At Indianapolis-based Indiana University Health, leaders are rethinking where pharmacy fits within the health system’s growth strategy.
For years, pharmacy operations were often treated primarily as a cost center, focused on managing drug expenses and ensuring medications were available when clinicians needed them. But as care shifts into outpatient, specialty and home-based settings, Derek Imars, PharmD, executive director of pharmacy supply chain at IU Health, said pharmacy supply chain is increasingly becoming a driver of access and growth.
“Specialty pharmacy growth has helped move pharmacy from a cost center to a strategic organizational asset,” Dr. Imars said on the “Becker’s Pharmacy Leadership Podcast,” adding that infusion services are following a similar trajectory.
The shift reflects broader changes in care delivery. Payers are increasingly steering treatments — including infusion therapies — away from hospital outpatient departments and into ambulatory clinics or home settings. Health systems that cannot adapt risk losing patients to outside providers.
To respond, IU Health has invested in centralized infrastructure and supply chain operations designed to support care wherever patients receive it. A major focus has been expanding the system’s centralized service center, including new capacity to compound oncology and hazardous medications for home infusion.
The goal is to create access points closer to where patients live, particularly in a largely rural state where travel distances can be a barrier to care, Dr. Imars said. Expanding home infusion allows some patients to avoid driving hours for treatment while maintaining clinical oversight within the health system.
Behind those care shifts is a quieter operational transformation. Dr. Imars’ team has worked to centralize pharmacy purchasing across the system, allowing frontline pharmacy staff to focus on patient care while centralized buyers handle contract optimization, shortage allocations and sourcing decisions.
“Field teams act as requesters, but our centralized buyer team actually takes responsibility for reviewing all wholesale orders,” he said. The structure helps ensure contracts and rebates are applied correctly while managing supply disruptions more consistently across sites.
IU Health has also built tighter financial and inventory controls, including custom integrations that allow the system to track purchases, inventory and expenses more accurately than many traditional pharmacy models.
At the same time, pharmacy supply chain leaders are navigating mounting financial pressure. Specialty drugs and advanced therapies such as CAR-T can carry price tags in the millions of dollars, forcing health systems to weigh how they operationalize and fund treatments while keeping care affordable.
“These are high-cost drugs that really perform miracles for our patients,” Dr. Imars said. “But they end up costing and have price tags in the millions.”
Policy uncertainty adds another layer of complexity. Changes tied to the Inflation Reduction Act, Medicaid reimbursement shifts and ongoing scrutiny of the 340B drug pricing program have created caution around new investments.
Meanwhile, drug shortages remain a persistent operational challenge, forcing pharmacy leaders to continually adjust sourcing strategies to avoid disruptions in care.
Still, Dr. Imars sees opportunity ahead — particularly as data and automation tools reshape supply chain decision-making. Health systems are increasingly using analytics, robotic process automation and emerging AI tools to guide contracting, sourcing and operational workflows.
Looking ahead, he argues leaders need to broaden how they think about medication costs. Drug price alone tells only part of the story.
“There are real costs tied to inefficient labor models, technology that’s not optimized, inaccurate contract loading, weak master data, expired inventory,” he said. Those hidden inefficiencies ultimately affect both health systems and patients.
For Dr. Imars, the takeaway is clear: Pharmacy supply chain decisions affect more than purchasing departments.
When workflows, data and system integration improve, “you ultimately uncover efficiencies that do ripple far beyond the immediate problem you’re looking at and solving,” he said.
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