Health system and hospital pharmacy departments are heading into next year with a familiar set of pressures: a shrinking graduate pipeline, unpredictable drug shortages, evolving 340B and reimbursement rules, and the ongoing task of keeping experienced staff engaged.
Becker’s asked pharmacy leaders: What is your biggest challenge for the next 12 months, and how are you preparing for it? Their answers, below, point to a shared strategy: building pipelines and processes now so the team isn’t reacting to the next disruption later.
Editor’s note: Responses have been lightly edited for clarity and length.
Matt Sapko, PharmD. Chief Pharmacy Officer, Nationwide Children’s Hospital (Columbus, Ohio): Payor changes, technology evolution and thoughtful integration, and workforce development and experience that is meaningful and purposeful for team members and enhance patient care and experience.
Keith Thomasset, PharmD. Chief Pharmacy Officer, Dartmouth Health (Hannover, N.H.): Over the next 12 months our focus will be attempting to continuously grow or pharmacy services in rural areas where options continue to both shrink and face more competition all with the threat of continued reimbursement threats and changing regulatory landscape. From broadening our ability to provide therapies through potential new alternative pharmacy sites in concert with optimizing infusion services in the same areas where for profit competition enter, continuing to ensure our patients continue to receive needed therapies within the system is paramount for wholistic care. Success will require innovative models and ability to provide high level care with continued stress on both medication cost and reimbursement.
Melissa Ortega, PharmD. Chief Pharmacy Officer, Mass General Brigham (Boston): My greatest challenge — and opportunity — over the next 12 months is to lead our pharmacy transformation amid growing clinical complexity, workforce constraints, financial pressures, and rapidly evolving therapies, while ensuring that every patient receives consistent, reliable, evidence-based care.
I see this moment as an opportunity to challenge historical practices, simplify complexity, and standardize where it improves care—while preserving the innovation and expertise that make our teams exceptional. My focus is bringing our pharmacy teams together as one integrated enterprise and harnessing our collective medication expertise to improve outcomes and help shape the future of patient care across our system.
Tyson Frodin, PharmD. Assistant Vice President, Clinical Pharmacy, MultiCare Health System (Tacoma, Wash.): The biggest challenge facing pharmacy over the next 12 months is adapting to the rapid transformation of drug reimbursement driven by the Inflation Reduction Act and the emerging 340B rebate model. As additional drugs enter the Medicare Maximum Fair Price program and rebate-based purchasing models expand, pharmacy leaders must navigate an increasingly complex intersection of pricing, reimbursement, compliance, and technology.
Preparing for that future requires more than policy awareness. It requires operational readiness. We are investing significant effort into understanding the nuances of the MFP process, building workflows to accurately capture eligible transactions, and developing robust rebate reconciliation capabilities. We are also evaluating strategic vendor partnerships that can help automate rebate tracking, resolve denials, and provide greater transparency across the medication-use process.
Ultimately, organizations that can successfully translate these regulatory changes into scalable, data-driven operations will be best positioned to protect margin, maintain compliance, and continue delivering affordable care to patients.
Chris Saboura. Assistant Vice President, Supply Chain Pharmacy and Lab, Corporate Supply Chain Services, Orlando (Fla.) Health: The biggest challenge I am anticipating is dealing with then unstable political landscape especially as it relates to the “tariff’ situation. We work diligently to estimate the yearly financial increases in drug spend/budget so that our organization plans accordingly. These changes are tracked monthly and we are measured based on the proposed budget. This year, we have some uncertainty which is causing us to think differently since we do not have the specific impact. This on top of our ongoing drug availability concerns in terms of recalls, shortages and other drug market disruptions are weighing heavily on our minds.
Yen Pham. Senior Vice President, Chief Pharmacy Officer Pharmacy and Clinical Dietitian Services, Oregon Health & Science University (Portland): One of the most significant challenges facing academic health systems is ongoing financial compression across the tripartite mission of clinical excellence, research, and education. Academic healthcare organizations depend heavily on savings generated through the 340B Drug Pricing Program to help subsidize uncompensated and safety-net care, support residency and training programs, and fund critical clinical research initiatives. However, evolving manufacturer restrictions and potential policy changes continue to threaten the sustainability of these essential funding streams.
To address this uncertainty, pharmacy leaders must adopt innovative and proactive strategies that reduce financial vulnerability while strengthening long-term organizational resilience. Key approaches include conducting robust scenario-planning exercises to evaluate the potential impact of future 340B policy changes and developing mitigation strategies in advance. In addition, expanding internal specialty pharmacy and home infusion services can create new revenue opportunities, improve continuity of care, enhance patient outcomes, and reduce dependence on third-party pharmacy benefit managers (PBMs). By diversifying revenue sources and strategically aligning pharmacy services with institutional goals, academic health systems can better withstand financial pressures while continuing to advance their missions in patient care, research, and education.
