Medication management used to be pharmacy’s job. Increasingly, it’s an enterprise leadership issue — and health systems that still treat it as a departmental function are already behind.
For most of my career, pharmacy leaders and clinical teams built the processes and safeguards intended to make sure patients got the right medication, the right dose, at the right time. That work still matters. But medication use now extends through hospitals, clinics, infusion centers, ambulatory surgery centers, physician practices, prescription services, and increasingly the home. Medications have also gotten more expensive and more complex. In some large health systems, medication is the biggest line of spend after labor. I believe that alone should put it on the enterprise agenda, not just pharmacy’s.
The boundaries have changed
Acquisitions, affiliations, expansion — every one of them brings different processes, policies, and technologies into the same health system. One hospital runs a different EHR or med-distribution system than the one next door. The same therapy gets handled a different way depending on which building you’re standing in.
As care moves into clinics and outpatient settings, pharmacy doesn’t always have the same presence or oversight it has in acute care. In my opinion, that’s fine — not every setting needs to reproduce an acute-care pharmacy. But responsibility for medication management still needs to be clear, and health systems need governance that fits the needs of each setting without losing centralized oversight. Growth without that is just an integration problem waiting to surface.
Clinical and economic responsibility are converging
Medication is one of the largest costs a health system carries, and in my experience the organization’s view of it is often the least complete. I’ve seen systems that can tell you exactly what they pay for gloves down to the unit, yet can’t give you the same clarity on medication spend across the enterprise.
In a large system, that spend runs into hundreds of millions of dollars. Advanced therapies raise the stakes further — real clinical promise alongside hard questions about infrastructure, access, and affordability. A clinician’s instinct is to ask, “How do we get to yes for this patient?” Executive leadership’s job is figuring out how to make that yes possible, reliably, at scale.
Medication management belongs in the enterprise conversation
If I had ten minutes with a health-system CEO, I’d ask three things: How well can you actually see medication management across the organization? Who owns integration as the system grows? And how confident are you that every dose is managed with the level of safety you’d expect for your own family?
None of this has a single clean answer — every system’s history, footprint, and technology stack is different, and I don’t think there’s one governance model that fits all of them. But I believe the answers to those three questions tell you whether medication management is still a pharmacy function or an enterprise one. As executive teams work through strategy, growth, and technology decisions, pharmacy needs a seat at that table — not because it’s pharmacy’s turn, but because the safety and cost of every dose depend on it.
