Pharmacy is no longer operating behind the scenes — it’s driving the business and clinical transformation of healthcare.
At Becker’s 2025 Fall Chief Pharmacy Officer Summit, held Nov. 5-6 in Chicago, pharmacy executives from leading hospitals and health systems convened to chart the next phase of this evolution. The conversations reflected a profession at a crossroads: balancing innovation with regulation, digital transformation with workforce fatigue, and enterprise influence with measurable impact.
Across two days of discussion, one theme stood out: pharmacy leaders are redefining their role from departmental managers to strategic architects of systemwide value. From expanding specialty services and tackling persistent drug shortages to navigating 340B complexities and advocating for fair reimbursement, today’s CPOs are driving initiatives that affect every corner of the health system.
Below are 10 key trends and insights shared by pharmacy executives that highlight where the field is heading — and what it will take to sustain pharmacy’s momentum into 2026 and beyond.
Ten key takeaways from the summit:
1. CPOs agreed their role continues to evolve from operational oversight to enterprise strategy. They’re increasingly seated at the executive table, contributing to discussions about cost, workforce, and digital transformation. As organizations face tighter margins and more scrutiny over spending, pharmacy leaders are being asked to articulate measurable return on investment and systemwide value. Next year’s priority is to strengthen pharmacy’s influence as a clinical and financial driver within health systems.
“To boost that strategic influence, one of the things I suggest is set up a meeting with your CFO or CEO and take data points – cost savings, patient capture, revenue increase – and tie those to system goals,” said Adetoro Oriaifo, PharmD, chief pharmacy officer at Total Health Care, a federally qualified health center in Baltimore. “The way you increase influence is by delivering value and then let them see how what you’re doing in pharmacy ties to what the organization is trying to achieve.”
2. Leaders reiterated that pharmacy’s ultimate purpose is improving patient outcomes, but the conversation is shifting toward how to prove it. CPOs plan to focus more on data collection, analytics, and dashboards that show pharmacy’s measurable impact on quality, safety, and satisfaction. Many are exploring partnerships with IT and quality departments to automate data capture and reporting. The long-term goal is to build an evidence base that supports pharmacy-led improvements in care delivery.
These collaborations also make organizations more nimble and innovative to compete with disruptors.
“In the next five years, we’ve really got to be thinking of that proactive mindset and personalized approach I love. If you’re thinking about threats, who are the new entrants that are coming in and how are we adapting or being nimble?” said Hillary Blackburn, director of medication access and affordability at Ascension Rx. “Amazon is putting kiosks in all these doctor’s offices. Is that going to work or not work? Should we be doing and watching that?”
3. Pharmacy is no longer confined to one department; it’s becoming a systemwide function. Leaders discussed embedding pharmacists in service lines such as oncology, primary care, and population health to close communication gaps and ensure optimal medication use. This enterprise integration is expected to deepen in 2026 as health systems pursue consistent medication management across inpatient, outpatient, and ambulatory settings. Integration, however, will require more coordination, clearer governance, and stronger collaboration with nursing and medical leadership.
4. Pharmacy executives are navigating an increasingly complex regulatory environment while trying to innovate. Between shifting 340B guidance, PBM transparency rules, and controlled substance policies, compliance demands are intensifying. Leaders acknowledged the challenge of keeping up with regulatory change without slowing down progress in digital transformation or workflow modernization. Many CPOs see 2026 as a year to balance agility with accountability — maintaining compliance while continuing to push boundaries.
“We’re only capturing about 10% of our patients so we have that flexibility to be able to obtain more patients and leveraging AI and technology to do that is critical,” said Ghada Ashkar, associate chief of ambulatory pharmacy at UCLA Health. “If you think about it, we’re such an antiquated industry right now and we should leverage the fact that we have ROI. It’s still there and we can bring the money. This is our time to get better and do better so we can reach our patients. We have to grab the moment right now because we all know that’s not going to stay forever.”
5. Specialty and infusion services remain among pharmacy’s fastest-growing and most resource-intensive programs. Leaders expect continued expansion next year, but sustainability is a top concern. CPOs are prioritizing payer alignment, clinical oversight, and infrastructure scalability to manage growth responsibly. The goal is to maintain high-quality patient experiences while ensuring these programs remain financially viable amid market and reimbursement uncertainty.
“A lot of providers are increasingly becoming aware of the specialty infusion opportunity,” said Jorge Garcia, founder and principal of Patagonia. “How are they evolving over time means understanding who is the formal lead for the service. What I find out there is that drugs come to the market, thinking about rare diseases. You have these siloed processes that begin to bubble up in the system. For example, you may have the cardiology team wanting to take ownership of [specialty drug savings] and claim the benefit that comes with cost recovery of the drugs.”
The decentralization sparks inefficiencies that challenges health systems trying to standardize processes and optimize results.
