Beyond the Pharmacy Plateau: Unlocking Untapped Value
In 2026, pharmacy is the cornerstone of financial sustainability. Even teams with average results in 340B, infusion, and specialty pharmacy have stabilized margins and subsidized struggling service lines. As health systems face greater financial pressures, the role of pharmacy will only continue to expand.
Pharmacy’s impact creates a paradox: its reliable contribution can mask broader organization dysfunction even while its own performance has plateaued below potential. Many systems have seen impressive early gains through recent investments in ambulatory pharmacy performance—$40 million, $60 million, even $80 million in annual financial improvements—but few are going to be able to sustain that trajectory without heightened focus, investment, and an ongoing entrepreneurial spirit.
Pharmacy’s Growth Barriers
Over time, infusion centers hit capacity limits, specialty prescriptions shift to payer-owned competitors, and 340B savings shrink under manufacturer and policy restrictions. These plateaus are not failures of pharmacy leadership. They are signs that the system has reached the limits of what it can achieve without deeper investment, analytic visibility, and executive alignment.
The Root Cause: Underinvestment & Organizational Blind Spots
Pharmacy is often expected to drive system-level outcomes without receiving the necessary organizational support. To realize its full growth potential, pharmacy programs require adequate staffing, dedicated physical space, modern technology, and executive sponsorship. When these elements align, pharmacy can exceed clinical and financial expectations.
When Pharmacy’s Potential Is Overlooked
On the other hand, progress stalls when opportunities remain untapped. For example, a specialty pharmacy may limit the number of patients it serves, not due to lack of demand, but because of staffing shortages or fragmented coordination. And clinics may still ask patients, “Which pharmacy should I send your prescription to?” instead of proactively guiding them to the system’s own pharmacy. These operational inefficiencies mirror larger structural challenges, such as patient leakage, missed revenue, and insufficient system ownership.
Just as other parts of the organization have made strides—reducing leakage from PCPs to specialists or from specialists to surgical locations—addressing gaps in pharmacy operations requires strategic, system-wide coordination. This includes nurturing strong relationships between chief strategy officers and chief pharmacy officers, embracing innovations like AI to enhance operational efficiency, optimizing the pharmacy supply chain, and so much more.
A System Cannot Manage What it Cannot See
Most health systems underestimate the analytics infrastructure required to fully realize pharmacy’s value. Even highly capable chief pharmacy officers often lack integrated data on utilization, reimbursement, and leakage across sites of care. Without analytical support from finance, IT, or dedicated data teams, pharmacy leaders cannot identify payer-driven margin erosion, infusion bottlenecks, or changes in 340B capture rates.
A system cannot manage what it cannot see. Today, most pharmacies lack visibility into millions of dollars of leakage across infusion, specialty, and 340B.
Experienced external consultants can accelerate discovery. They bring comparative data, modeling, and process expertise that reveal inefficiencies and quantify opportunity, equipping internal leaders rather than replacing them.
Pharmacy Buried in Structure
Despite pharmacy’s financial and clinical impact, it remains buried in many organizational structures. Chief pharmacy officers often sit multiple layers below the C-suite, limiting visibility in enterprise planning. This invisibility creates a self-reinforcing loop: lack of visibility leads to underinvestment, underinvestment leads to plateaued performance, and plateaued performance leads executives to assume pharmacy is already optimized.
To break the cycle, leadership must elevate pharmacy’s role, and pharmacy must communicate its impact in terms that resonate with the C-suite. This can be achieved by building relationships across the organization, tying results to clinical outcomes that are closely measured and monitored by health system leadership, and pushing to continuously grow the financial impact of pharmacy on the health system.
The Measurement Problem
Pharmacy performance is often tracked through operational metrics that don’t tell the strategic story. External benchmarking offers limited insight because pharmacy programs vary widely in scope and payer mix.
A more effective approach is internal benchmarking (measuring performance year over year). By focusing on internal metrics, organizations can ensure that their data is clean, actionable, and closely aligned with enterprise priorities, allowing for targeted improvements and more strategic growth.
Leading C-suites now ask, “Is our pharmacy performing better this year than last year — financially, operationally, and clinically?”
A Pharmacy Scorecard for the C-Suite
Every health system should maintain a pharmacy scorecard presented alongside other executive dashboards. Five essential domains create visibility and unlock meaningful improvement:
- Pharmacy Margin Contribution: Tracking total enterprise pharmacy operating margin and identifying where plateaus signal missed opportunity.
- 340B Savings Performance: Measuring captured savings vs. eligible potential.
- Specialty Pharmacy Performance: Net revenue and margin, retention, internal fill rates, and clinical alignment.
- Infusion Services Performance: Net revenue and margin, denials, site-of-care shifts, and capacity.
- Pharmacy Revenue Cycle Effectiveness: Measuring and improving billing, coding, and denial patterns for high-cost drugs.
A Call to the C-Suite
When Pharmacy plateaus, it is not a failure of leadership but a failure of alignment. Pharmacy teams have delivered extraordinary results with limited support, but they cannot sustain growth without adequate resources, analytics, and executive visibility. To unlock pharmacy’s full potential, health systems must:
- Invest in people, space, and infrastructure
- Integrate analytics to measure and act on performance=
- Elevate pharmacy in enterprise strategy and decision-making
- Leverage outside partners to clarify opportunity and bottlenecks, and accelerate success
From Plateau to Peak: Unlocking Pharmacy’s Full Potential
Pharmacy has become a cornerstone of financial sustainability in health systems, but its potential often remains underutilized due to structural barriers and underinvestment. To break through these limitations, executives must elevate pharmacy’s role and provide the necessary resources, strategic alignment, and visibility.
Five Takeaways for Executives
- Early gains often mask a plateau.
- Underperformance reflects underinvestment.
- Internal benchmarking is more meaningful than external comparisons.
- A C-suite pharmacy scorecard drives visibility and alignment.
- Partner with pharmacy (equip it, don’t pressure it).
To learn how Visante can help your organization discover pharmacy’s full potential, reach out to Visante today.
Subject Matter Expert: Steve Rough & Phil Brummond