PHARMACY
Where Will the Pharmaceutical Industry Be in the Next Five Years? Be prepared to advise your clients by emma peters
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e currently live in the age of artificial intelligence (AI) and emerging medical technologies, and it’s only natural that the pharmaceutical world would be affected by these fast-paced developments. Alongside these technological developments, brokers can also expect to see new policies and models that will affect the accessibility of prescription drugs. In the next five years, we can expect to see AI further streamline the drug discovery process, new pharmaceutical models to evolve to increase accessibility and decrease costs for drugs, and personalized medicine developments with pharmacogenomics. In this article we will discuss these changes so that health insurance professionals can be aware of the direction that the pharmaceuticals are entering. Be well-equipped to give their clients the best information and advice in this rapidly changing industry.
Artificial Intelligence
AI-driven diagnostic tools, such as image recognition and predictive analytics, can detect diseases like cancer, diabetes and heart conditions before symptoms become apparent. With timely interventions, 34 | CALIFORNIA BROKER
physicians can implement preventative measures and prescribe medications when necessary. This proactive approach can potentially save lives and reduce the overall healthcare costs associated with late-stage disease treatments. In Optum’s analysis of the four key forces shaping the future of pharmacy, they describe the impact of using AI as a preventative measure, using the example of their diabetes progression machine learning model … “Our diabetes progression machine learning model runs on pharmacy claims data. It was trained using an integrated pharmacy and medical data application. The model can predict the probability of diabetes-related hyperglycemic events in the next two years at the patient level. This enables Optum Rx to concentrate on connecting with highrisk members in our diabetes management program. Ideally, we can help them avoid complications related to diabetes such as vascular disease, coronary artery disease, kidney disease and eye problems.” (www.optum.com/business/insights/ pharmacy-care-services/) Tools are available that can analyze multiple data sets including pharmacy, medical, lab, demographic, social, behavioral and environmental data. These different data can be merged and analyzed to CalBrokerMag.com
allow pharmacy benefit managers to act on behalf of patients to identify opportunities for targeted interventions with improved outcomes, and potentially lower costs for clients. Hayley Burgess, PharmD, chief clinical officer at VigiLanz, an EHR clinical surveillance company, believes the use of AI for medication management and preventing errors will prove to be incredibly effective: “AI creates smart, actionable information that reduces the noise burden,” she said. “Potential errors or inconsistencies in prescriptions can be flagged, triggering pharmacists to intervene sooner to avoid adverse drug events.” For health insurance professionals, knowing these advancements are available can help when assisting clients to review coverages and lead to selecting medical plans and networks that offer this type of technology.
Pharmacogenomics
Pharmacogenomics is the study of how genetics influences drug response, which allows for personalized medicine tailored to a patient’s unique genetic profile. The National Institute of General Medical Sciences describes how pharmacogenomics will affect drug design, development, and prescribing guidelines: “The Food and JANUARY 2024