Kavish Choudhary, PharmD. Chief Pharmacy Officer, University of Utah Health (Salt Lake City): Our biggest challenge is to think creatively address healthcare access and trust issues, while navigating a lot of uncertainties, such as 340b reform, decreased reimbursement, unstable supply chains, etc. Patients and healthcare professionals have an opportunity to partner and push for some real changes through advocacy efforts.
Rox Gatia, PharmD. Vice President of Pharmacy Shared Services, Henry Ford Health (Detroit): Our biggest challenge is managing increasing complexity at a time when the traditional pharmacy operating model is under significant pressure. Drug costs, shortages, reimbursement changes, regulatory requirements, workforce constraints, and continued growth in high-cost and complex therapies are all converging. We are preparing by accelerating enterprise standardization, centralizing work that does not need to occur locally, investing in automation and technology, and using data to better align our workforce and resources with the highest-value clinical activities. The goal is not simply to do more with less, but to fundamentally redesign how pharmacy services are delivered at scale.
Chris McLaurin, PharmD. Director, Pharmacy Services, Sports Medicine Pharmacy (Jackson, Miss.) In our current space of ambulatory surgery center and employee pharmacy, the impact of tariffs upon the costs of our medications will be at the forefront of our activity. Sourcing doesn’t seem to be as much as an issue as it is with the pricing of the meds. Yes, some items of need are on allocation but the costs will still be our focus.
Jennifer Anderson-Fung, PharmD. Pharmacy Business Coordinator, Infirmary Health: One of the biggest challenges I see for us over the next 12 months is addressing space constraints within our hospitals. Space inside hospitals is greatly needed for patient care. We are addressing this challenge by establishing a centralized pharmacy service center that is slated to open in the spring 2027.
Brandon Berkemeier, PharmD. Pharmacy Manager, Infusion Services, TriHealth: As the manager of infusion pharmacy services for a large health system in Cincinnati, Ohio, my biggest challenge over the next 12 months is navigating a rapidly evolving infusion pharmacy, provider, and payer landscape. We are experiencing significant growth across oncology and other specialty infusions, including complex and high-cost therapies, while continuing to navigate shifts toward alternate sites of care. I am preparing for these challenges by better understanding how infusion pharmacy and healthcare delivery are evolving and by leveraging data, technology, and process optimization to strengthen pharmacy practice and ensure we can meet the needs of our communities in the years ahead.
Nicole Brand, PharmD. Director of Pharmacy, Hutchinson Regional Medical Center: I think our biggest challenge for the next 12 months will be the rising cost of expensive medications with decreased reimbursements in our outpatient infusion unit. We are performing an internal extensive review of every medication order that we receive in our outpatient infusion unit and recommend alternatives based on insurance as well as the cost of the medication and charge to the patient. We are looking at expanding our outpatient infusion department with more chairs that would target quick treatments like IV push medications and subcutaneous injections. We are also evaluating contracts with drug distributors and group purchasing organizations.
Curtis Hudson. Pharmacy Technician Education Coordinator, University of Kentucky HealthCare: My biggest challenge over the next 12 months is preparing the pharmacy workforce for growing demands while maintaining access, quality, and sustainability. Healthcare organizations continue to face workforce pressures, and I believe one of the greatest opportunities is ensuring every member of the pharmacy team is empowered to practice at the top of their license, certification, and training.
To prepare, we are investing in technician education, professional development, and career advancement opportunities while exploring innovative ways to expand advanced technician roles. By creating clear pathways for growth and leveraging the full capabilities of the pharmacy workforce, we can build more agile and resilient teams.
The organizations that will be most successful are those that view workforce development as a long-term strategy rather than a short-term staffing solution. Developing pharmacists and pharmacy technicians today is essential to meeting the healthcare needs of tomorrow.
Cathleen Cowden, PharmD. Administrative Director of Pharmacy at Augusta Health (Fishersville, Va.): Our biggest challenge over the next 12 months is pharmacy staffing shortages that strain morale, limit training capacity and slow team growth, a pressure compounded by a shrinking national graduate pipeline. PharmD graduates have dropped from a peak of 14,905 in 2018 to just 11,386 in 2024, a nearly 24% decline, with projections continuing downward, according to the American Association of Colleges of Pharmacy. We are addressing this locally by rebuilding pipeline relationships with schools of pharmacy for student rotations. We are also starting earlier, engaging teens through career fairs and job shadowing to build interest in the profession well before college.