“Most systems are looking at pharmacy being the common denominator to all drugs,” said Mr. Garcia. “How can we have a central process where all the drugs channel through? We understand the authorization component, we develop expertise, and we have two decades of experience doing that in the oncology phase, so how do we transfer that to some of these new specialties that are just now beginning to see ‘buy and build’ services? That’s one of the fastest evolving infrastructure and program design things we see across the board at different health systems when we engage with them regarding specialty pharmacy.”
6. Ongoing uncertainty around 340B and drug pricing reform continues to create anxiety among pharmacy leaders. CPOs are preparing for potential regulatory shifts that could alter how hospitals capture and report savings. In 2026, financial stewardship and advocacy will remain key priorities, with many leaders working closely with legal and compliance teams to protect program integrity. Pharmacy departments are positioning themselves as essential financial stabilizers in an unpredictable reimbursement environment.
WVU Medicine has systematized the 340B work for the corporate leadership to oversee it; directors of pharmacy don’t oversee the program. They do constant auditing and bring in outside consultants to ensure program success.
“We take our 340B program very seriously because we are a safety net hospital and rely on that savings,” said Todd Karpinski, PharmD, chief pharmacy officer at Morgantown, W.Va.-based WVU Medicine. “We understand the complexity and regulatory requirements behind the program. We have come a long way. We have also moved from focusing solely on compliance to focusing on compliance and optimization. How are we going to use our audits to improve our program and optimize our program? What money are we leaving on the table that we’re not seeing because we are so focused on compliance?”
7. The workforce conversation was both urgent and forward-looking. Leaders expressed concern over persistent staffing shortages, burnout, and limited leadership pipelines. Next year, many plan to expand mentorship programs, optimize scheduling, and invest in automation that allows pharmacists to work at the top of their license. The future of pharmacy, they emphasized, depends on cultivating adaptable, engaged, and well-supported teams.
“You can run a pharmacy with technicians and robots, and the pharmacists can go do more meaningful work that’s care coordination or trying to help patients,” said Michael Brownlee, PharmD, chief pharmacy officer at University of Iowa Health Care and chief administrative officer at the University Hospital in Iowa City, noting that pharmacists prefer doing the higher-skilled work and human interactions. “I don’t want to redesign my workforce. I want to redesign how I do production, how I provide services, so that we can think differently about what our teams are doing because if you look into the future, that’s what our teams are going to look for.”
8. Drug shortages remain a persistent operational threat. CPOs said they plan to strengthen relationships with manufacturers and distributors, improve internal forecasting systems, and maintain safety stock strategies. Many are investing in predictive analytics to anticipate shortages before they occur. Supply chain resilience is expected to be a top strategic focus in 2026, given its direct link to patient safety and continuity of care.
“There’s a lot of consequences to these drug shortages, especially when it comes to therapy delays or increasing costs for our hospital system, and most importantly these drugs could have potential harmful, negative outcomes and effects on outcomes for our patients,” said Erica Marchese, clinical pharmacy program director at City of Hope for Chicago. “I recently saw something ASCO published that said the workarounds that are caused during shortages cause a health system annually over $230 million in increased drug costs and about $359 million annually in increased labor costs just to mitigate and manage those shortages, and those are pretty eye opening for numbers for our healthcare system.”
9. As health systems continue shifting toward value-based care, pharmacy leaders are prioritizing alignment with organizational metrics. They’re developing dashboards that link clinical performance to cost reduction and patient outcomes. Pharmacy’s role in reducing total cost of care — through formulary management, medication optimization, and transitions of care — is becoming a measurable differentiator. In 2026, demonstrating pharmacy’s contribution to value-based contracts will be a central strategic objective.
“Pharmacy needs to be embedded upstream in the care delivery process where they’re part of that financial decision-making for the health system,” said Jennifer Halsey, director of ambulatory pharmacy service at the University of Illinois Chicago. “Some easy ways definitely to reduce spend is by centralizing your formulary decisions and your contracting decisions across the network.”
10. Leaders expressed concern about how pending policy changes — from CMS drug reimbursement adjustments to potential federal PBM reforms — could reshape pharmacy economics. Many are watching closely for implications on 340B, Medicare Part D, and biosimilar adoption. The coming year will demand proactive advocacy and scenario planning to navigate uncertain legislative outcomes. Pharmacy executives want to be partners in policy development, not just reactors to it.
“Over the last five years, there’s been a lot of unknowns with the challenges to the 340B program, with the litigation that we’ve all been watching closely in terms of the rebate model and some of these unknowns,” said Rachel Joseph, clinical manager of specialty pharmacy at Northwestern Memorial Hospital in Chicago. “We are having tabletop discussions and working through all the possible things that could occur, trying to work out how a rebate model potentially worked within contract pharmacy, for example. It’s working internally but also working with our vendors, our TPAs, to understand all the different perspectives and things we may face in the near future. I’m trying to proactively plan as best I can.”
