Becker’s asked pharmacy executives from hospitals and health systems across the U.S. to share where they see hospital consolidation going within the next five years.
The 14 executives featured in this article are all speaking at the Becker’s Healthcare Spring Chief Pharmacy Officer Summit, from April 15-16, 2026 at the Hyatt Regency Chicago.
To learn more about this event, click here.
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As part of an ongoing series, Becker’s is talking to healthcare leaders who will speak at our conference. The following are answers from our speakers at the event.
Question: What’s your outlook on hospital consolidation over the next three to four years and how will it affect pharmacy?
Nilesh Desai. Chief Pharmacy Officer of Baptist Health (Louisville, Ky.): Hospital consolidations will continue to happen and this will provide great opportunities for pharmacies to expand and enhance services in better inventory management, specialty pharmacy, retail pharmacies, clinical services, home infusion, and value-based care. This will enable better medication access for patients and utilization of staffing and technologies.
Bickkie Solomon, PharmD. Director of Pharmacy and Director of Residency Program Director PGY-2 HSPAL at HCA Florida North Florida Hospital (Gainesville); Assistant Professor of Pharmacy of West Coast University (Irvine, Calif.): Mergers and acquisitions among large health systems and integrated delivery networks are expected to persist, with many acquiring smaller hospitals, regional networks, or rural facilities. In contrast, some hospitals may face closure due to unsustainable financial pressures. These trends are driven by declining reimbursement rates and rising labor costs, which continue to exacerbate staffing shortages — particularly in rural and semi-urban communities.
Automation, powered by artificial intelligence, is reshaping pharmacy operations. Centralized pharmacy services using a hub-and-spoke distribution model and robotic compounding are gaining traction. While some health systems remain cautious in adopting these technologies, those that do benefit from enhanced compliance with USP <797> and <800> standards. Importantly, automation does not eliminate the need for skilled personnel — it redefines their roles.
AI-driven clinical decision support tools are empowering pharmacists to make more informed choices, while also creating new roles in pharmacy informatics and AI integration. These roles require advanced training and offer more strategic, rewarding responsibilities. As automation expands, regulatory scrutiny intensifies, requiring robust oversight and governance to ensure safety and compliance.
Ultimately, these developments are closely tied to profitability, reimbursement challenges across pharmacy and healthcare in the U.S., and the financial resilience required to thrive in the U.S. healthcare environment. Larger organizations (health systems, IDNs) are more proactive and tend to be more resilient. They respond more rapidly in anticipation of changes with more resources and analytics capabilities. Smaller organizations or standalone organizations are more reactive.
This stands in contrast to the universal healthcare model in Australia — my mother country — where I maintain strong ties and a deep understanding of its system. The Australian model distributes financial pressures differently, offering a unique perspective on how healthcare systems can evolve under varying economic and policy frameworks.
Kuldip R. Patel, PharmD. Senior Associate Chief Pharmacy Officer of Duke University Health System (Durham, N.C.): I would expect hospital consolidation to increase, mainly due to cost efficiencies necessary for long term financial stability in health systems. This increase in consolidation means a greater need for pharmacies to reimagine practice standards, service delivery and sites of care, focusing on optimizing them to enable broader access, drive clinical outcomes, and improve financial performance. Drug prices will continue to grow, hence the need for continued focus on evidence-based formulary management and incorporating payer insights to guide therapeutic decisions.
Joshua Weber, PharmD. Senior Director of St. Luke’s Health System (Boise, Idaho): Over the next three to four years, I expect hospital consolidation to accelerate particularly in markets like Idaho where scale is essential to sustain rural access and allow us to continue to invest in advanced, automated, and lean pharmacy operations. There is so much scrutiny around 340B program reform, payer owned and vertically integrated contract pharmacy oversight and changing reimbursement models. All of which can be seen as opportunities for health systems with entity-owned, integrated and mature ambulatory, retail and specialty pharmacy services with a unified vision and strategic direction. St. Luke’s Health System is focused on leveraging this integration to accelerate medication access, implement automation and AI tools across our pharmacy enterprise, optimize total cost of care via IDN pharmacy best-in class outcomes, and expand value-based partnerships with payers and manufacturers particularly on the specialty pharmacy side. Organizations that marry disciplined financial stewardship with clinical excellence and measurable outcomes across the pharmacy care continuum will capitalize on these consolidation opportunities and emerge as national leaders in access, affordability, and accountable care.