At its core, pharmacy remains one of the most rewarding and impactful careers in healthcare, a profession where science, patient care and problem-solving meet every single day. Our job is not to just fill open positions; it’s to help the next generation see what we already know: that pharmacy work is critical to patient care and it is work worth doing.
Nishaminy Kasbekar, PharmD. Vice President and Chief Pharmacy Officer of University of Pennsylvania Health System (Philadelphia): For the next 12 months, I believe one of the biggest challenges in pharmacy will be balancing increasing patient care demands with ongoing workforce and operational pressures. Pharmacists are taking on expanded clinical responsibilities while also managing staffing shortages, higher prescription volumes and evolving healthcare regulations.
To prepare for this challenge, we are exploring innovative staffing models and embracing technology to enhance workflow and improve efficiency. Our goal is to ensure pharmacy teams can focus more on direct patient care while maintaining safe, high-quality services. By optimizing how we work and supporting our teams with the right tools and resources, we can continue to meet the evolving needs of our patients and the healthcare system.
Ashley Peekstok, PharmD. Pharmacy Coordinator, Procurement and Drug Shortage Mitigation, at Duke University Hospital (Durham, N.C.): I think the biggest challenge over the next year is keeping up with how quickly drug shortages continue to evolve. We’ve put a lot of work into building a proactive approach, so it’s less about reacting to the next shortage and more about making sure we’re ready for whatever comes next.
For me, that means staying connected with the people doing this work every day — our buyers, pharmacists, technicians, clinicians and suppliers. It also means looking for better ways to use data and technology to take some of the manual work out of shortage management. The more we can simplify the process, the more time we have to focus on solving problems and making sure our patients get the medications they need.
Joe Davis, PharmD. Pharmacy Operations Manager at ECU Health (Greenville, N.C.): One of the biggest challenges our team faces over the next 12 months is the evolving 340B and reimbursement landscape. These financial headwinds require us to continue to innovate while being stewards of our resources. To prepare, we are focusing on expense management, labor and productivity optimization, and reimagining our workflows and services.
Jennifer Anderson-Fung, PharmD. Pharmacy Business Coordinator, Infirmary Health: One of the biggest challenges I see for us over the next 12 months is addressing space constraints within our hospitals. Space inside hospitals is greatly needed for patient care. We are addressing this challenge by establishing a centralized pharmacy service center that is slated to open in the spring 2027.
Brandon Berkemeier, PharmD. Pharmacy Manager, Infusion Services, TriHealth: As the manager of infusion pharmacy services for a large health system in Cincinnati, Ohio, my biggest challenge over the next 12 months is navigating a rapidly evolving infusion pharmacy, provider, and payer landscape. We are experiencing significant growth across oncology and other specialty infusions, including complex and high-cost therapies, while continuing to navigate shifts toward alternate sites of care. I am preparing for these challenges by better understanding how infusion pharmacy and healthcare delivery are evolving and by leveraging data, technology, and process optimization to strengthen pharmacy practice and ensure we can meet the needs of our communities in the years ahead.
Nicole Brand, PharmD. Director of Pharmacy, Hutchinson Regional Medical Center: I think our biggest challenge for the next 12 months will be the rising cost of expensive medications with decreased reimbursements in our outpatient infusion unit. We are performing an internal extensive review of every medication order that we receive in our outpatient infusion unit and recommend alternatives based on insurance as well as the cost of the medication and charge to the patient. We are looking at expanding our outpatient infusion department with more chairs that would target quick treatments like IV push medications and subcutaneous injections. We are also evaluating contracts with drug distributors and group purchasing organizations.
Curtis Hudson. Pharmacy Technician Education Coordinator, University of Kentucky HealthCare: My biggest challenge over the next 12 months is preparing the pharmacy workforce for growing demands while maintaining access, quality, and sustainability. Healthcare organizations continue to face workforce pressures, and I believe one of the greatest opportunities is ensuring every member of the pharmacy team is empowered to practice at the top of their license, certification, and training.
To prepare, we are investing in technician education, professional development, and career advancement opportunities while exploring innovative ways to expand advanced technician roles. By creating clear pathways for growth and leveraging the full capabilities of the pharmacy workforce, we can build more agile and resilient teams.
The organizations that will be most successful are those that view workforce development as a long-term strategy rather than a short-term staffing solution. Developing pharmacists and pharmacy technicians today is essential to meeting the healthcare needs of tomorrow.
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