Community pharmacy encompasses a huge variety of issues, with significant variation in approaches from country to country. What would I say are the three biggest issues facing pharmacies over the coming 5 years?

1. Three challenges
facing the
pharmacy
in the next five
years
j.acostapharm@gmail.com
@JaimeAcosta_
/jaimeacostagomez

2. Three challenges facing the pharmacy
in the next five years
Can the pharmacy industry still afford a remuneration
system based heavily on commercial mark-ups?
Can pharmacies survive without integrating large molecules into their
operations, basing their business in small molecules only?
Is there room for pharmacies in electronic commerce and e-
health? Will pharmacies continue their important place in the heart
of communities?

3. The need to contain health spending has forced those
paying for medicines (public administrators, insurers,
patients) to achieve a reduction in rates of growth or
even a decrease in price and mark-up in medicines
dispensed in pharmacies, through various mechanisms.
Because pharmacies depend largely on volume of
products sold and mark-ups for financial gain (and
discounts from manufacturers and wholesalers in
countries where this is legal, which have also decreased),
the profitability of pharmacies has been significantly
affected.
By this pressure, business management has gained
prominence in pharmacies, with pharmacists maximizing
the economic performance of their companies as much
as possible.

4. Thus the pharmacy:
1. Has strengthened its position in the healthcare business,
moving from the treatment of disease as the sole main
activity and incorporating many new professional activities
as diverse as vaccination, screening for diseases, promoting
healthy habits and treating addiction or substance abuse.
2. The business side has progressively gained importance not
only behind the counter, but also more visibly on the shelves,
especially with better management of categories.
However, the core business remains the traditional distribution of
nonprescription and prescription patient medications which is still
heavily based on mark-up in many countries, although in some
countries this is toned down with a fixed amount payment per
item dispensed (Germany and Norway, for example).
This mark-up does not recognize the services that community
pharmacists can provide to society, and it is vital to implement
payment systems that recognize the complexity, capabilities and
time invested, as well as the results obtained for users of
pharmacies.

5. Different compensation systems other than mark-up from dispensing
would not only decrease dependence on prices, mark-ups and
discounts, but would also…
 Align pharmacists with the core objectives of health systems
through essential business incentives.
 Promote activities of higher-value, complexity and recognition for
pharmacists rather than merely the informed dispensing of
medications.
 Enhance the purely commercial image that the pharmacy can
give, both to public opinion and other agents (administration,
insurance companies, and health care professionals).
 Encourage the registration of actions that pharmacists perform
which is essential to prove their professional value.
 Promote professional relationship and contact with other health
professionals through more complex activities that require their
interaction.
Can the pharmacy industry still afford a remuneration
system based heavily on commercial mark-ups?

6. Pharmaceutical R & D-based innovation has shifted to having a greater focus
on specialty products, which are products that will increase expenditure on
medicines in the short and medium term, especially in developed markets.
Growth will take place in the areas of oncology, auto-immune, anti-viral and
immunosuppressant therapies. The number of new large molecular entities that
will be launched is expected to remain at levels higher than in the past decade,
which is aided by an accelerated regulatory review.
Community pharmacies generally dispense small molecule products and these
faced a loss of exclusivity in developed markets totalling $154Bn. Though savings
from small molecule patent expiries will be dramatically reduced, pharmacies
cannot relinquish the large molecule market that is currently restricted to other
channels (especially hospitals) by their high budget impact and complexity of use
These new drugs would not increase the business for pharmacies, but they
would also facilitate the adoption of new services and new products
throughout, in addition to an approach to patients completely different to
those found in today’s pharmacies.
Can pharmacies survive without integrating large molecules into
their operations, basing their business in small molecules only?

7. While big players in the pharmacy sector are increasing in size
and reaching relevant agreements with wholesalers (Walgreen's,
Alliance Boots, AmerisourceBergen, McKesson, Celesio, CVS, Cardinal
Health) large electronic traders are gaining market share and
positioning in the health and welfare sector and prescription and
non-prescription medications (AliBaba).
At the same time, the development of e-commerce also allows
direct manufacturer to end customer access to products online,
without the traditional intermediaries (wholesalers and
pharmacies).
Meanwhile, new developments in digital health (apps, wearables,
telemedicine, Internet of Things (IoT)), require positioning in digital
healthcare platforms which have the potential to broadly affect the
use of medicines and their role in patient care.

8. This means that the traditional logistical capacity, which
gave a competitive advantage to the fragmented
community pharmacy sector against larger players, will lose
its relevance. Now it is possible to reach the customer
efficiently, reliably and securely.
Pharmacies compete in an electronic ecosystem where the
shopping experience is very different from those traditions
and customs in their facilities, and the developments in new
technologies that are building new circuits in the healthcare
network are generally alien to them.
Is there room for pharmacies in electronic commerce and
e-health?
Will pharmacies continue their important place in the
heart of communities?

9. j.acostapharm@gmail.com
@JaimeAcosta_
/jaimeacostagomez
Recently included in the Top 10 Pharmacist Influencers on Social
Media ranking in Spain.