National trends in prescription drug expenditures and projections for 2021.

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.

Metal complexes in medicine and pharmacy - the past and the present III.

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.

Women in oncology pharmacy leadership: A white paper.

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.

Pharmacists Focus on Adapting for the Future.

A wide range of changes are in the future for health care: value-based reimbursement, delivery of integrated services, the continued breakdown of silos, and interoperability maximizing communication/information exchange. The American Society of Consultant Pharmacists recently held a conference focusing on key innovations in post-acute/long-term/senior care and how pharmacists can function successfully in this new paradigm in ways that promote quality medication management, address polypharmacy, improve patients' quality of life, reduce costs, and eliminate avoidable readmissions.

Development and validation of a pharmacy-based comorbidity measure in a population-based automated health care database.

STUDY OBJECTIVE: To develop the Pharmacy-Based Disease Indicator (PBDI), and to evaluate its performance versus the diagnosis-based Deyo version of the Charlson Index in predicting subsequent-year hospitalization in adults. DESIGN: Retrospective cohort analysis. DATA SOURCE: Longitudinal health insurance database derived from the national health insurance system in Taiwan. PATIENTS: Two adult populations were identified: 697,823 individuals who were at least 18 years of age on January 1, 2005 (dataset 2005), and 714,072 who were at least 18 years of age on January 1, 2006 (dataset 2006). MEASUREMENTS AND MAIN RESULTS: Based on the Chronic Disease Score framework and the Anatomical Therapeutic Chemical classification system, we developed the PBDI, a comorbidity measure that is a function of 37 drug categories that correspond to major diseases in Taiwan. The relationship between individuals' PBDI score and subsequent-year hospitalization was evaluated by use of logistic regression models. Covariates in the models included age group, sex, PBDI score, and Deyo score. Using the two overlapping adult populations, we calculated both the PBDI score and the Deyo score for each individual in each year. Using subsequent-year hospitalization as the outcome and each comorbidity measure as the predictor, we demonstrated that the c statistic of the PBDI versus the Deyo version of the Charlson Index was 0.72 versus 0.69 for both the 2005 and 2006 populations. The Akaike information criterion, Bayesian information criterion, model calibration, and reclassification measures also confirmed the utility of the PBDI. CONCLUSION: The PBDI demonstrated acceptable predictive performance for subsequent-year hospitalization. It can be used as a general comorbidity measure to describe the health status of populations based on data derived from population-based automated health care databases.

A trajetória dos cursos de graduação na saúde: 1991-2004 / The trajectory of health graduation courses: 1991-2004

INTRODUÇÃO: A publicação ora apresentada é produto da parceria instituída pela Portaria Interministerial nº 2.118, de 3 de novembro de 2005, que estabelece a cooperação técnica para, dentre outros, produzir, aplicar e disseminar conhecimentos sobre a formação de recursos humanos na saúde. OBJETIVO: apresentar a trajetória dos cursos de graduação na área da saúde, no período de 1991 a 2004 (Biomedicina, Ciências biológicas, Educação física, Enfermagem, Farmácia, Fisioterapia, Fonoaudiologia, Medicina, Medicina Veterinária, Nutrição, Odontologia, Psicologia, Serviço Social, Terapia Ocupacional) MATERIAIS E MÉTODOS: fontes de dados o Exame Nacional de Desempenho dos Estudantes ­ ENADE, o Questionário dos Alunos, o Censo da Educação Superior, o Cadastro de Instituições de Educação Superior, Cursos e Docentes (2004) e a Pesquisa Nacional por Amostra de Domicílio ­ PNAD (1991 a 2004), do IBGE. CONCLUSÃO: Espera-se, com esta publicação, contribuir para o planejamento e a implementação das políticas de formação e inserção profissional no campo da saúde.

[Biosensors in the pharmaceutical domain]. / Les biocapteurs dans le domaine pharmaceutique.