Mohamed Mahmoud, PharmD. Director of Specialty and Retail Pharmacy Services at Corewell Health (Grand Rapids and Southfield, Mich.): I believe financial pressures will continue to influence many decisions within the healthcare sector. An increasing number of hospitals are establishing outpatient surgery centers due to the potential revenue these centers generate. Acquisitions and mergers will enable systems to achieve economies of scale. In the pharmacy sector, consolidation is expanding through centralized service centers, which facilitate larger drug purchases and help mitigate drug shortages. This approach also allows for significant discounts on bulk purchases. Additionally, centralizing the drug purchasing process reduces waste, duplicates orders, and consequently lowers the rate of drug returns.
Dejuan Branch, PharmD. Director of Pharmacy Services at Bon Secours – Richmond Community Hospital (Va.): Over the next few years, hospital consolidation will continue but with a stronger focus on partnerships, shared services, and operational scale rather than traditional mergers. For pharmacy, this means greater emphasis on enterprise standardization, centralized compounding and distribution, and expanded ambulatory and specialty pharmacy models. As health systems streamline operations, pharmacy teams will play a key role in driving cost efficiency, ensuring quality and compliance, and improving medication access across care settings. Ultimately, success will hinge on balancing systemwide integration with the personalized care patients expect from the healthcare system.
Onisis Stefas, PharmD. CEO of VIVO Health, Northwell Health (New Hyde Park, N.Y.): My outlook is that hospital consolidation will continue, if not accelerate, over the next three to four years, driven by persistent financial pressures, staffing shortages, and the strategic need for greater scale and leverage with payers.
For pharmacy, this trend presents a significant opportunity to actively drive systemwide formulary standardization, centralized purchasing, and optimization of operational workflows, leading to enhanced cost efficiencies and superior patient outcomes across the larger enterprise. Crucially, consolidation allows us to merge diverse pharmacy assets, substantially improving our network, increasing our scale, enhancing clinical service capabilities, and enriching our collective talent pool. This expanded reach and strengthened infrastructure will enable us to help more people, elevate community health, and strategically invest in pharmacy services, especially in areas of greatest need, alongside accelerating technology adoption, data analytics integration, and the expansion of ambulatory and specialty pharmacy services.
While integration will require significant adaptability from pharmacy teams, these efforts will be focused on maximizing value and positioning pharmacy as a vital asset within the newly formed entities.
David Coriale, PharmD. Director of Pharmacy at Finger Lakes Health (Geneva, N.Y.): I believe this will increase the pool of available pharmacists and technicians. I don’t think it is good for patient care due to the probable increase in wait time. It will bring opportunities for innovation.
Luis Alfonso, PharmD. Director of Pharmacy Services at Jackson North Medical Center, Jackson Health System (Miami): As we navigate a complex financial, operational, and regulatory landscape, we have witnessed an increase in hospital consolidations, primarily through mergers and acquisitions. The main forces driving hospital consolidation are persistent increases in labor costs, supply chain complexity, payer mix pressure, shifts in site-of-care to ambulatory, and the adoption of value-based/risk contracts. Throughout my 28 years of pharmacy practice, I have observed that hospital consolidation is accelerating rapidly, leading to increased cost pressures and demands for services that drive positive clinical patient outcomes and revenue growth.
Hospital consolidations always bring the critical need for centralization and standardization of pharmacy services with strong platform support of artificial intelligence, enterprise analytics, automation, technology and expansion of clinical pharmacy services with innovation and redesigning of the existing programs. Growth in hospital consolidations always facilitates alignment in the development of hospital-owned specialty pharmacies, ambulatory infusion centers, home infusions, and PBMs to recapture revenues in the new Hospital consolidated ecosystem.
Barbara Higgins, PharmD. Director of Pharmacy at Michigan Medicine (Ann Arbor): Consolidation exists in many industries, including almost all facets of healthcare for many reasons. How hospital consolidation will impact the practice of pharmacy during and after consolidation will depend largely on the reason for the particular consolidation as well as how pharmacy leaders approach the circumstances. It may create jobs with lower wages, decreases in position availability and dissatisfied pharmacy staff particularly if it reduces competition in the local area. However, it may also create a collaborative environment resulting in the discovery of better practice models and provision of services leading to more satisfied pharmacy staff.
