As oral GLP-1 therapies draw increasing attention, most pharmacy leaders say they are not making major operational changes yet. However, they are closely monitoring how a potential shift could reshape distribution, reimbursement and pharmacy strategy.
Rather than prompting immediate action, the emergence of oral options is raising broader questions about channel control, 340B dynamics and the long-term role of specialty pharmacy.
That scrutiny comes as drugmakers, retailers and digital health platforms move quickly to expand access to the fast-growing drug class. Eli Lilly is pushing its newly approved oral GLP-1 through retail and direct-to-consumer channels, including Amazon Pharmacy, GoodRx and telehealth platforms, while Novo Nordisk has launched subscription-based distribution models.
At the same time, retailers are moving deeper into longitudinal care. Amazon and Walmart have launched or expanded GLP-1 weight management programs that integrate prescribing, monitoring and follow-up — functions traditionally managed within health systems.
Against that backdrop, many pharmacy leaders say the market is not developed enough to warrant major operational changes.
“At this point, we’re watching the oral GLP-1 space closely more than making any major operational changes around it yet,” said Paul Green, PharmD, director of pharmacy services at Valhalla, New York-based Westchester Medical Center Health Network. While the clinical potential is significant, he noted that many unknowns remain around payer coverage, prescribing patterns, distribution models and long-term adherence.
That uncertainty is shaping a measured approach across many health systems. But leaders say the stakes extend beyond clinical performance.
“The oral GLP-1 transition is not just a clinical story — it is a distribution, reimbursement and 340B strategy story,” said David Young, vice president of pharmacy operations at Brockton, Mass.-based Signature Healthcare. “The risk is not that oral GLP-1s fail. The risk is that they succeed rapidly, migrate volume to channels outside your control and coincide with the most significant period of 340B program pressure in the program’s history.”
His insights reflect a growing concern among pharmacy leaders: A faster-than-expected shift to oral therapies could redirect prescription volume away from health system-owned specialty pharmacies and into retail or other external channels, challenging existing care and revenue models.
At the same time, many organizations are still building infrastructure around today’s injectable-driven demand.
“Due to the increased use of GLP-1s, we’ve had to add refrigerators to our outpatient pharmacies to accommodate stocking a larger quantity of these medications,” said Donna Feild, chief pharmacy officer at PeaceHealth in Vancouver, Wash. While oral options are appealing, she noted they are not yet matching injectables in effectiveness and can be more difficult for patients to take consistently.
“Should there be a swift shift to oral GLP-1s, we can definitely use the refrigerators for other purposes,” she added.
That dynamic — investing in current demand while preparing for a future uncertainty — is emerging as a central challenge for pharmacy leaders.
“It’s not simply whether the market shifts from injectables to oral agents,” Dr. Green said. “It’s how that shift could affect access, reimbursement, channel strategy and overall care model design.”
In particular, leaders are closely watching how oral GLP-1s could influence 340B eligibility and the value proposition of health system specialty pharmacies — areas that have become critical to both patient access and financial sustainability.
To prepare, some leaders say organizations need to begin mapping their exposure now, even before the market fully shifts.
“The organizations that will fare best are those who map their GLP-1 prescribing ecosystem now, protect their in-house dispensing capture and build the administrative infrastructure to survive the rebate model transition,” Mr. Young said.
For now, flexibility remains the dominant strategy.
“The organizations that will be best positioned are the ones staying flexible, paying close attention to the market and avoiding strategies built too narrowly around today’s injectable-focused model,” Dr. Green said.
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