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Executive Summary

"Mega-health centers" will provide the majority of pharmacy and medical services to consumers by the year 2010, according to a consensus of pharmacy leaders who met March 26-28 to discuss the future of pharmacy in the 21st Century. The conference was organized by Project Hope and sponsored by seven pharmacy and trade assns. and eight drug companies. In a statement released at a March 28 press conference concluding the event, the participants agreed that "our drugs will also be delivered at new sites. Mega-health centers will provide all care from prenatal exams to major surgery in a central location. At these comprehensive medical centers pharmacists will dispense not only drugs but also valuable advice on the taking of the medicines." Meeting in a retreat-style conference at Project Hope's Millwood, Va. headquarters outside Washington, over 50 pharmacy leaders, drug industry officials, govt. officials and academicians presented forecasts for the health care environment in the next century. Among the major predictions, a consensus that the health care system will become highly centralized emerged. "There is generally more aggregating in the health care system and it's not only on the supplier side, but on the buyer side" as well, Exec. Director of the Institute for Alternative Futures Clement Bezold, PhD, said. Bezold noted at the press conference that "there was a lot of discussion about how the health care system is going to become more corporatized generally." The centralization trend will have a strong impact on the nation's independent pharmacies, whose continued viability will be threatened by economic pressures in the next 30 years, Stephen Schondelmeyer, PhD, Purdue University predicted. Independents will have to join together to form group buying networks, or to join the mega-health centers, he said. Drug Cost Effectiveness, Now A "Given," Will Have To Be Actively Shown In Future -- Upjohn's Hoff Such arrangements could involve "dissimilar units such as pharmacists and physicians and dentists and nursing homes all aggregating," or similar units joining together in cooperative buying arrangements, he said. "Independents in an area in order to compete with the big chains that come in, or the HMOs that cover an entire city, [are] going to have to aggregate similar units together and put together a cooperative of independents, and become sort of like IGA [Independent Grocers of America] grocery stores," he said. Noting that "the Independent Grocers of America started out as a cooperative of independents and it became a chain of . . . franchise-type agreements," Schondelmeyer said the cooperative arrangement is intended to achieve "economies of scale to compete with the rest of the market." Independent pharmacists and health care providers are not the only groups conference participants expect to enter into cooperative arrangements or aggregations. Washington Health Business Group President Willis Goldbeck predicted that a "a new 'mega buyer'" will emerge in the 21st Century. In a prepared paper submitted to the conference, Goldbeck said the new "mega buyer" would be comprised of "assns. of individuals and smaller employers who come together for the purpose of economic protection." "These groups will be much larger, more sophisticated and demanding than their 1984 counterparts," he said. Goldbeck also predicted that "big business' will still exercise significant economic clout by being the major aggregate consumers of health care." Goldbeck was joined in his projection that "the individual will have attained a position of dominance in determining his/her own health status and medical care" by Upjohn Exec. VP Lawrence Hoff. The trend toward increased consumer involvement in health care, Hoff said in a paper prepared for the conference, has been accompanied by "more and more pressure from consumers for greater involvement in health care decisions -- right down to the selection of a drug by the doctor." Hoff asserted the trend "suggests greater demand for drug information and changes in consumer habits" in the future, with patients demanding "a role in all those decisions that impact them personally." "A result will be a need for pharmaceutical mfrs. to learn to talk directly to these consumers," he said. Noting the current debate over direct-to-consumer advertising, Hoff contended: "In the end, a true demand for increased information to consumers will be served, but perhaps not by the advertising approach now advocated by some." Hoff also stressed the need for the pharmaceutical industry to demonstrate cost-effectiveness, stating: "There's no doubt that pharmaceuticals are cost effective, but where this has been more or less a given in the past, mfrs. are going to have to provide evidence in plain economic language to decision makers." Generally, conference participants believed that the 21st Century will provide continued growth for pharmacy. Conference Chairperson Jerry Halperin, VP/Technology at Ciba Consumer Pharmaceuticals, told the press conference that the group also projects an increase in self-medication by consumers and the emergence of "a third class of drugs that would be pharmacy-only dispensed." Computer-Controlled Time Release Medications, Individually Adjusted, May Be Coming Soon Although the conference projected that "the number of pharmacists would probably remain about the same in proportion to the population," it anticipates that those pharmacists will play an increased role within the health care delivery system. "There's also a belief that by the year 2010, pharmacists would have some role in initiating" and changing drug therapy, Halperin said. The introduction of specialized delivery systems and high-tech drugs providing specialized therapy tailored to individual patient needs are expected to change pharmacy practice as well. In addition to becoming more specific, new drugs will include entirely new types of agents possible because of genetic engineering, William Check, PhD, Medical & Scientific Communications, asserted in a report to the conference. "An entire new type of therapeutic agent will emerge, natural products such as peptides and proteins based on substances secreted by the body," he said. "Recombinant human insulin, human growth hormone and interferon are the first examples, but many others will arise." Check's report also discussed recent advances in drug delivery systems such as transmucosal delivery and Alza's Oros controlled-release delivery system. Developing systems such as implanted pumps, respiratory, and liposome delivery systems were also noted, as well as delivery activated by a magnetic field. Two systems Check identified as "still in the concept stage" are a pulse delivery system that could be used for anti-cancer drugs "envisioned by Dr. Jane Shaw at Alza," and an enzyme-controlled release system that "is the brainchild of Dr. Robert Langer of the Massachusetts Institute of Technology." Advances in the application of computers include computerized pharmacokinetics to adjust drug dosages for individual patient characteristics and computer implants, he said. "Time-released preparations under computer control are the next form of sustained-release medications," he reported.

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