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The article presents insights into the future of pharmacy education based on the results of the American Society of Health-System Pharmacists Section of Pharmacy Educators' Crystal Ball project. Observations include enrollment of students into colleges and schools of pharmacy, use of technology within didactic and experiential learning and pharmacy placement and the job market. Future implications and recommendations for academic pharmacy, health systems and patient care are also discussed.

New measures and research are needed to limit the ecological impact of pharmaceuticals.

Purpose: To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2021 in the United States, with a focus on the nonfederal hospital and clinic sectors., Methods: Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2021 were reviewed-including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for biosimilars, cancer drugs, generics, coronavirus disease 2019 (COVID-19) pandemic influence, and specialty drugs. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2021 were based on a combination of quantitative analyses and expert opinion., Results: In 2020, overall pharmaceutical expenditures in the United States grew 4.9% compared to 2019, for a total of $535.3 billion. Utilization (a 2.9% increase) and new drugs (a 1.8% increase) drove this increase, with price changes having minimal influence (a 0.3% increase). Adalimumab was the top drug in 2020, followed by apixaban and insulin glargine. Drug expenditures were $35.3 billion (a 4.6% decrease) and $98.4 billion (an 8.1% increase) in nonfederal hospitals and clinics, respectively. In clinics, growth was driven by new products and increased utilization, whereas in hospitals the decrease in expenditures was driven by reduced utilization. Several new drugs that will influence spending are expected to be approved in 2021. Specialty and cancer drugs will continue to drive expenditures along with the evolution of the COVID-19 pandemic., Conclusion: For 2021, we expect overall prescription drug spending to rise by 4% to 6%, whereas in clinics and hospitals we anticipate increases of 7% to 9% and 3% to 5%, respectively, compared to 2020. These national estimates of future pharmaceutical expenditure growth may not be representative of any particular health system because of the myriad of local factors that influence actual spending., (© American Society of Health-System Pharmacists 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has created unprecedented challenges for health systems around the world. We describe our approach to adapting the pharmacy leadership structure to address critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy., Summary: Yale New Haven Health deployed a system incident management command structure to effectively respond to the COVID-19 crisis. System pharmacy services adopted a similar framework to enable efficient communication and quick decision-making in key domains, including drug procurement and policy. By refining a model to project health-system medication needs, we were able to anticipate challenges and devise alternative treatment algorithms. By leveraging big data and creating a system knowledge base, we were able to consolidate reporting and coordinate efforts to ensure system success. Various procurement strategies were employed to ensure adequate supply, including frequent communication with our wholesaler, sourcing direct from suppliers, outsourcing of sterile products compounding to registered 503B outsourcing facilities, and acquisition of active pharmaceutical ingredients for compounding of essential medications. Strategic positioning of pharmacists within the health system's incident command response teams and rapid adaption of drug use policy governance fueled accelerated response and nimble implementation. Communication was streamlined and executed via multiple outlets to reach a broad audience across the health system., Conclusion: With medication shortages posing a threat to patient care, dynamic pharmacy leadership proved essential to providing patient care at the height of the COVID-19 pandemic. System alignment and the rapid adaption of the existing framework for drug shortage management and medication use policy were crucial to success in crisis response., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To review specific literature that aimed to predict the future of US pharmacy, beginning in the late 1980s. Data Sources: Articles were identified from searching MEDLINE, CINAHL, Google Scholar, and references of relevant articles. The following combinations of search terms were used: future , pharmacy , prediction , and forecast . Study Selection and Data Extraction: The following inclusion criteria were applied: (1) full-text commentary, review, or original research and (2) focused predominantly on the pharmacy in the United States. Data on predictions for the future of pharmacy were extracted. Data Synthesis: We selected 3 articles published between 1988 and 2006, with each aiming to project the future for the following decade. We examined each prediction in light of the current knowledge. Relevance to Patient Care and Clinical Practice: Educators, practitioners, and other stakeholders should consider reflecting on the changes in pharmacy for the past 3 decades and applying both historical and emerging trends to improve patient care and sustain practice in the third decade of the 21st century and beyond. Conclusion: Most of the predictions for the future of pharmacy from the past 3 decades materialized, with some still in progress (reimbursement for pharmacy services), whereas others manifested in unexpected ways (transition from shortage to excess of pharmacists). Current forces shaping pharmacy include, but are not limited to, growing spending and use of specialty drugs, automation of pharmacy operations, growth of pharmacy in the digital health enterprise, and growing consumer interest in the use of analytical pharmacy that tests drugs before dispensing.

