Originally published by our sister publication Specialty Pharmacy Continuum

By Myles Starr

The ASHP 2025 Pharmacy Forecast, presented at the ASHP Midyear 2024 Clinical Meeting & Exhibition, in New Orleans, highlights how hospital pharmacies can prepare for industry changes and turn them into competitive advantages. The report homes in on four new trends that are expected to shape hospital pharmacies in the next five years: lack of primary care physicians (PCPs), generative artificial intelligence, a focus on whole-person health (WPH) and use of ultra-high-cost drugs (UHCDs).

“These are all critical issues for pharmacy leaders,” explained Joseph T. DiPiro, PharmD, an editor of the forecast and a professor emeritus of pharmacotherapy and outcomes science at Virginia Commonwealth University School of Pharmacy, in Richmond. “By being more informed about these topics, pharmacy leaders can be better prepared for the future and how it will impact their enterprise and healthcare in general.” 

The forecast authors surveyed a diverse group of hospital-system administrators and clinicians and then developed recommendations regarding each of these trends (Am J Health Syst Pharm 2025;82[2]:17-47).

The Primary Care Gap 

A 2023 report by the Health Resources and Services Administration projected a shortage of 68,020 full-time PCPs by 2036. The ASHP forecast suggested that pharmacy leaders can relieve pressure on overburdened PCPs through the following actions:

  • Pursue policies that encourage collaborative practice and integrate pharmacists into primary healthcare, including substance use disorder treatment, HIV pre-/post-exposure prophylaxis efforts and access to contraceptives.
  • Advocate for improved payment systems, metrics and quality indicators that facilitate reimbursement and recognize pharmacists’ contributions to primary care teams.
  • Expand remote pharmacist services.
  • Collaborate with government agencies to determine best practices and incentives for integrating pharmacists into primary care clinics.


Generative AI

Between 80% and 90% of experts surveyed by ASHP believed there is a high probability that generative AI will improve care for diverse populations, streamline patient referrals and facilitate prior authorizations. However, concerns about the technology’s high cost, impact on jobs and potential for bias underscore the importance of implementing AI in a way that does not harm pharmacy practice. Achieving that goal will requires several steps:

  • Hospital leaders must empower pharmacists to drive a generative AI agenda that achieves enhanced safety, quality and access to care for all patients. The use of pilot programs and fostering a culture where AI helps, but does not replace, pharmacists is recommended.
  • Workflows and electronic health record documentation must be adapted to facilitate the adoption of AI.
  • Pharmacy schools must incorporate AI principles and practices into their curricula. Professional societies offering ongoing education and training must cover topics such as the responsible use of AI and bias awareness.


Whole-Person Health 

This patient-centric approach to delivering care addresses behavioral, societal and environmental factors affecting patients. Health-system leaders need to develop methods to measure the impact of this shift on their bottom line and patient outcomes. This will involve several steps:

  • advocating for payment models that recognize pharmacists’ role in supporting WPH;
  • strengthening infrastructure that allows hospital pharmacies to partner with community programs, social care and public health systems;
  • including WPH in pharmacy school training; and
  • development of tools by health-system pharmacies to integrate WPH into the daily practice of medication management and use.

Ultra-High-Cost Drugs 

Some gene and cell therapies, which typically target orphan and rare diseases, have a very high cost, but their use is nonetheless expected to grow. Hospitals and pharmacists must be prepared to build the infrastructure and expertise to administer and be reimbursed for such expensive treatments. Once a hospital system or pharmacy determines that it has the financial resources, established service lines and clinical expertise to provide these high-cost medications, several preparatory actions are needed:

  • Pharmacy leaders should work with their state Medicaid program to determine whether their state will participate in covering UHCDs.
  • Becoming a preferred site of UHCD clinical trials will enable administrators to proactively negotiate with manufacturers to ensure ongoing access for their site if the product becomes commercially available.
  • Health-system pharmacists must work with organizational revenue cycle and contracting teams to determine the potential cost of each UCHD.
  • Pharmacy leaders should actively participate in contracting discussions. In particular, when a payor uses an outcomes-based payment model, the party who pays for the drug and who receives compensation need to be negotiated.
  • Training programs are needed to equip pharmacists and technicians with the knowledge and skills to manage and administer UHCDs efficiently and safely.

“The report can be used as a strategic planning tool that draws on perspective from a large group of people,” Dr. BiPiro concluded. However, he acknowledged that while some of these recommendations are immediately actionable and directly under the control of pharmacy leaders, others will require state- or national-level changes and time to implement.

Dr. DiPiro reported no relevant financial disclosures.