Emerging trends in pharmacy operations: Perspectives on the 2024 AMCP Foundation Survey

The 2024 AMCP Foundation Emerging Trends Survey identified trends expected to impact managed care pharmacy over the next 5 years across 5 domains. This article provides expert commentary on the findings in the pharmacy operations domain. Specifically, the survey results on the likelihood of potential scenarios occurring in the next 5 years within the pharmacy operations domain are shown in Table 1. The methods and full results of the Emerging Trends Survey are reported elsewhere.¹

TABLE 1.

Responses to the Question “How Unlikely or Likely Is It That the Following Will Occur Within the Next 5 Years?”

Scenarios: pharmacy operations domain	Highly unlikely	Somewhat unlikely	Somewhat likely	Highly likely	Somewhat or highly likely
The number of community pharmacy closures will increase by 25%.	2.9	17.0	57.3	22.8	80.1
At least 25% of pharmacist jobs will have a virtual/remote component.	4.1	16.4	63.2	16.4	79.5
Real-time information about the status of prior authorization will be accessible online 75% of the time to clinics, pharmacies, and patients.	5.3	17.5	51.5	25.7	77.2
Data analytics applied to inventory management will reduce the cost of pharmacy operations by at least 10%.	2.9	24.6	57.9	14.6	72.5
Community pharmacies will increase their use of central fill of prescriptions by at least 25%.	2.3	28.1	51.5	18.1	69.6
The number of active drug shortages will increase by more than 25%.	1.8	36.3	48.0	14.0	62.0
The number of dispensing pharmacies integrated with medical practices and health systems will double.	4.7	35.1	47.4	12.9	60.2
Drones will be used for at least 10% of home delivery of prescriptions.	24.6	49.1	21.1	5.3	26.3
Radiofrequency identification will be used in 10% of prescriptions to monitor adherence.	24.0	49.7	24.0	2.3	26.3
At least 10% of prescription drug products dispensed will be made with 3D printing at the pharmacy level.	48.2	42.4	9.4	0.0	9.4

Data are presented as percentages. N = 201 responses.

The Role of Pharmacies in Accessing Care

Pharmacies have long been the quiet workhorses of the health care system—places in the community where the human side of medicine meets the practical demands of care. As the managed care landscape evolves, the role of pharmacists and pharmacies becomes more central. Pharmacies have grown from dispensaries to become an integral player in patient care management. For managed care pharmacy stakeholders, health insurance plans, and community pharmacies alike, this requires rethinking what efficient pharmacy operations truly entail. When pharmacies run well, patient access, quality of care, and overall health care costs improve for all stakeholders.

Health care is deeply personal, with consumers expecting trustworthy and personalized interactions with their providers. However, the expectations and behaviors of today’s health and wellness consumers are rapidly evolving, often outpacing the ability of health care stakeholders to adapt. This gap between patient expectations and the actual performance of health care delivery systems can lead to patient disengagement, which, in turn, affects health outcomes. Engaged patients, who feel supported in their care, tend to adhere better to care plans, resulting in better health outcomes and potentially lower health care costs.²

Consumers also increasingly look for trusted relationships and information sources beyond the traditional health care system. Although personal care remains vital, geographic proximity is no longer a requirement because of advances such as telehealth, which allows patients to receive care remotely.

Despite these advancements, access to personalized and trusted care in the United States faces challenges such as a shortage of primary care providers, high health care costs, delays in accessing care, and skepticism toward traditional health care models.

Pharmacists are well positioned to address some of these challenges. As trusted health care professionals, pharmacists are trained to provide services beyond just dispensing medication such as testing and rapid treatment for flu, strep, and COVID. Community pharmacies are also among the most accessible health care providers, with nearly 90% of Americans living within 5 miles of a pharmacy.³ This accessibility, combined with extended hours and telepharmacy services, allows pharmacists to offer timely, convenient care.

Despite their potential, several barriers limit pharmacies’ and pharmacists’ ability to fully address patient needs, including restrictions to scope of practice, financial pressures, operational inefficiencies, slow adoption of technology, and lack of interoperability across sites of care. Community pharmacy clearly demonstrated what is possible when these barriers are removed during the COVID-19 pandemic, when more than 300 million vaccine doses were administered to Americans who relied on their community and retail pharmacies for both vaccines and treatment.⁴

Authors’ Perspectives

In light of these challenges, the results of the Emerging Trends Survey provide valuable insights. Of the 201 respondents, 161 were pharmacists, which reflects a deep understanding of the pharmacist’s evolving role in health care. Although the stakeholder representation was well balanced across this ecosystem, the absence of respondent representation from retail and community pharmacies was notable.

We categorized the 10 scenario questions from the pharmacy operations domain into 3 subcategories: Patient Access, Pharmacist Scope of Practice, and Technology and Automation.