Early reports of potential treatment for coronavirus disease (COVID-19) have raised concerns related to pharmaceutical distribution. Despite the lack of high-quality evidence, the mere hope of effectiveness of potential treatments, such as hydroxychloroquine, has led to surges in demand for these products, and many pharmacists are already informally reporting shortages through social channels. As manufacturers and wholesale distributors struggle to fulfill orders for drugs such as hydroxychloroquine, short-term price increases may seem reasonable in a free market when demand increases. However, any price increases by manufacturers, wholesale distributors, and pharmacies might be seen as exploitive gouging of consumers during a declared emergency. In addition to concerns of price gouging, increases in prescription drug utilization during the pandemic may lead to increases in spending for all payers as members may be treated for COVID-19. This article explores pharmaceutical supply chain and drug pricing nuances that may cause problems for payers and pharmacies as the country battles this global pandemic. DISCLOSURES: No funding supported the writing of this article. Mattingly reports unrelated consulting fees from the National Health Council, Bristol Myers Squibb, G&W Laboratories, Allergy and Asthma Foundation of American, and the Massachusetts Health Policy Commission. Hogue has nothing to disclose.

Disclosures: No funding supported the writing of this article. The author is an employee of AmerisourceBergen and leads its Good Neighbor Pharmacy program, which supports independent community pharmacy customers.

Bioactive metal complexes represent a promising and rapidly evolving area of pharmacotherapy. After the first part of our survey on metallopharmaceuticals dealing with antimicrobial activity of metal complexes and their application in diagnostics and the second part dedicated to anticancer properties of these compounds, this third and last part of the review focuses on several other applications of metals in therapy (mainly on the therapy of rheumatoid arthritis, some mental diseases, diabetes, as well as on chelation therapy). Following a brief account of the historical development of clinical use of the respective category of drugs, their chemical properties, toxicity, clinical applications and mechanism of action are discussed. The aim of this brief survey is to provide basic outline of the area of metallopharmacy, aimed at specialists in pharmacy and chemistry as well as at the general educated public.

Purpose: This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change., Summary: A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation., Conclusion: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Gender disparity exists in leadership roles within healthcare. While the majority of the healthcare workforce is comprised of women, significantly fewer women occupy leadership positions, particularly at executive and board levels. As the field of oncology pharmacy continues to rapidly expand and evolve, an assessment of the current state of women in oncology pharmacy leadership roles is vital to the growth and development of the profession. In the fall of 2017, the Hematology/Oncology Pharmacy Association (HOPA) hosted a summit to explore leadership issues facing women in oncology pharmacy which have the potential to affect our membership and our profession. This meeting included invited participants from across the fields of oncology and pharmacy and was part of HOPA's strategic leadership initiative developed through the work of the HOPA Leadership Development Committee in 2016. This promotes a primary goal of HOPA, which is to support oncology pharmacists as they assume leadership roles within their practices and within healthcare to assure oncology pharmacy is integrated into cancer care. The purpose of this white paper is to (1) summarize key issues that were identified through a membership survey; (2) review ongoing efforts to address the needs of female oncology pharmacists in leadership development; (3) serve as a call to action for individuals and professional organizations to assist with and disseminate these efforts and highlight available resources, and (4) to provide practical steps to meet the needs of individuals, training programs, and institutions/employers.

