Health systems are pouring capital into specialty pharmacy, community pharmacy and infusion capacity, betting that owning the pharmacy touchpoint is now a strategic necessity, not a side business.
Here are four notes on where that investment is headed:
1. Specialty pharmacy build-out is accelerating across health systems.
- At Richmond, Va.-based VCU Health, specialty pharmacy has grown more than 50% and ambulatory retail pharmacy more than 30% over the past two and a half years, while Fort Lauderdale, Fla.-based Broward Health’s specialty pharmacy initiative has generated $75 million in top-line revenue on top of $44 million in 340B drug savings from a program restructuring.
- Charlottesville, Va.-based UVA Health opened its Pharmacy Central Services Center earlier this year to centralize automated fulfillment, call center operations and supply management, part of a strategic plan that drove more than a 40% increase in pharmacy revenue under Chief Pharmacy Officer Danielle Griggs, PharmD.
- The push toward integrated ownership is not new. In 2020, seven health systems formed the Health System Owned Specialty Pharmacy Alliance to advocate for the model, arguing it improves medication adherence and coordination compared with a fragmented approach. Mike Skafi, Renton, Wash.-based Providence’s interim chief pharmacy officer, said the system’s priority is being disciplined about where to standardize and centralize so the system can reinvest in growth areas such as specialty pharmacy.
2. Health systems are opening retail pharmacies as fast as national chains close them.
- Rite Aid has shuttered about 800 stores after bankruptcy, CVS has closed 900 locations and Walgreens has announced plans to close 1,200 more, leaving 46% of U.S. counties — 1,447 of 3,141 — without a drugstore within 10 miles, and counties with high social vulnerability were 30% to 40% more likely to be designated pharmacy deserts.
- Alongside those closures is a wave of 2026 openings. Middlesex Health opened its first retail and specialty pharmacy in Middletown, Conn. Cleveland Clinic opened a pharmacy at its South Pointe Medical Office to address pharmacy deserts in Cuyahoga County’s eastern suburbs. Iowa Methodist Medical Center in Des Moines opened a retail pharmacy supporting Meds to Beds and breast milk donation programs. Catawba Valley Health System opened a community pharmacy in Hickory, N.C. Mercyhealth opened a community pharmacy in Beloit, Wis., part of a growing footprint of health system-owned retail locations in that state. Ascension Wisconsin plans two more community pharmacies for summer 2026, and MetroHealth System opened its 12th retail pharmacy in Cleveland in March.
- Des Moines, Iowa-based MercyOne’s regional chief pharmacy officer named building out retail pharmacy infrastructure as the system’s number one priority in 2026 specifically to capture prescription volume as a margin driver.
- University of Miami Health System’s chief pharmacy officer, Nilesh Desai, told Becker’s the system is exploring alternative models for post-discharge and emergency department medication access as closures continue.
- Even CVS is recalibrating rather than retreating. The chain plans to open more pharmacies than it closes in 2026, including nearly 20 smaller, sub-5,000-square-foot locations designed for underserved markets.
3. Health systems are treating inventory infrastructure as a strategic investment.
- At Boise, Idaho-based St. Luke’s Health System, pharmacy leaders are making investments in automation, AI-enabled workflows and centralized operations to build what they call a “future-ready” pharmacy model. The system planned to launch the first phase of a central services center fill engine and has already secured limited distribution drug and payer network access for five additional specialty and rare disease medications, extending coverage to roughly 5,000 additional patients. The second phase, according to Josh Weber, PharmD, senior director, will include overseeing ambulatory medication access, retail and specialty pharmacy services.
- At New York City-based Mount Sinai, pharmacy leaders are evaluating AI specifically to strengthen inventory management alongside inpatient order verification and prior authorization workflows.
4. Oncology and infusion capacity are expanding fastest.
- Cancer centers are calling the daraxonrasib rollout “the most significant change in 20 years.” Mitesh Borad, MD, an oncologist and leader of the Novel Therapeutics and Therapeutic Modalities Program at Mayo Clinic Comprehensive Cancer Center in Phoenix, told Becker’s the system is taking a proactive approach. In doing so, it is opening front-line metastatic, adjuvant and combination-therapy trials, plus investigator-initiated trials for locally advanced pancreatic cancer, which represents about 40% of pancreatic cancer diagnoses.
- That scramble is landing on top of an oncology infrastructure base that already has grown. A total of 175 facilities have earned cell therapy accreditation from the Foundation for the Accreditation of Cellular Therapy, 168 within existing blood and marrow transplant units and seven as standalone programs, including Houston Methodist and UT MD Anderson, also based in Houston.
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