/healthcare/pharmacists.htm

Digital therapeutics. Digital Therapeutics Alliance. Accessed November 30, 2020. https://dtxalliance.org/aboutdtx

Lineaweaver N, LaRock Z. Digital therapeutics explainer. Insider. October 2019.

https://store.businessinsider.com/products/the-digital-therapeutics-explainer

Evernorth digital health formulary. Express Scripts. Accessed November 30, 2020. https://my.express-scripts.com/digital-health-formulary.html

MHE Staff. Express Scripts introduces digital health formulary. 

 December 20, 2019. Accessed November 30, 2020. 

https://www.managedhealthcareexecutive.com/view/express-scripts-introduces-digital-health-formulary

Relling MV, Evans WE. Pharmacogenomics in the clinic. 

 2015;526(7573):343-350. doi:10.1038/nature15817

Pharmacogenomics market size to hit $10.2 billion, by 2025 at 8.6% CAGR. News release. Allied Market Research; October 27, 2020. Accessed November 30, 2020. https://www.globenewswire.com/news-release/2020/10/27/2115269/0/en/Pharmacogenomics-Market-Size-to-Hit-10-2-Billion-by-2025-at-8-6-CAGR.html

Precision medicine and pharmacogenomics. University of Florida Health. Continuing Pharmacy Education. Accessed November 30, 2020. https://cpe.pharmacy.ufl.edu/courses-04-24-2019/pharmacogenomics/

Van Horn JD, Fierro L, Kamdar J, et al. Democratizing data science through data science training. 

, PharmD, BCPS, is an assistant professor of pharmacy practice at Touro University California and a clinical pharmacist at OLE Health. He is also a member of the Drug Topics® Editorial Advisory Board.

Articles

Pharmacists can adapt their skills to keep up with an evolving profession.

Build Career Skills for Pharmacy’s Future

Remember the first and one of the most important lines in the Oath of a Pharmacist? You likely recited it at least a few times in your career-during your white coat ceremony, your graduation, and attendance of either of these ceremonies. It is: 

“I promise to devote myself to a lifetime of service to others through the profession of pharmacy.”

 It is followed by another important statement: 

“I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical, and legal conduct.”

Two Arizona pharmacists made headlines when it seems they may have not adhered to this pledge. 

In the first case, a community pharmacist chose not to fill a hormone prescription for a transgender patient. Based upon news reports, the pharmacist apparently denied filling the prescription and continually asked the patient why she needed the therapy, in front of other customers. The patient claimed the pharmacist refused to give her back the written prescription, forcing the prescriber to call in a new prescription to another pharmacy. The patient reported feeling “mortified.” She eventually filed a complaint with the Arizona State Board of Pharmacy.

In the second case, a nine-week pregnant woman was told by her prescriber that there was no fetal heartbeat and that her pregnancy would likely end in a miscarriage. The woman had two options: have a surgical procedure to remove the fetal tissue or take a medication, i.e., misoprostol, to produce a miscarriage. She chose the latter. 

When she presented the prescription to the community pharmacy, the pharmacist refused to fill it based upon “ethical beliefs,” and refused to give the prescription back. The patient left the pharmacy feeling “ashamed” and “humiliated,” and contacted her husband. The husband came to the pharmacy to explain the situation, but the pharmacist continued to refuse to fill the prescription. Eventually, the pharmacist sent the prescription to another pharmacy location where the patient was able to pick up the medication. She also filed a complaint with the Arizona State Board of Pharmacy.

In both cases, the pharmacists refused to fill the prescriptions based upon personal moral objections. And while I may morally disagree with their actions, they legally had the right to refuse to fill the medications. 

Arizona is a state with a law that allows pharmacists to refuse to fill a medication because of “sincerely held religious beliefs.” However, pharmacists must make a good faith effort to refer or transfer the prescription to another pharmacist to meet the clinical needs of the patient in a timely manner, as required by the Arizona law. By not doing so, pharmacists may end up getting fired (as was the case with the pharmacist who refused to fill the hormone prescription), and they may be investigated by the State Board of Pharmacy. 

If you live in a state that allows you to refuse to fill a medication based on moral or religious beliefs-and you have beliefs that could lead you to refuse-consider identifying pharmacists to whom you will be able to refer prescriptions. If you are a pharmacist who does not hold such beliefs, offer to be a referral for pharmacists who do. Also, review your own company and state policies to clarify how you should effectively manage a prescription that you are morally conflicted about. 

Doing so will allow you to continue to devote your lifetime of service to not only patients, but other pharmacists as well.

Two Arizona pharmacists made headlines when it seems they may have not adhered to the Oath of the Pharmacist.