Purpose: Pharmacy departments and schools of pharmacy have long held professional affiliations. However, the success of each entity is often not interdependent and aligned. In 2010, our institutions found ourselves in a position where the complementary motivations of each aligned to support a more meaningful and committed engagement, leading to the development of the Partnership in Patient Care. The impact of the partnership was evaluated 7 years postimplementation, and both the successes realized and the lessons learned are described., Summary: The partnership provided many advantages to our pharmacy department and the school of pharmacy. This initial iteration of the partnership was a strong proof of concept that an intentional approach to the relationship between a school of pharmacy and a pharmacy department can lead to substantive improvements in a wide array of meaningful outcomes. We experienced an increase in the number of student rotation months completed, growth in the American Society of Health-System Pharmacists-accredited residency programs, and enhanced clinical services. However, the partnership was not without challenges. For instance, lack of a formalized tracking method made certain outcomes difficult to track., Conclusion: The purposeful establishment of the Partnership in Patient Care, built on the needs of a school of pharmacy and an academic medical center pharmacy department, allowed our institutions to develop an intertwined mission and vision. Over the initial years of the partnership, many successes were realized and lessons were learned. Both the successes and the challenges are serving as the foundation for future iterations of the partnership., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: There is a critical need to establish and teach a uniform pharmacists' patient care process (PPCP) to create consistency in the profession. Little is known about preceptor incorporation of the PPCP into experiential teaching., Methods: Using a pre-/post-program survey, this study aimed to characterize preceptors' perception of PPCP incorporation in teaching, confidence in PPCP articulation to team members and students, and ability to identify precepting strategies before and after completing a continuing education (CE) webinar., Results: 103 of the 158 preceptors enrolled in the CE program completed pre-/post-program surveys. Preceptors' perception of PPCP incorporation with introductory pharmacy practice experience (IPPE) students did not change significantly after the program (1.98 vs. 1.88, p = 0.317). However, advanced pharmacy practice experience (APPE) preceptors were less likely to strongly agree to PPCP incorporation after completing the program (1.91 vs. 1.72, p = 0.016). Preceptors felt increased confidence in their ability to articulate the PPCP to both team members (2.07 vs. 1.60, p = 0.000) and students (2.01 vs. 1.63, p = 0.000). Preceptors strongly agreed they had new strategies to use in precepting., Conclusion: In order to prepare student pharmacists, preceptors must be prepared to explicitly incorporate the PPCP into their teaching. A webinar with case examples and a preceptor tool can help equip preceptors to articulate the PPCP to colleagues and students, and to identify strategies to incorporate the PPCP into their precepting., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Members from Cohort 13 of the Academic Leadership Fellows Program (ALFP) 2016-2017 were challenged to present a debate on the topic: "In Turbulent Times, Pharmacy Education Leaders Must Take Aggressive Action to Prevent Further Declines in Enrollment" at the American Association of Colleges of Pharmacy INfluence 2017 meeting in Rio Grande, Puerto Rico. This paper is the result of thoughtful insights emerging from this debate. We present a discussion of the question of whether pharmacy education leaders must take aggressive action or strategic approaches to prevent further declines in enrollment. There are many thoughts regarding current declines in enrollment. Some educators contend that a more aggressive approach is needed while others argue that, while aggressive actions might lead to short-term gains, a more viable approach involves strategic actions targeting the underlying causes for decreasing enrollment. This paper explores themes of enrollment challenges, current and future workforce needs, and financial issues for both pharmacy programs and students. In summation, both aggressive actions and a strategic, sustainable approach are urgently needed to address declining enrollment.

Objectives: To provide a case for transforming community-based pharmacy practice through financially sustainable centers for health and personal care., Summary: Macro-level changes in health care laws, markets, technology, organizational systems, and professional education have increased the capacity for pharmacists to competently provide patient care and public health services that surpass the current workflow designs of most community pharmacies. Community-based pharmacy practices have an opportunity to fundamentally transform into financially sustainable centers for health and personal care. This would require changing our objective from connecting products with customers to one that connects practitioners to patients. Rather than inventory generating revenue, patient care generates revenue. Rather than success being measured by number of prescriptions filled, it would be measured by patient outcomes. Physical spaces would no longer be organized to display and sell products; they would be organized for patients to receive services. Finally, this would require that business would change from being sought through the generation of prescriptions to being sought through recruitment of patients., Conclusion: Community-based pharmacy practice can be transformed through the development of financially sustainable centers for health and personal care that would (1) be focused on optimizing care, (2) use patient care business models, and (3) be conducive to patients "receiving care" rather than "purchasing products.", (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this evaluation was to determine whether the percentage of women as first authors in pharmacy journals has continued to increase over the past decade., Methods: Key pharmacy practice journals were identified from the American Association of Colleges of Pharmacy Core List of Journals for Pharmacy Education. Articles were analyzed from January 2007 through December 2017. The outcome of interest was the proportion of articles having feminine names as the first author. Femininity was determined for first authors by matching the first name to data from the U.S. Social Security Administration or genderize.io. The Cochran-Armitage trend test was used to determine differences in proportion of women as first authors over time., Results: The listed first authors over the past decade were 52.7% female for all studied journals from 2007 through 2017. All but 1 journal demonstrated a significant increase in the proportion of female first authors over the time period studied. Subanalyses of journals (1) containing more than 90% gender-identifiable articles, (2) focused predominantly on contemporary drug therapy or pharmacy practice and not typically including pharmaceutical- or pharmacokinetics-related topics, and (3) that did not focus predominantly on contemporary therapy or practice and included pharmaceutical- or pharmacokinetics-related topics were each significant., Conclusion: Female first authorship in pharmacy practice journals appears to have increased in the past decade but may potentially be reaching a plateau. The proportion of female first authorship is close to reaching that of women in the U.S. pharmacy workforce when compared over the same time period., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