Biosensors are analytical devices which incorporate a biological component (enzyme, antibody, animal or plant cell, DNA fragments, lipids.) intimately connected to a physical transducer (electrode, optical fibre, vibrating quartz.). This dual configuration allows the study of a great variety of compounds of pharmaceutical interest which react with the biocomponent. The latter is selected depending on the application and the performance criteria requested. Biosensors are suitable for real time monitoring such as in bioreactors, and for the determination of various physiological and pharmacological parameters. Biosensors may be employed in home testing (glucose, lactate.), in hospitals (bedside testing, emergency, surgery, dialysis monitoring, etc.) in clinical laboratory analyses (immunoassays, DNA analysis.) and at research centres. Ideally, a biosensor should be easy to use, allowing direct analysis without sample pre-treatment. Measurements should be automatized and remote controlled. The biosensor may be miniaturized for single use or for implementation in sensor arrays. Applications to microenvironments (in vivo, single cell.) or discrete one shot decentralized tests may also considered.

Research and development of drugs and biologic entities.

Uses of and problems associated with the products of biotechnology are described, and implications of the new technology for pharmacy practice and education are outlined. Biotechnology is the application of biological processes to the generation of new therapeutic and diagnostic drug products and vaccines. More than 100 biotechnology products are under development in the United States. Sixteen products, including 13 therapeutic agents and three vaccines, have been marketed. The largest category of biotechnology products now in development is monoclonal antibodies; nearly half of these are targeted for cancer therapy. The second largest group of agents undergoing clinical trials is vaccines. Showing particular promise are products such as colony-stimulating factors and growth factors, which may offer therapy for conditions that are currently untreatable. Problems intrinsic to the products of biotechnology include their short half-lives, difficulties associated with delivering the product in a timely fashion to a specific site, and, in the case of vaccines, the ability of the target organisms to change their structure. Ethical and economic considerations complicate decisions facing those concerned with the rational use of these products. Preparing pharmacy students and practitioners to take a lead role in the use of the products of biotechnology will require substantial modifications in pharmacy education and training at all levels. While some schools of pharmacy have instituted major curriculum revisions to accommodate such needs, others have yet to respond to the challenge of biotechnology. Biotechnology offers increasing opportunities for pharmacists to take an active role in therapeutic decision making, drug delivery, and the education of their health-care colleagues and of patients.

Farmácia clínica / Clinical pharmacy

Importantes mudanças ocorreram na profissäo do farmacéutico, notadamente a retirada das atividades de compor medicamentos e a transferência para a indústria de produtos químicos. O têrmo farmácia clínica surgiu em 1970 nos EE.UU. passando o farmacêutico a compor a equipe de saúde. No âmbito hospitalar, este profissional passou a colaborar nas atividades médicas com referência as decisöes de esquemas terapêuticos, monitorizaçäo de drogas e levantamento da anamnese farmacológica. O farmacêutico clínico pode ser de três níveis, sem especializaçäo, especializado e como cientista clínico

Gene technology and the drugs of tomorrow.

The progress of pharmaceutical research depends on three factors: on the evolution of medical needs, on societal attitudes, and on scientific and technical feasibility. Among the factors which are 'internal' to science, molecular biology seems to be the most important driving force, at least for the foreseeable future. The influence of molecular biology on pharmaceutical research is occurring in several distinct phases. The first phase was characterized by the use of gene technology as a production instrument for known proteins. In the second phase, gene technology is instrumental in the identification of novel proteins and in the elucidation of their gene structure and physiological function. A great number of proteins which have therapeutic potential will eventually emerge from this phase, with the more important ones like the hematopoietic factors yet to come. During the third phase, gene technology will provide proteins that can serve as pharmacological tools: receptors, ligands, enzymes, cytokines and other proteins provided by gene technology will enable us to open up new fields of pharmacology from which novel drugs, often low molecular weight chemical entities, will emerge. Finally the fourth phase will be characterized by a knowledge of gene structure and regulation extensive enough to develop a pharmacology of gene regulation and to establish somatic gene therapy. New drugs that can be expected to emerge from the interaction of molecular biology and pharmaceutical research within the next ten to twelve years are discussed. It is expected that pharmaceutical research will in the end be transformed into a discipline in which molecular biology and structural chemistry play dominating roles while synthetic chemistry will be reduced to the role of an important tool.

Biotechnology products: new opportunities and responsibilities for the pharmacist.