PATIENT ACCESS

A striking 80.1% of respondents predicted a 25% increase in pharmacy closures. Although not revealed in this survey, there are likely differing views on the reasons behind these closures. Some believe they are caused by oversupply and lack of innovation, whereas others point to the declining financial viability of community pharmacies owing to increased costs, lower reimbursements, and limited access to products and patients driven by the growth of closed network specialty pharmacies and vertical market integration. Of course, these views need not be mutually exclusive. This is further supported by Walgreens announcing that it may close 25% of its stores,⁵ CVS announcing the closure of 900 stores,⁶ and the National Community Pharmacists Association citing that 1 independent pharmacy closes each day.⁷ According to data from Inmar Intelligence, pharmacy profitability from 2023 to the first half of 2024 shows that the combination of effective reimbursement rates, direct and indirect remuneration fees taken at point of sale, and the mix of brand/generic filling patterns have taken an additional $0.84 per prescription dispensed out of gross profit year over year. The growing percentage of prescriptions reimbursed below cost is a significant driver in these pharmacy closures.⁸ Among several recommendations proposed by organizations including the National Association of Chain Drug Stores and the National Community Pharmacists Association, creating reimbursement models that include a “reimbursement floor” that at minimum covers the cost of the medication and cost to dispense would be a first step in stabilizing the financial health of community pharmacies.

Regardless of the cause, stakeholders in managed care should be concerned about the rise of “pharmacy deserts,”⁹ which could reduce patient access, increase health care costs, and worsen outcomes. Managed care stakeholders should continue to work on new payment models that ensure pharmacy viability, incentivize care beyond dispensing, and address pharmacy access issues in underserved areas.

Drug shortages were another area of concern, with 62% of survey respondents predicting a 25% increase in shortages. In our view, this is likely a result of the US generic drug supply chain’s reliance on foreign manufacturing and the downward pressure on generic drug prices, which has led some manufacturers to reduce or stop production of select molecules owing to lack of profitability. To address this, the industry needs to diversify supply sources, confront the unusually poor economics, and stabilize surety of supply, while maintaining reasonable cost savings for both sponsors and consumers.

Respondents’ dim view that we will witness a sharp decrease in pharmacy locations along with a sharp increase in drug shortages implies that Americans should prepare for far less access or will demand far greater change from trend. Get prepared, innovators!

PHARMACIST SCOPE OF PRACTICE

Two scenarios in the survey focused on the expanding role of pharmacists. Eighty percent of respondents believed that virtual or remote components would become part of the pharmacist’s role, while 60% expected that the number of pharmacies integrated into other care sites would double.

As more dispensing duties are transitioned to pharmacy technicians and automated systems, pharmacists will have more time to perform nondispensing tasks, some of which can be done remotely. Likewise, as pharmacist scope of practice expands, and payment models accommodate payment for value-based care, the roles of “pharmacy” and “pharmacist” will become more distinct, meaning that whereas some people may need a physical or remote pharmacy for dispensing, others will require the specialized services of a pharmacist.

There is also growing interest in embedding more pharmacists within health systems and medical practices, a trend driven by the growth of specialty drugs and changes to the 340B program’s contract pharmacy arrangements.

Patients have become more comfortable with omni-channel for pharmacy services, and value-based care models are demonstrating success with pharmacist participation in integrated care models. The combination of patient preferences, technology advancements, and value-based care success is driving virtual and remote care models. Although this partially fills the gaps in pharmacy desserts, it is not a full solution. An important corollary for those operating pharmacies is to develop operational models that are viable in an integrated care and omni-channel environment. In addition, it will be very important for pharmacists in these settings to “double down” on building and maintaining trusted relationships with their patients to ensure that the personal touch that pharmacists have been known for is leveraged to keep patients engaged in the ownership of their care.

TECHNOLOGY AND AUTOMATION

The trends discussed to date tee up an opportunity for technology and automation. Survey responses highlighted 3 trends related to technology and automation:

• 77.2% predict that real-time information about the status of prior authorizations will be accessible online 75% of the time to clinics, pharmacies, and patients.

• 72.5% believe data analytics applied to inventory management will reduce the cost of pharmacy operations by at least 10%.

• 69.6% expect that community pharmacies will increase their use of central fill by at least 25%.

These trends are further support for a view that technology and centralization will continue to be key themes in order to reduce operating costs. Of course, the adoption of technology varies greatly, with larger operators being faster to invest because of their economies of scale. And smaller pharmacies may struggle to see the return on investment for technologies like central fill. Such large investments may squeeze out smaller players or those unwilling to invest. And gains will then accrue to the investors and innovators. To combat this, smaller pharmacies will need to be thoughtful in where they place their technology investment bets and potentially take advantage of strategic partnerships or opportunities of pricing synergies that may be available through group purchasing organizations or offerings through wholesalers or other aggregators. Innovative pharmacies, regardless of size, that embrace these technologies will be better positioned to thrive in the changing health care environment, benefiting from new and diverse payment models.

Closing Discussions

Pharmacies, once the quiet workhorses of health care, are now emerging as a vital link between patients and the broader world of managed care. To truly elevate pharmacies’ role, we must do more than acknowledge the trends and potential. Indeed, we must act. By addressing regulatory barriers, financial challenges, and operational inefficiencies, pharmacies can become full partners with managed care in improving patient outcomes and driving cost efficiencies.

And as managed care programs evolve, collaboration must deepen. Collaboration between managed care stakeholders, investment in technology, and an expanded role for pharmacists are essential steps to migrate from dispensaries to integral players in the health care system. In doing this, we won’t just streamline operations—we will deliver the quintuple aim: better health outcomes, lower costs, improved patient experiences, improved health equity, and enhanced provider satisfaction.¹⁰

Funding Statement

No funding was received for the development of this manuscript. The publication of the supplement was funded by Pfizer.