Pharmacy at a Crossroads: It’s Time for Entrepreneurial Growth

Pharmacy has long been a quiet force behind health system performance through managing medication costs, supporting compliance, and improving the patient experience. But in today’s quickly shifting healthcare ecosystem, that behind-the-scenes role doesn’t cut it.

As health systems shift focus from inpatient care and cost control to ambulatory expansion, pharmacy remains a major growth opportunity. However, sometimes the value of pharmacy can get lost in the boardroom. Fortunately, this mindset is reversible! The new year is the perfect time to position pharmacy as a platform for generating revenue, driving business innovation, and accelerating enterprise growth.

Bringing Pharmacy Into Focus: A Strategic Opportunity for Health System Finance

Most modern chief financial officers (CFOs) have moved beyond cost containment. Their focus is now on identifying scalable service lines, uncovering new revenue streams, and expanding the organization’s ambulatory footprint.

Pharmacy leaders have a powerful story to tell, but it’s not always communicated in terms that resonate with CFOs (such as return on investment, strategic growth, or competitive advantage). This miscommunication means that many health systems are missing high-value opportunities in specialty pharmacy, infusion services, internal pharmacy benefit management (PBM), and employer partnerships. Additionally, the financial potential of the 340B program, pharmacy revenue cycle, and supply chain performance is often underutilized.

Eight Bold Pharmacy Strategies to Propel Enterprise Growth

Pharmacy must go beyond listing initiatives and instead present a comprehensive vision for how it fuels enterprise transformation. This means connecting pharmacy services directly to system-level goals around ambulatory strategy, payer alignment, market growth, and employer relationships.

Forward-looking health systems are implementing a set of innovative pharmacy strategies that include:

1. Investing in an In-house Specialty Pharmacy Program

Establishing and aggressively investing in an in-house specialty pharmacy program to reclaim high-value prescriptions, reduce leakage to external providers, and improve medication adherence for patients with complex conditions. These platforms not only capture margin on high-cost therapies but also allow tighter clinical integration and better outcomes reporting—critical for payer and manufacturer partnerships.

2.Expanding Retail & Ambulatory Pharmacy Networks

Expanding retail and ambulatory pharmacy networks by opening on-site and community-based locations, integrating discharge prescription services (“meds-to-beds”), and enabling prescription synchronization. These efforts enhance care continuity, increase prescription capture, and improve patient satisfaction while generating incremental revenue through medication dispensing and clinical services.

3.Launching Ambulatory Infusion Services in Non-hospital Based Settings

Launching ambulatory infusion services in non-hospital-based settings, including the home setting enabling health systems to meet payer demand for lower-cost care alternatives without cannibalizing hospital-based services.

Rather than shifting volume away from the hospital, these models expand the system’s reach into new sites of care, creating additional capacity and capturing demand that might otherwise go to external providers. By delivering high-cost infusion therapies in non-hospital settings, systems can increase overall infusion volume, generate new reimbursable revenue streams, and improve access and convenience for patients with chronic and acute conditions.

4.Developing or Insourcing PBM Capabilities

Developing or insourcing PBM capabilities to manage internal employee pharmacy benefits more efficiently and transparently. Over time, these capabilities can evolve into a commercial service line, allowing the system to offer value-driven, cost-transparent PBM solutions to local employers and capture both the administrative fees and downstream prescription volume.

5.Integrating Pharmacy Into Direct-to-Employer Strategies

While direct-to-employer strategies may be relatively new territory for pharmacy, they’re quickly becoming a strategic priority for health systems. These approaches help build stronger relationships with local employers by offering healthcare solutions that improve access, quality, and cost-effectiveness.

By embedding pharmacy services—such as chronic disease management, medication therapy optimization, and preventive care (including vaccinations)—into employer offerings, health systems can boost referrals, improve employee health outcomes, and lower total healthcare spend. These services also open new revenue streams for pharmacy, enhancing operating margins and strengthening the health system’s competitive position in local markets.

6.Optimizing the Pharmacy Revenue Cycle

Optimizing the pharmacy revenue cycle through comprehensive audits, staff training, and technology enhancements that ensure accurate charge capture, timely billing, and reduced denials—particularly for high-cost medications and infusion therapies. These improvements translate directly into recovered revenue and reduced financial leakage.

7.Maximizing 340B Program Participation

Maximizing 340B program participation through compliant expansion of contract pharmacy networks, eligibility optimization, and inventory management. In tandem, enhancing pharmacy supply chain performance through strategic sourcing, biosimilar adoption, and inventory efficiency can significantly improve margins without sacrificing quality or access.

8.Engaging External Consulting Partners

Engaging external consulting partners to bring in cutting-edge expertise, and fast-track implementation of complex initiatives such as home infusion start-up, PBM design, or specialty pharmacy business growth. These partnerships allow pharmacy teams to scale faster and more confidently with a proven roadmap.

What This Means for Pharmacy Leadership

These aren’t just operational improvements—they represent a strategic redefinition of pharmacy’s role in enterprise performance. When pharmacy leaders frame these initiatives in financial and strategic terms, they shift from being seen as support functions to becoming valued business partners.

Act Now: You Have the Chance to Shape the Future of Pharmacy

2026 is a pivotal year for pharmacy. As retail chains, national PBMs, and insurer-led platforms race to capture market share, health systems have a narrow window to act. The longer the delay, the harder it becomes to reclaim control and accelerate meaningful growth. Pharmacy must rise to this moment—not just to defend its ground, but to lead in innovation, revenue generation, and enterprise performance.

For health system leaders, the question is simple: is your pharmacy strategy bold, visible, and financially aligned with your organization’s broader goals?

For pharmacy executives, the mandate is urgent: speak the language of enterprise value, advocate for your seat at the table, and embrace calculated risk.

Let’s define your next move (before the competition does)! Visante partners with health system leaders to develop bold strategies that drive enterprise value. Get in touch with our team today!

Visante Subject Matter Experts: Steve Rough and Phil Brummond