This commentary is an observation of longitudinal trends in national data on the pharmacist workforce and pharmacy education. Data indicate seismic shifts in supply and demand, from critical shortage to imminent oversupply. The change in the profession to employing more patient-care focused jobs has been observed as slow and minimal, although academia has focused on the clinical training and rapidly increased enrollments. Pharmacy is on the brink of transforming the profession, but several important changes are still required to alter the current trajectories of supply and demand. Pharmacy schools, associations, and employers must devote all energies to immediate and significant actions that tip the balance in favor of pharmacists of the future.

About two years have passed since the formal establishment of the category "family pharmacist" in Japan's revision of dispensing fees. In the pharmacy vision for patients, many problems were raised among the category of "family pharmacists" or "family pharmacies". Furthermore, in the future restructuring of pharmacy practices, by 2025 all pharmacies are to serve as "family pharmacies", and by 2035 they will exercise their family pharmacy function in daily living areas. In order to demonstrate the "family function", home medical care and outreach type health support etc. will be required, not only from conventional pharmacy work but also in outside (off-site) pharmacy activities. Therefore, future pharmacies need to gain the confidence of their local communities, such as in active collaboration with multi-occupational physicians and healthcare providers, work with multi-occupations in general, participation in local activities, and so on. Therefore, I would like to introduce activities that I am actually doing to this end, such as at-home activities, community activities and cooperation with multiple occupations.

There are several indicators to evaluate the impact of the scientific publication in pharmacy. Given their number, complexity, heterogeneity, strengths and weaknesses, we believe that pharmacists are not sufficiently familiar with these indicators. The main objective is to present an inventory of available indicator to measure the research impact. PubMed, GoogleScholar and Google were interviewed in October 2017 from the following terms: bibliométrique/bibliometrics, facteur d'impact/impact factor, impact de citations/citation impact, revue/journal, chercheur/researcher, article, indicateur/indicator, score. For each identified indicator, the following variables were extracted: name, calculation method, calculation time window, data sources considered, access conditions, inclusion of self-citation, strengths and weaknesses. A total of 15 indicators were included: seven for journals, four for researchers and four for articles. Among them two are non-bibliometric indicators: the Altmetric attention score, the RGscore and one other indicator deriving from the impact factor: the SIGAPS indicator developed to finance the research activity of French hospitals. Of the 12 bibliometric indicators, nine include self-citation. All involve forces (e.g. exclusion of editorials, letters, free access) and weaknesses (e.g. self-citations included, time window too short, disciplinary indistinction). There is no indicator with no weaknesses and pharmacists should be able to understand their strengths and weaknesses., (Copyright © 2018 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Across all care environments, pharmacists play an essential role in the care of people who use and misuse psychoactive substances, including those diagnosed with substance use disorders. To optimize, sustain, and expand these independent and collaborative roles, the Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA) has developed core competencies for pharmacists to address substance use in the 21st century. Key concepts, skills, and attitudes are outlined, with links to entrustable professional activities to assist with integration into a variety of ideally interdisciplinary curricular activities.

The article discusses the 2018 Pharmacy Forecast released by the American Society of Health-System Pharmacists (ASHP). The report covers a range of elements driving complexity and ambiguity in the U.S. healthcare sector, including advances in clinical information technology and health policy programs. It is expected to help pharmacists and pharmacy leaders in their strategic planning and decision making practices.

