Asembia 2021: A Futuristic Vision of Specialty Pharmacy

George Van Antwerp, MBA, leads Deloitte’s “Future of Pharmacy” efforts, and he shared some futuristic thinking about the specialty pharmacy at the concluding session of Asembia’s 2021 Specialty Pharmacy Summit on Thursday.

Van Antwerp

Continued care transformation to a digital or virtual service will enable a more precise focus on both the consumer and data in the future, Van Antwerp said. The shift may impact how prescriptions actually get written — potentially by pharmacists instead of providers— and help shape the role of a pharmacist in the healthcare world.

“If you look at some of the clinical innovations in the pipeline, things that are happening to move toward a more curative (endpoint). The idea of integration of technology with drug, it drives a very fascinating picture of the future,” said Van Antwerp, a Deloitte managing director who focuses on pharmacy and PBM issues.

Thinking about the causes of disruptive change, Van Antwerp and his Deloitte colleagues considered a range of technologies that may come into play: nanotechnology, quantum computing, nutraceuticals, CRISPR.

Van Antwerp asked the Asembia attendees to contemplate a future for drug development that would be based on simulations: “If you look at the future and the ability to create simulated data for people, then simulate potential drug combinations that can be formed, and run those to simulate a data against a simulated chemical compound, and try to figure out what might work to develop drugs, it creates a whole different way that we can begin to cut down on the pipeline and change some of the ways that drugs come to market.”

And of at-home drug manufacturing using 3D printers: “You see a couple people working on polypharmacy 3D printing, so multiple molecules to be printed into one molecule. I think the interesting thing … was could you get to the point of 3D printing generic drugs, basically at pennies per cost and put it in the home? What would that mean to the supply chain, to manufacturers? How would people get the 3D printers?”

Precision medicine may become more dominant, Van Antwerp said. Although precision medicine tends to be thought of treatments guided by genomic testing, Van Antwerp mentioned the possibility of individualizing the diets of patients with diabetes to their microbiomes.

Virtual remote monitoring could shift resources from treatment to preventive measures, Van Antwerp said. He also envisions a larger role for pharmacists.

Some health systems are moving towards relying on pharmacists to prescribe medications and having the clinician work up the diagnosis before handing over much of the care of the patient to the pharmacist.

But, along with these innovations will come myriad challenges, Van Antwerp acknowledged. As care becomes more digitally based and potentially more complex, patients may not be able to keep up. Health literacy already poses a problem today, and Van Antwerp stressed the importance of mitigating patient burdens.

But Van Antwerp also noted that 80% of healthcare costs are the result of human behaviors and social determinants of health. That proportion may eventually affect how healthcare is paid for and by whom, he said: “You can think about how payment models could evolve to say, ‘Are there things that you're born with, and you can't do anything about?’ We should be covering that cost from a society perspective versus the (healthcare costs that) you can influence or your employer can influence or your health plan can influence.”