Introduction
The 21st century has brought unprecedented growth and innovation in the healthcare sector. Critical issues such as such as data availability, safety, infrastructure, and technology continue to impact the management of healthcare systems across the globe. Recently, the Covid-19 pandemic has forced another trajectory for healthcare organizations amidst emerging trends like accountable care organizations, robust large-scale health systems, and the growth of information sources for patients. Currently, most patients are highly informed consumers, and this poses certain implications on traditional healthcare systems. While most healthcare providers have adopted patient-centered care as the core of healthcare delivery, there still are gaps regarding effective implementation. Thus, current emerging trends have a direct impact on patient outcomes. Herein, the impact of patients becoming more informed consumers and specialty drug use driving the cost of care and their impact on clinical decision-making are discussed. Ultimately, these trends are a core element of nursing practice.
Specialty Drugs and the Rising Cost
The number of specialty drugs has increased owing to recent innovations in drug technology and biotechnology in general. Compared to the 1900s, the number of specialty drugs in the market has increased 3-fold in the 2000s, and this implication has increased the number of specialty drugs approved by the Food and Drug Administration. A recent study estimates that approximately two-thirds of the drugs in pharmaceutical industry are specialty, and the cost of using these drugs is at all-times high (Anderson-Cook et al., n.d.). For example, a patient would need to spend around $2 million for a one-dose therapy of Zolgensma targeting spinal muscular atrophy (Specialty Drugs and Health Care Costs, n.d.). Interestingly, specialty drugs are being currently developed for common conditions like asthma; the trend no longer affects rare conditions or orphan diseases. For instance, there has been an influx of specialty drugs for eczema, and they reportedly offer remarkable improvement of the condition. If used over a few years, these drugs promise to cure the condition. The status of specialty drugs in the U.S. healthcare system is affected by key stakeholders, including pharmacies, consumers, pharmacy benefit managers, and insurance providers.
Figure 1: Specialty Drugs and the Percentage Net Pharmacy Spending (Source: (Drug Channels, n.d.)
Managing the Economic Burden posed by Specialty Drugs
Due to increased use and the higher prices associated, specialty drug usage causes an indirect increase in total healthcare costs incurred by the U.S. government. According to a recent report, specialty drug spending totaled an estimated $121 billion, which means that an increase in usage could comprise half of total drug spend in the next 3 years (Robinson, Howell & Pearson, 2018). Most researchers attribute this trend to the attractive revenue that the pharmacy industry has recorded over dispensing specialty drugs. With this opportunity, there has been an increase in the number of specialty pharmacies that have oriented their operations to case management and coordination of care for patients requiring specialty drugs. Undoubtedly, this shows that there is also an influx of other stakeholders involved in patients’ therapies.
Figure 2: A pie chart showing trends in prescription drug spending in the U.S. Retrieved from the U.S. Department of Health and Human Services, 2016.
Specialty Drug Use Challenges in Nursing Practice
The efficacy of specialty drugs is undisputed. However, there are numerous challenges surrounding their usage. For instance, specialty drug use required immense patient education, a high level of compliance and adherence as well as intensive clinical monitoring. Without proper adherence, specialty drugs can cause adverse effects that might endanger the life of the patient, leading to worse outcomes. Therefore, to improve outcomes, the patient must be well-educated, and must be able to access the drugs while needed. However, issues such as poor distribution and the need for special storage and handling, administration and follow-up might be too complicated for patients that already have other challenges with managing the quality of life caused by the disease. As such, specialty drug use might pose a higher burden if not managed properly.
Although specialty drugs are used by only up to 2% of the patient population requiring prescription drugs, they represent about 51% of the drug benefit for key pharmaceutical companies (Specialty Drugs and Health Care Costs, n.d.). These drugs offer much needed breakthrough treatment for deadly medical conditions such as multiple sclerosis and cancer but the price tag is too high and has a negative impact on the balance of healthcare in the U.S.
In order to overcome these challenges, policy makers need to consider key aspects such as drug spend, rebates, out-of-pocket costs, and integrated care management to improve healthcare plan performance. For example, it is important to analyze drug spend and establish the projection over time, taking into account pharmacy benefits and medical implications for patients. Currently, most employers exclude certain drugs in their medical plan. Moreover, a reevaluation of the financial impact of pharmacy rebates for specialty drugs would help reestablish better costs. As majority of health plans do not offer coverage of drugs indicated for special usage, and this could be related to factors such as lack of alternatives and safety warnings. Overall, the difference in coverage across key healthcare plans available to the public have direct effects on the ease of access to treatment and total costs.
