Pharmacy Practice

Pharmacy Forecast Identifies Growing Societal Challenges Expected to Impact Care

Published: December 4, 2023
Pharmacy Forecast

Ultra-high-cost drugs likely to lead to health-system service-line closures

Societal issues — including the growth in ultra-high-cost treatments, the epidemic of mental health and substance use disorders, climate change, and the rise of artificial intelligence (AI)— could alter how health systems serve their communities within five years, according to the latest annual ASHP/ASHP Foundation Pharmacy Forecast Report. The 2024 Pharmacy Forecast, released today at the ASHP Midyear Clinical Meeting & Exhibition, drew its findings from a survey of more than 250 pharmacy leaders from across the United States on key topics impacting health systems.

“This 12th annual Pharmacy Forecast contains topics of broad healthcare importance underscoring societal challenges that will likely drive profound changes to healthcare delivery, including not only our practices as pharmacists, but even the future structure of our health systems,” said ASHP CEO Paul W. Abramowitz, PharmD, ScD (Hon), FASHP. “As healthcare evolves at an unprecedented pace, pharmacists’ engagement is crucial to ensuring safe and effective care for all patients.”

Ultra-high-cost drugs

The rise of innovative and ultra-high-cost new treatments, which often come with complex delivery systems, provide new hope for preventing, curing, and treating devastating diseases. These treatments, which can cost millions of dollars per patient, may fundamentally alter how health systems deliver care. More than three-quarters of survey respondents indicate formulary and policy decisions for ultra-high-cost drugs will be made by payers or service-line stakeholders, weakening the scope of the pharmacy and therapeutics committees, which have led the selection of drugs provided by health systems for decades. In addition, 77% of survey respondents believe that it is somewhat to very likely the cost and complexity of new treatments will result in the termination of service lines within some health systems.

The report recommends pharmacy leaders collaborate with health-system finance experts to assess the financial risk associated with the provision of ultra-high-cost drugs to ensure long-term program feasibility and sustainability.

Mental health and substance use disorders

In the 2024 survey, 71% of participants noted pharmacists are well prepared to initiate and modify medication treatment plans for individuals with substance use disorders. Pharmacy Forecast authors recommend health-system leaders integrate the expertise of pharmacists into innovative strategies to bridge gaps in treating substance use and mental health disorders.

“An ‘all-hands’ approach is needed so that everyone involved in direct care increases their skills and knowledge in mental health,” said Joseph T. DiPiro, PharmD, editor of the Pharmacy Forecast. “To do this, we need health systems to develop additional infrastructure and support. Providing mental health first-aid training to healthcare workers should be as common as CPR training.”

Public health emergencies

Survey participants expect the frequency of public health emergencies related to climate change to double in coming years, affecting health systems and the communities they serve.  Pharmacy departments should continue to engage in the emergency response of health systems by taking part in routine assessments of disaster preparedness. Pharmacists’ knowledge and abilities are essential to managing supply chain disruptions, contingency staffing, and coordination with local public health and community groups.

Artificial intelligence

The growth of AI in healthcare is a double-edged sword, bringing potential rewards and risks. Most survey respondents (86%) believe AI technology can provide automated drug dosing adjustments based on things like kidney function, weight, and age; and more than half of respondents believe advanced technologies, including AI, will help close the gap on healthcare disparities. At the same time, respondents agree it is crucial to balance patient safety, equity, and security in the implementation of these rapidly advancing technologies. A full 80% expect that a high-profile failure of AI that causes patient harm will accelerate government regulation of AI technology.

“As AI progresses, it is imperative to ensure that the models used in healthcare are unbiased and benefit a diverse population,” said DiPiro. “Health systems should establish AI as a strategic priority and engage pharmacists’ expertise to optimize its safe, ethical, and equitable use.”

The Pharmacy Forecast is published online ahead of print and will appear in print in the January 15, 2024, issue of AJHP. The Pharmacy Forecast report was supported by a donation from Omnicell Inc. to the David A. Zilz Leaders for the Future Fund of the ASHP Foundation.

About ASHP

ASHP is the largest association of pharmacy professionals in the United States, representing 60,000 pharmacists, student pharmacists, and pharmacy technicians in all patient-care settings, including hospitals, ambulatory clinics, and health-system community pharmacies. For over 80 years, ASHP has championed innovation in pharmacy practice, advanced education and professional development, and served as a steadfast advocate for members and patients. In addition, ASHP is the accrediting body for pharmacy residency and technician training programs and provides comprehensive resources to support pharmacy professionals through every stage of their careers. For more information, visit and ASHP’s consumer website,

About the ASHP Foundation

The ASHP Foundation was established in 1968 by ASHP as a nonprofit, tax-exempt organization. As the philanthropic arm of ASHP, the Foundation shares ASHP's vision that medication use will be optimal, safe, and effective for all people all of the time. Our mission is to support ASHP by advancing the professional practice of pharmacists and the pharmacy workforce by funding research and education that improves health outcomes through optimal, safe, and effective medication use. To learn more about the Foundation’s programs, visit


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Posted December 4, 2023

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