If you have been following my work, you are well aware of my passion and dedication towards getting pharmacists aware of digital health and its implications for future health practice. However, in all honesty, I think I have seen little takeoff amongst the profession by and large, and it has led me to question why that is, so let me break down my current thought process.

Current Issues in Pharmacy

Foremost, I think there are a lot of issues hitting the pharmacy profession that really are important right now that are leading towards pharmacists concerns to problems that are a large issue right now, such as:

• DIR Fees and Lost Profits - The loss of money in community settings is enormous. Implications of this are that there is a substantial loss of profits in the pharmacy space, which means that businesses need to start trimming corners...

• Community Pharmacies are Closing and Hours are Being Cut - Because of the loss of profits, we are seeing a consolidation across the market where businesses are shutting down pharmacies or cutting pharmacy hours across the whole spectrum of community settings. But it's not just lost profits due to drug-sales that is a concern. Pharmacy has often served as a loss-leader for many businesses. Take retail establishments (e.g., Target, Walmart) or grocery stores that have a pharmacy located in them. Notice that they are usually placed in a location to encourage you to shop around while waiting on your prescription? That's the intent. You also had many of these pharmacies offering $4 plans or such to lose money on scripts to encourage shoppers to come in. BUT... online shopping (e.g., Amazon and others) and a changing consumer market are making an impact. Using pharmacies to bring in shoppers as they did in the previous decade isn’t working out as it once did. So, cut the hours, sell the business, or close shop seems to be the growing mentality for many retail establishments that had gotten in on the pharmacy business.

• Job Concerns - In turn, this is leading to extensive discussions amongst pharmacists about their futures. Pharmacists have incurred high student loans, and in turn, underemployment or loss of potential jobs is really making our profession question what our future holds. If you are not aware, >50% of pharmacists go into the community/staffing roles, so the above-mentioned issues are an immediate pressing concern especially when the Bureau of Labor Statistics puts out data saying 0% job growth and job loss in the community setting.

So What does Pharmacy Do?

It's no lie that many people that are recognized as the leaders for the pharmacy profession are looking to find new ways to secure the future for the profession. This includes tackling the economics of drug-sales (to save the community and independent pharmacies), finding novel roles for pharmacists (collaborative practice or working in a primary practice clinic), 'Working at the top of their license' by providing clinical services (e.g., MTM or CMM, prescribing medications), and more.

My Concerns

I think that these are all good intentions, but I do not necessarily agree with them, as alluded to in a previous post:

• Retail Health mentality really is going to change how consumers/patients access care in the US. People are going to shift towards teleservices and engaging in online products/platforms for medical services. Take Ro/NURX/HIMS for example; if pharmacy wants to prescribe, these businesses will be a big competitor we need to recognize.

• MTM and CMM are going to be integrated with AI at some point, and the concept of having pharmacists providing these services will be influx. We know mismanagement of medications is a $500 billion problem in the US. So needless to say, many entrepreneurs and startups are looking to disrupt this space. Some are focussing on adherence, but others are making high-quality software that provides a platform that can deliver MTM/CMM without a pharmacist involved. That is going to be an issue.

• Pharmacists working in clinical settings is nothing new. Training for this is possible. Getting buy-in and paying for pharmacists to do this is a long road and a long process that I don't see taking off for some time, though.

So Why Do I Believe in Digital Health?

For me, DH offers a number of novel solutions that can capitalize on where pharmacy is trying to make inroads for jobs. I think MTM/CMM in a medical office is appealing, and that if we start working with companies trying to make these products, it can make it feasible. I look to companies like Arine that could help leverage pharmacists' abilities by making the scut work of information dredging easier and allow a pharmacist to provide clinical services as an ideal. Putting pharmacists in a clinic to work with providers is of interest, but as mentioned before, I think we need to be training for an eventual remote presence and take on teleservices as a means to deliver such services. We as a profession cannot be so focused on providing care for the baby boomers and miss what patient care will be like in a decade, and it would be short-sighted of us. Having pharmacists provide and 'dispense' digital health products, I think, opens a new pipeline that goes beyond just medications. It helps us think 'beyond the fill,' and we can look towards the use of wearables/sensors and digital therapeutics as a means to generate real-time data and patient treatment where we serve as digital health coaches. Because, at the end of the day, most providers aren't going to want to monitor and intervene on the data day by day. So let pharmacists do it. We need to show we can perform, lower patient costs, and make this a profitable endeavor. So add on digital to our current initiatives to help look towards future problems and patient care expectations and not the immediate practice environment. That will ensure our longevity.

But, again, getting pharmacists aware of this is time-consuming and hard to sell, I feel. I'm hoping others in the pharmacy community can start taking this up and pointing this out to leadership and our associations so that they can leverage it. Because, I think the timeline is small to get into this space before others start to own it, like nursing or PAs, who have already taken the midlevel practitioner space we wanted.