Impact of Clinical Algorithms to Specialty Drug Coverage by Healthcare Plans
Currently, having access to one or more healthcare plans is a necessity for most Americans. There are numerous healthcare plans in the market with differing coverage for certain medications albeit variably. Some factors such as the drug coverage decisions and clinical algorithms affect both the patients’ and physicians’ treatment choices. In light of the current instability posed by the Covid-19 pandemic, healthcare providers must analyze decision making for insurers to understand how coverage impacts the distribution of drugs into healthcare.
Considering the importance of nursing role in medication administration, nurses should be adequately educated on different safety measures, dispensing protocol, and staying updated on drugs that are not commonly prescribed in order to minimize medication errors. In addition, nurses need to be able to correctly advise patients on specialty drug use and how to increase adherence to prevent adverse impacts. Thus, the emerging trend in specialty drug use is a key aspect of healthcare as it pertains to best practices in nursing care.
Patients as Informed Consumers
The ease of access to information has contributed to a new breed of healthcare consumers that are aware of many aspects pertaining their health. Specifically, the spread of smartphone use in everyday life has sparked a health-conscious living in most people. For instance, patients with heart problems can manage their health from their smartphones, and having access to millions of educational materials means that they are more knowledgeable about their health status. In addition, most people have developed the habit of self-diagnosis way before they decide to go to a hospital by doing quick searches about their symptoms. Considering this shift in healthcare consumerism, healthcare providers in the United States must find approaches that keep up with the informed patient. Some of the challenges associated with this healthcare trend include incorporating the role of fitness and wellness apps, new communication platforms for physician-patient interaction as well as the necessity to integrate these facets of technology at levels that did not exist a few decades ago (Bolz-Johnson et al., 2021). Another major trend in the digital age is the impact of direct-to-consumer advertising; patients might even be tempted to make decisions regarding their health without proper guidance.
Global Perspectives and the Direct-to-Consumer Market
Given the recent advances in internet and technology and the growth of direct-to-consumer markets, patients are more willing to incorporate diverse digital and physical products. Furthermore, the growing population of the empowered patient has created an opportunity for global markets that, in turn, have significant implications on existing models of care. For instance, patients are now demanding more convenient, affordable, and transparent services as opposed to the traditional approach where healthcare providers decide what the patient gets regarding their treatment plans. In this case, the private sector in healthcare industry is growing and posing financial implications on healthcare revenue for traditional players. Thus, the willingness of patients to embrace flexibility on access and management of their conditions as opposed to accepting the traditional model of hospital-based care necessitates key stakeholders in healthcare delivery to shift their approach to therapies.
As patients are more willing to self-manage their conditions, healthcare providers must be willing to integrate this aspect and further leverage the easily accessible health information, mobile health and the new technology in general. According to Gómez-Olmedo and Tsirintani (2019), healthcare providers need to acknowledge the ongoing wave of “demystification of medicine” and move in stride to offer transformational and valuable patient-physician conversations. Ultimately, patients are now more aware of their conditions and more likely to ask direct questions as opposed to maintaining a passive role in in-depth conversations.
The Effect of Current Trends in the present “Improving Oral Health in School Setting” Project
While specialty drugs use for oral care is still rare, this trend will unlikely pose challenges for the progress of a project focusing on oral health. However, the ripple-effect of increased spending on prescription drugs for other conditions might pose a risk to reduced allocation of oral health budgeting for majority of households. In addition, people are more likely to pay attention to existing illnesses or conditions as opposed to learning how to preserve the other aspects of well-being that are presently not troublesome. Overall, the high cost associated with specialty drug use indirectly affects all other sectors.
Conclusion
The proliferation of smartphone use into different areas of patients’ lives has a number of implications for the present DNP project. Notably, ta majority of students have unlimited access to the internet and technology, and thus the role of the well-informed consumer in the success of an oral health project in school settings cannot be underestimated. In this case, the way patients interact with their health information is changing rapidly, and healthcare providers must acknowledge this trend and implement better planning and delivery. Given the role of nursing care in patient outcomes, nurses need to be educated on these emerging trends to improve shared decision-making outcomes.
