For decades, the friction between a prescription and a patient was accepted as part of the process. Now, pharmacy leaders are closing that gap with AI because “to wait one moment longer is untenable.”
Pharmacy has become one of healthcare’s most valuable strategic assets. As health systems chase growth, capacity and margin relief all at once, the pharmacy is where all three converge — and chief pharmacy officers are helping shape the questions that decide a system’s future: financial performance, workforce and technology.
To understand what pharmacy’s renewed magnitude looks like from the inside, three leaders who built their careers in pharmacy recently sat down for extended conversations about the discipline’s changing place in health system strategy: Dr. Deborah Simonson, vice president and chief pharmacy officer of Ochsner Health; Marjorie Lazarre, PharmD, associate chief pharmacy officer of Yale New Haven (Conn.) Health; and Lisa Stump, MS, chief digital information officer of New York City-based Mount Sinai Health System, who began her career as a clinical pharmacist and director of pharmacy.
Also lending perspective on pharmacy’s shift is Sri Somasundaram, co-founder and CEO of Latent, the enterprise pharmacy intelligence platform built to help health systems simplify the patient journey from diagnosis to health. He sees how much greater that need has become.
“Our CEOs and presidents need help,” Dr. Lazarre said. “The healthcare ecosystem is changing. The insurance system is changing. How people can and will afford their medications is changing, and per capita, we spend the most in the universe on medication.”
Overall pharmaceutical expenditures in the U.S. grew nearly 13% in 2025 to more than $915 billion, an increase driven primarily by utilization. Hospitals are absorbing an outsized share: Their drug expenses rose 13.6% in 2025, one of the fastest-growing pieces of the hospital cost structure, according to the American Hospital Association. At academic medical centers, which treat the most complex patients, drug expenses climbed more than 20% in a single year.
“Medicine has advanced faster than the systems built to deliver it,” Sri said. “The information you need to get one patient on one medication is scattered and siloed across multiple disparate places, and no one holds the whole picture. That’s a data problem, not a staffing problem you can hire your way out of, and it isn’t something general-purpose AI solves on its own. It takes a whole platform built for the entire patient care journey and the way pharmacy actually works.”
For the leaders inside these systems, that gap is also an opening. “This is a real and present opportunity for pharmacy leaders to step up,” Dr. Lazarre said. “We already have, and I know we can do more.”
From cost center to revenue engine
Start with the arithmetic. Chief pharmacy officers remember when a high-cost hospital medication was $40 a dose. Then higher-cost medications moved toward $100,000 a dose. Now, leaders are encountering million-dollar doses of medications.
Spend at that scale makes pharmacy a board-level concern by default. But there is also opportunity here, and that’s where specialty pharmacy comes in. The department known for trimming expenses is now one capable of generating revenue. “We’ve started as a cost center,” Dr. Lazarre said of pharmacy, noting that the lion’s share of her career was spent in that space before specialty drugs rewrote that role. “Specialty has really changed the dimension of pharmacy, allowing us to be revenue generators — and it’s a responsibility we hold really highly,” she said.
That shift changed the math and, she argued, the obligation that comes with it. Her team now weighs financial toxicity alongside clinical toxicity, knowing that a therapy a patient cannot afford is not much of a therapy at all.
“It is one thing to give someone a terrible diagnosis,” Dr. Lazarre said. “It’s another to then say, ‘This is what you should take, but you do not have access to it.’ That is a sin, and that is what we’re trying to prevent. Access must be real. It is not a figurative statement — we take it extremely seriously. We want people to leave healthy both clinically and financially,” she said. “Our patients are choosing their health or their food, their rent or their tuition versus this medication. These are life-altering, long-term commitments.”
At Ochsner, that conviction is how the specialty business got built in the first place. Dr. Simonson has always played a long game. “To move your organization forward, you’ve got to be three or four years ahead of it,” Dr. Simonson said.
In 2012, she pointed executives toward the coming wave of oral chemotherapy — cancer treatment dispensed as a pill and taken at home, where a missed fill could mean a missed cure. The pitch was about patients; the result was also a business. Executives approved a pilot with a single drug, and Ochsner’s specialty pharmacy operation — now a significant contributor to the system’s performance — grew from there.
‘We are out of time’
Finances earned pharmacy its seat at the table; workforce projections are making everyone around it lean in.
“We have an aging population. There are more therapies being discovered and coming to market every day, and each of those therapies is often more complex than what we had before,” Ms. Stump said. “At the same time, we see a plateau or shrinking in many of the clinical disciplines. More people needing more things, and fewer people to provide them, is the inequality in the math that is troubling.”
Dr. Lazarre, who teaches residents and students, is blunt about the pipeline: “We are out of time. We’ve had shortages in workforce for over a decade. They’re not being remediated with these coming classes.”
That is the kind of math no hiring plan can solve, which is why pharmacy leaders have stopped treating artificial intelligence as a someday technology. The work swallowing their teams — reconciling a patient’s record against payer rules, benefit designs and clinical criteria, case after case — was never really a staffing problem. It was an information problem.