The opportunities and responsibilities of pharmacists with respect to the new biotechnology products are described. Recent advances in the fields of molecular genetics and nucleic acid chemistry have resulted in a proliferation of biotechnology products. Those produced by recombinant DNA techniques offer particular promise for the treatment of a wide variety of medical disorders such as cancer, anemia, neutropenia, diabetes, and myocardial infarction. Since the turn of the century, the pharmacy profession has expanded its role from drug preparation and distribution to modern clinical pharmacy, in which pharmacists act as a source of drug information for physicians, nurses, and patients. In response to the new biotechnology revolution, pharmacists must once again undergo a role expansion, this time actively assuming responsibility for educating themselves about the nature and clinical use of the new biopharmaceuticals. The curriculum of students undergoing training in pharmacy should cover such areas as immunoglobulins, immunomodulators, growth hormones, targeted drug-delivery systems, and advanced diagnostic techniques that use biotechnology products. Continuing-education programs in these areas will update currently practicing pharmacists on the new biotechnology products. Although use of biologic proteins is currently targeted toward hospitalized patients, future advances may allow for dispensing these new drugs through community pharmacies as well. Therefore, change will be necessary at all levels of the pharmacy profession. As pharmacists accept the responsibility of dispensing, monitoring, and providing information about the new biotechnologic agents, they will enhance the rational use of these compounds.

Colony-stimulating factors and tomorrow's pharmacy: why we must be ready.

The characteristics and clinical uses of recombinant colony-stimulating factors (CSFs) are described, and the pharmacist's role as a consultant and educator on biotherapeutic substances is discussed. CSFs stimulate the formation and differentiation of the erythrocytes, neutrophils, eosinophils, basophils, monocytes, and platelets that compose the blood cell population. Recombinant CSFs represent a means by which the numbers of hematopoietic cells can be modulated, thus making these agents potentially useful in treating hematologic and immunologic deficiencies. CSFs also can increase the ability of neutrophils and monocyte-macrophages to protect the body against foreign invasion. Granulocyte macrophage colony-stimulating factor (GM-CSF) has increased host defenses in acquired immunodeficiency syndrome patients with Kaposi's sarcoma; increased neutrophil, platelet, and erythrocyte counts in preleukemic patients; and increased neutrophil counts in patients with aplastic anemia. GM-CSF and granulocyte colony-stimulating factor (G-CSF) have appeared to alleviate the drastic decrease in neutrophil counts associated with cytotoxic chemotherapy. G-CSF also has shown promise in stimulating neutrophil production in patients with transitional cell carcinoma, congenital agranulocytosis, and hairy-cell leukemia. Mild adverse effects such as fever, chills, rash, fatigue, myalgia, and bone pain are associated with GM-CSF therapy; G-CSF therapy is associated mostly with mild to moderate bone pain. Areas of education for pharmacists working with biotherapeutic substances include stability, storage temperature, drug interactions, novel drug-delivery systems such as monoclonal antibodies or liposomes, variations in biologic activity, and the evolving nature of the information about these investigational drugs. The pharmacist can anticipate an increasing role as a consultant on the use of CSFs and other biotherapeutic substances.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacy practice in the Veterans Administration.

The current status of pharmaceutical services in the Veterans Administration (VA) is described. The mission of the VA Department of Medicine and Surgery is to ensure that quality medical care is provided on a timely basis to all eligible veterans. The VA operates 172 medical centers and 225 ambulatory-care clinics, which makes the VA Pharmacy Service the largest multiinstitutional pharmacy system in the United States. VA pharmacy staffs in VA hospitals range in size from four or five people to more than 100 employees. The VA Pharmacy Service programs are divided into inpatient programs and ambulatory-care programs. Clinical pharmaceutical services and education and research activities are integrated into these programs. A Regional Pharmacy Advisory Council composed of chiefs of pharmacy service from seven geographical regions coordinates the exchange of information between the Central Office and the regions. Current issues of priority for the VA Pharmacy Service include human resource management, material resource management, information resource management, public relations, program enhancement, and new technology. The VA health-care system is comprehensive and complex, and the Pharmacy Service programs reflect the VA mission to provide quality services and support programs that will generate new information or knowledge to improve the care of veterans.