A series of recent developments is highlighting a pattern: Pharmacy is facing overlapping pressure from drug pricing, supply instability and policy changes.
Over the past month, some of the most significant pharmacy moves have centered on rising drug costs, growing supply vulnerabilities and shifting regulatory decisions. While each development is distinct, together they point to a landscape shaped by multiple, simultaneous forces.
Here are four pressures that are converging:
1. Drug pricing pressure is intensifying from multiple directions.
Recent developments show how pricing pressure is being driven by both policy and market dynamics. The Trump administration’s move to impose a 100% tariff on patented drug imports is expected to increase costs for certain medications, with duties taking effect July 31 for large companies and Sept. 29 for smaller ones.
Meanwhile, a Senate report found that drugmakers continue to raise prices despite participating in President Donald Trump’s most favored nation pricing initiatives. The three largest pharmacy benefit managers — Caremark, Express Scripts and Optum Rx — also each excluded more than 600 drugs from their 2026 formularies.
At the state level, Arkansas became the first to ban PBMs from owning pharmacies, with that law taking effect Jan. 1. Tennessee has since passed similar legislation, prompting CVS to warn of more than 130 potential pharmacy closures — a signal of how quickly state-level PBM policy could affect patient access.
2. Drug supply instability is becoming more visible.
Supply concerns are surfacing across multiple signals. Drug shortages are trending upward in 2026, with new medications continuing to be added to shortage lists. Active shortages reached 223 in the first quarter — the second consecutive quarterly increase.
On the tariff front, roughly 80% of active pharmaceutical ingredients used in U.S. generics are sourced from China and India. Generic drugs currently carry a carve-out from the branded drug tariff, but the administration has said it will reassess in one year — meaning hospital pharmacy leaders who have found some stability in generic sourcing may face renewed cost and supply pressure ahead.
3. Policy decisions are reshaping the pharmacy landscape.
Regulatory and legal developments are adding another layer of uncertainty. A federal court decision vacating a 340B policy on hospital drug purchasing has direct financial implications for health systems — court documents showed the policy had cost some Premier member hospitals between $500,000 and $1.6 million annually. HHS has dropped its proposed 340B rebate pilot program after court rulings but is seeking feedback on potential redesign options, leaving hospital pharmacy leaders without a clear picture of where the program is headed.
At the federal level, six national pharmacy organizations backed PBM reform provisions in recent spending legislation — what they called the first major overhaul of Medicare Part D PBM policy in nearly 20 years.
4. Workforce strain is emerging as a compounding pressure.
Behind the pricing, supply and policy dynamics, a workforce challenge is sharpening. Pharmacy leaders have sounded alarms about a brewing crisis: Technician shortages that have persisted for more than 15 years are being compounded by an oncoming pharmacist shortage, even as both roles are being asked to take on more in insurance, ambulatory care and gene therapies.
U.S. prescription drug spending is also projected to exceed $1 trillion in 2026, with hospital drug spending expected to grow 4% to 6% — a spending trajectory that adds financial pressure to departments already managing staffing constraints.
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