Consider the simplest version of it. In a hospital with 900 patients, Ms. Stump said, identifying the handful who would most benefit from a pharmacist on a given day is “like finding a needle in a haystack.” Her team stopped searching by hand.
“We use the data to surface and prioritize those, so the right patients get the right level of care right away,” she said. Pulling scattered details together at speed is one thing this generation of AI does well and is why, in a growing number of pharmacy departments, the enterprise AI platforms built specifically for pharmacy are moving from talking point to critical infrastructure.
Mount Sinai, Ochsner and Yale New Haven are putting AI to the grunt work: pulling a patient’s history from the EHR and outside records, matching it against the payer’s coverage criteria, and assembling the documentation a pharmacist then reviews and submits. Hours of digging and phone calls shrink to minutes. Its proving ground has been prior authorization, the longstanding obstacle that can stall a prescription for weeks.
Dr. Lazarre knows that obstacle intimately. “It makes it very hard to read notes and documentation and come to a conclusion quickly,” she said. “Now you’re comparing all of those documents to a third-party system — the insurance carrier has their own details, their own requirements. Everything requires prior authorization, and those are details that may or may not be in the record.”
She calls the stretch between prescription and pill “the last mile.” Nationally, patients can take about 21 days to cross it, in some cases 30. “After you’ve seen all of the specialists, after you’ve done all the things, to wait one moment longer is really untenable,” Dr. Lazarre said. At Yale New Haven Health, her team’s prior authorization turnarounds now average about three days. “Anything that accelerates that time frame allows people to have access, create adherence and be educated,” she said. The technology has let her team do all three.
Meeting three goals at once is one test; the harder one is keeping pace when the pressures climb together. Another $13 billion health system used the same technology to absorb a more than 40% jump in prior authorization volume between 2023 and 2025 — alongside a 90% jump in mail-order volume — without delaying turnarounds or adding the seven full-time hires the growth would otherwise have required.
For Dr. Simonson, the appeal is speed against a bottleneck that has only worsened. “I need data, and I can’t find the data fast enough,” she said. “That’s why I’m extremely excited about AI.” At Ochsner, she said, it has cut the time she spends hunting for information by up to 80%. “The thing that makes me happiest is that now people can do the things that only they can do, and AI can do the things they don’t need to do,” she said.
At Mount Sinai, Ms. Stump points to a pharmacy team that set out to double its operation’s revenue and got there without proportional hiring, after deploying AI to clear the administrative work standing between patients and their medications. “It helped patients get better care, it helped the care team reduce a bunch of cognitive burden, and it improved the financial performance of the entire enterprise,” she said.
None of the leaders describe a technology that displaces people. They describe the opposite, in which pharmacists are getting back to their actual jobs. “Technology has helped us come out of the jobs that we don’t want and into the jobs that we were trained to do,” as one put it.
The subplot becomes the story
For all the measured results, prior authorization is, to these leaders, a proof of concept — not a destination. “I really believe that together we can solve for more than just the prior authorization,” Dr. Lazarre said. “That’s the start.”
What she’s after, ultimately, is connection. “How do we create connection for patients and the clinician and the care team that’s meaningful and actionable?” she said. “That really traverses so many parts of healthcare.”
That ambition is reshaping what these leaders demand of their technology. Dr. Simonson has no use for finished products; she wants co-builders who will sit with her technicians, learn the workflow firsthand and make changes in days. “What I really want is someone adaptable that I can go to and say, if we had this, it would change this — and you can do it for me in a week or an hour, not six months,” she said.
Their destinations differ, and none is small. Chief pharmacy officers are adopting technologies and innovations designed around outcomes rather than transactions, where automation handles dispensing and pharmacists return focus to care gaps and conversations with patients. Dr. Lazarre wants the tools proven at academic systems put within reach of the community and rural hospitals that cannot build them alone. Ms. Stump is pushing for AI to be treated as a member of the care team — and for pharmacists to be recognized, and paid, as providers. She believes AI’s value is not in replacing pharmacists, but in restoring the practice of pharmacy by integrating clinical, operational and financial data so they can focus on outcomes, access, and patient support. “As both a pharmacist and digital leader, I believe the future lies in using technology to elevate clinicians and enable more personalized, proactive, human-centered care,” said Ms. Stump.
None of it makes the pressure disappear. Drug spending is still compounding at double digits, the workforce math is still unresolved, and payers are not getting easier.
What has changed is who’s in the room when those problems are taken up. The department that ran for decades from an office past the dialysis unit is no longer out of sight. The people who built it there, quietly, all along, intend to stay at the table. Pharmacy, of all departments, knows what waiting costs. Now its leaders aim to spare patients even one more moment of it.
Learn more:
- From cost center to growth engine: How intelligence is transforming pharmacy at 4 health systems
- Why 4 Leading Health Systems Centralized Pharmacy Intelligently: The Playbook & The Results
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