The future of the pharmacy profession and concerns about professional identity have been popular and recurring themes in professional journals and at international pharmacy conferences for more than 30 years. The aim of this paper is to contribute to realistic and viable visions for the future of the pharmacy profession via insights through labor market and work organization theories. These insights provide an understanding of contemporary work patterns and what they mean for the future role of community pharmacists. It appears that an important and influential contemporary trend in work organization today is precarious work, i.e. non-standard employment that promotes and relies on a flexible and fluid work force. Contrary to permanent employment, precarious work is often poorly paid, insecure, unprotected, and in many cases cannot support a household. The growth of precarious work among professionals, including pharmacists has been documented in many countries. In the early 21st century a major concern in the UK was the growth in the number of pharmacists who choose to be self-employed "locums" as opposed to seeking permanent employment. With the spread of precarious work a new, involuntary form of employment appeared a decade later with the spread of "zero-hour contracts" and "exclusivity agreements". Particularly affected by these flexible, precarious work conditions are the highly-educated young health professionals such as pharmacists. The profession needs to be proactive in order to stay abreast of economic/workforce and organizational trends. The way forward is a commitment to a dynamic, knowledge-based vision that includes an ongoing analysis of the outside world. The core role of pharmacists in the future includes: 1. engagement in interprofessional education with other healthcare professionals; 2. an acceptance of the contribution that lay knowledge provides to the understanding of health and medicines, and 3.keeping ajour with new and revolutionary treatments, both pharmaceutical and non-pharmacological., (Copyright © 2018. Published by Elsevier Inc.)

Background: Healthcare is under significant pressure with the explosion of long term conditions, shift in worldwide demographics and is evolving through advances in technology. Aligned with this is the changing role of pharmacy from the traditional dispenser of medicines to having (in addition) a more advanced clinical role. This study aimed to understand what the pharmacy practice research agenda might look like from the viewpoint of pharmacy academics and practitioners across five high-income countries., Method: Qualitative methods were used, and thirty one-hour interviews were undertaken with practitioners and academics from five economically advanced countries. These nations have comparable socio-economic status but differing health systems and include; Australia, Canada, New Zealand, United Kingdom and United States of America. Six key informants were chosen from each country, three academics and three community pharmacists. A general inductive analysis was undertaken to analyse the most common and recurring themes., Results: These themes of research were based around current community pharmacy practice issues and the enablers to changing the profession. Specific areas pharmacy practice could be more involved with included long term health conditions. Some community pharmacists also believed that research into the impact of professional standards and policy change would be beneficial. The findings of this research suggest that current pharmacy practice research methods are sufficient, but need to be used more effectively., Conclusion: Participants identified a wide range of issues within community pharmacy practice. Academics largely focused on how research can be utilised in the community and how to implement findings to ensure sustainability of pharmacy practice research. Issues that community pharmacists would like to research are related to the current practice model, such as allocating time to provide patient-focused services in addition to managing a business., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Competing Interests: DisclosuresThe author has declared no potential conflicts of interest.

Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions. While there have been significant strides by key health care stakeholders to further the development and use of PROs, there are a number of challenges limiting more widespread use. In light of these current challenges and the potential for PROs to improve health care quality and value, on October 19, 2017, the Academy of Managed Care Pharmacy convened a forum of key stakeholders representing patients, payers, providers, government, and pharmaceutical companies to discuss and identify solutions to the current challenges and barriers to further use of PROs. These discussions informed the development of participants' ideal future state in which PROs maximize the goals of all health care stakeholders and the actionable steps required to make the future state a reality. While stakeholders shared unique perspectives throughout the forum, they had consensus on 2 overarching issues: the importance of PROs in defining value, improving patient care, and implementing value-based payment models and the need for strong organizational and operational systems to achieve optimal adoption and use. Participants identified several key challenges in PRO use and adoption: achieving a representative patient population, inclusion of PRO data in medication labels, the necessity for both standardized and customizable PROs, and operational and organizational barriers to collecting and analyzing PROs. To overcome these challenges, participants recommended that manufacturers should engage key stakeholders early and throughout the drug development process to ensure the most valid and representative PROs and patient populations will be included. To streamline the PRO collection process, participants suggested engaging pharmacists and other providers who may have more frequent interaction with patients. Participants also recommended that PRO collection and analysis should use common technology platforms, streamline components of clinician care to reduce workflow, and be integrated with claims data to provider payers a better understanding of patient health in real time. Finally, additional work should be done to develop patient-reported outcome measures that contain relevant measures for all healthcare stakeholders. While significant challenges remain in PRO development and adoption, participants agreed that greater use can only be achieved through collaboration and patient-centered care., Disclosures: The AMCP Partnership Forum titled "Improving Quality, Value, and Outcomes with Patient-Reported Outcomes" and the development of this proceedings report were supported by Amgen, Boehringer Ingelheim Pharmaceuticals, Genentech, GlaxoSmithKline, Novartis Pharmaceuticals, Novo Nordisk, Precision for Value, Premier, Sanofi, Takeda Pharmaceuticals USA, and Xcenda.