With healthcare costs continuing to rise and margins under increasing strain, cost reduction alone is no longer sufficient. These challenges are pushing organizations to take a closer look at how and where existing assets are being fully leveraged.
One asset gaining renewed attention sits inside the health system itself: the in-house pharmacy.
Long treated as an operational function, the in-house pharmacy has always played an important role in patient care but hasn’t always been viewed as part of the core strategy. That’s beginning to change. As integrated and value-based care models take hold, pharmacies are becoming more visible across the organization and more central to both clinical performance and revenue outcomes.
When aligned with organizational priorities and supported by modern, data-driven tools, the in-house pharmacy can strengthen patient engagement and help health systems retain revenue that might otherwise flow outside the organization.
Why the in-house pharmacy is moving into the spotlight
For decades, health system pharmacies were primarily built to support inpatient dispensing and discharge prescriptions. That operating model no longer reflects the realities facing health systems today. Pharmacies now sit at the intersection of several shifts, including growing employee populations, expanded pharmacy services, broader participation in 340B programs, and the continued growth of specialty drug utilization.
As pharmacy’s role expands, its financial impact becomes harder to ignore. For many health systems, the issue is not insufficient pharmacy demand, but the steady decline of prescription share after the first fill. Patients may start therapy within the system, then move refills to retail, mail, or external specialty pharmacies. These transitions often happen without visibility, but over time they can erode both revenue and margin tied to care already delivered.
“One of the most common sources of revenue leakage is losing prescriptions to retail and external specialty pharmacies,” said John Zevzavadjian, President of Enterprise and Partner Solutions at RxSense. “Health systems with in-house specialty capabilities are increasingly focused on retention, particularly around refills, by improving patient engagement and aligning incentives. Many are also reevaluating benefit design for employee populations to better direct utilization toward in-house pharmacy assets.”
Pharmacy retention challenges can sometimes be compounded by PBM structure. In some arrangements, PBMs control dispensing channels and claims data in ways that limit a health system’s insight into prescription activity or its ability to intervene. Without timely access to data or flexibility in benefit design, health systems may struggle to engage patients early and retain prescriptions, even when care begins within their own facilities.
As care delivery becomes more integrated, retaining pharmacy volume beyond the first fill increasingly depends on coordination across clinical, pharmacy, and benefits teams.
“For example, when a health system operates a diabetes or metabolic disease clinic, pharmacy involvement can begin as soon as therapy is initiated,” Zevzavadjian explained. “By identifying new starts, such as insulin or GLP-1s, pharmacies can engage patients earlier, connect them to system programs, and support more coordinated care. When prescriptions remain within the in-house pharmacy, the health system retains both revenue and margin.”
How one health system strengthened its in-house pharmacy strategy with RxSense
To better leverage in-house pharmacy assets, organizations can either bring PBM capabilities in-house under their own brand or partner with a PBM while maintaining greater transparency and control. Both approaches enable more flexible plan design, preferred dispensing strategies, and closer alignment between benefit management and pharmacy goals.
For example, an RxSense health system client sought to operate as its own PBM. After partnering with RxSense, the organization achieved a 163% increase in specialty pharmacy share captured by its in-house pharmacy. Even modest gains in in-house specialty share can lead to meaningful, long-term improvements in patient care by keeping prescriptions within the health system. The organization also saw a 130% increase in in-house claims, further demonstrating that pharmacy retention can be achieved.
Strengthening the Role of the In-House Pharmacy
In today’s healthcare environment, health systems are taking a closer look at how pharmacy fits within the broader organization.
Leading organizations are moving beyond pharmacy cost management to focus on the broader value pharmacy can deliver. With improved visibility into claims and utilization, in-house pharmacies can evolve from a support function into a more integrated part of benefit strategy—helping strengthen financial performance while improving patient access and outcomes.
Drawing on deep pharmacy benefit expertise and flexible, modern platforms, RxSense helps health systems gain the transparency and control needed to better align benefit management with pharmacy operations and organizational priorities.
To learn how RxSense supports organizations in maximizing the value of their pharmacy operations, visit https://www.rxsense.com/health-systems.
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