Jeffrey Akers, PharmD. Vice President of Pharmacy at UC Health (Cincinnati): As healthcare continues to evolve and consolidate, it is even more important for pharmacy to be involved in the strategy setting and operations of hospitals and health systems. Healthcare systems and payers are actively decreasing inpatient stays in favor of more outpatient, ambulatory care and visits. Pharmacy is in the unique position to provide a myriad of services to this growing patient population. I truly believe the future of pharmacy is in the ambulatory space whether it is through brick-and-mortar or home delivery outpatient and specialty pharmacies, clinic embedded and telehealth ambulatory clinical pharmacists, infusion and injection services, and hospital-at-home and home infusion pharmacy services. Pharmacy provides the required expertise to help manage these patients either in person or virtually. Therefore, hospital consolidation provides a unique opportunity for pharmacy to be an important provider in the American healthcare evolution.
Edith Okolo, PharmD. Director of Pharmacy at Cedar Crest Hospital (Belton, Texas): The process involves the merging of entities within the healthcare sector in order to increase operational efficiency, healthcare accessibility by consumers, financial profitability and overall gain for parties involved in the consolidations.
The cons with the hospital consolidation entails less competition amongst hospitals and providers of healthcare, we know competition most times breeds the desire for excellence,this could limit growth and can lead to one size fits all thus limiting patients’ and consumers choice of where and how to receive care since there are not many options the same processes, insurance, policy and procedure across the organization.
The striving for excellence could decrease knowing there are not many options leading to universal health, pharmacy will end up with one formulary that may not be adequate. Another issue is the downsizing of pharmacy labor which could limit growth in the field since they are managed by the same organization and limiting opportunity to diversify the practice.
Brian Dotter, PharmD. Senior Director of Pharmacy at St Luke’s Boise Medical Center (Boise, Idaho): Organizations are facing financial challenges with raising operational costs, regulatory challenges, and increasing technology demands which I believe will continue to lead to increased hospital consolidation. One strategy that our organization has utilized is through creation of a Consolidated Service Center which assists with our ability to centralize services, help drive standardization, improve our inventory control, and provide greater purchasing power. Centralization helps allow for efficiencies of scale and expanding service while standardization helps drive our utilization of contract preferred products. These operational efficiencies as well as cost savings can help offset the rising costs of medications and supplies we have been experiencing.
Michael Stepanovic, PharmD, MS. Assistant Professor at UNC Eshelman School of Pharmacy (Chapel Hill, NC): Hospital consolidation will continue, but the next wave will be less about size and more about shared infrastructure and scale efficiency, especially in pharmacy. As systems consolidate, pharmacy enterprises may find it advantageous to developed a shared services approach early through activities such as centralized sterile compounding, consolidated contracting, bulk purchasing, and other systemwide projects. This opens up tremendous possibilities for standardization, automation, and data integration, but it also necessitates a strong governance to keep clinical nuance and flexibility. Consolidation also gives health systems a chance to rethink how they run the Pharmacy Supply Chain (PSC) and move from a departmental procurement model to an enterprise-wide PSC framework that more closely resembles modern supply chain operations. A more modern PSC framework, will enhance resiliency and cost-effectiveness, while still allowing for growth. This creates a pharmacy operational backbone that supports new clinical and revenue-generating services, which function best in a shared service setting and helps to keep improving patient care.
Carlette Norwood-Williams, PharmD. Chief of Pharmacy Services at Tuba City Regional Health Care Corp (Ariz.): Hospital consolidation is projected to accelerate, driven by severe financial pressures—specifically, the significant Medicaid resource reductions expected from the One Big Beautiful Bill Act (OBBBA).
This loss of federal funding will place extreme duress on the industry, forcing organizations to seek the scale necessary for survival.
For rural-based healthcare organizations, consolidation may be the last viable strategy to prevent closure, though capital constraints will limit which deals are financially feasible.
In response, pharmacy departments will be mandated to drive deep efficiency gains, primarily through the centralization of purchasing and system-wide standardization.
Furthermore, a major push to expand both Specialty Pharmacy and 340B programs will be leveraged to recapture revenue and mitigate the dramatic financial shortfalls.
