Rising drug spending, persistent shortages and a thin workforce pipeline are among the top challenges for Denise Scarpelli, PharmD, vice president and chief pharmacy officer at UChicago Medicine.
Dr. Scarpelli oversees pharmacy operations, strategy, finances and growth across the system’s main hospital campus, Comer Children’s Hospital, Ingalls Memorial Hospital in Harvey, Ill., and a microhospital in Northwest Indiana. She discussed the pressures on a recent episode of the Becker’s Healthcare Podcast.
Here are five pressures facing Dr. Scarpelli and her team:
1. Utilization is driving drug spending.
Dr. Scarpelli said drug spending is climbing because of expensive new therapies, not inflation.
“Everyone thinks it’s due to inflation, and it’s not really inflation,” she said. “Inflation of drugs has been flat. It’s the new therapies that are coming to market that are expensive.”
She pointed to GLP-1s, gene and cell therapies and biosimilars as the main drivers, with some gene and cell therapies carrying price tags of $1 million to $2 million. The increase is concentrated in outpatient settings, including clinics, retail, specialty and mail. Dr. Scarpelli credited inpatient formulary management with keeping hospital drug spending in check.
2. GLP-1 demand.
UChicago Medicine keeps GLP-1s on an open outpatient formulary but restricts them on the inpatient side, where they require a nonformulary request.
“A lot of these therapies don’t need to be started on the inpatient side, and the patient can wait until they get discharged,” Dr. Scarpelli said.
To manage outpatient demand, the system launched PharmaFit about a year and a half ago. Clinics and providers can refer patients to a pharmacist-led team. The team confirms coverage, selects the right product for each patient’s plan and tracks progress toward weight loss goals. The program also supports patients taking GLP-1s for other indications, such as diabetes and sleep apnea.
3. Payer mismatches on biosimilars.
Dr. Scarpelli said early biosimilar adoption stalled because health systems would select one product for their formularies only to find payers had chosen different ones.
About two years ago, UChicago Medicine moved to what it calls a payer-adaptive model. The system now stocks multiple biosimilars in the same class and dispenses whichever one a patient’s Medicare, Medicaid or commercial plan covers.
“It is more time consuming for us, and we have to keep more inventory, but it is working,” she said.
4. Shortages of lifesaving generics.
Dr. Scarpelli said drug shortages have not improved over the past year and may be getting worse. Long-standing generic oncology drugs such as carboplatin and cisplatin have been hit particularly hard.
When those drugs are unavailable, her team often turns to brand-name versions or 505(b)(2) products, which she said carry higher costs.
“These are drugs that we have to have,” she said. “These patients need it to save their life.”
Her team meets three days a week to review shortages. Each substitution requires clinical pharmacists to choose an alternative, secure supply from manufacturers or wholesalers and update the EHR and automation systems.
5. A shrinking workforce pipeline.
Dr. Scarpelli said pharmacy is becoming a strategic revenue arm for health systems through specialty pharmacy, infusion centers and retail sites. Some systems are stepping in as the community pharmacy in areas that big-box retailers have left.
That growth depends on a workforce she said has been difficult to recruit for about six years. Pharmacies compete with other healthcare employers for pharmacists and technicians, and pharmacy school enrollment is down.
“It concerns me long term,” she said. “Are we going to have enough pharmacists to be able to cover everything that we need as healthcare continues to grow?”
UChicago Medicine is exploring internal technician training programs and encouraging technicians to pursue pharmacy school. Dr. Scarpelli said the longer-term answer likely lies in automation and AI.
“Can we use AI to do some of the manual tasks so that we can repurpose people to do more clinical functions?” she said. “I think the workforce is going to continue to be a struggle.”
