What Pharmacy Leaders Really Want to Say About Pharmacy Challenges in 2026

Pharmacy has become one of the most strategically important, operationally complex, and financially impactful areas in healthcare. Pharmacy leaders are stewards of billions of dollars in drug spend and revenue, overseers of critical clinical services, and linchpins in enterprise growth strategies. However, the outdated view of pharmacy as a cost center, coupled with organizational silos, often leaves pharmacy leaders unsure of how to effectively communicate their strategic ideas.

Here’s what pharmacy leaders often want to say, but are unsure how:

Drug Prices and the 340B Program

The 340B Drug Pricing Program has long been a financial backstop for hospitals serving high-need populations. Between manufacturer-imposed restrictions, shifting payment models, and evolving federal oversight, the program has become increasingly volatile.

“340B is a federal program. But you’re constantly working with state-specific policies, billing rules, and cross-team coordination. It’s never just one thing,” shares Sean Hall, Senior Program Director at Visante.

Three key disruptions that health systems are facing include:

1. 340B Rebate Model: There is a shift toward a rebate model, where 340B savings are received after purchase instead of upfront. While manufacturers argue this offers greater oversight, hospitals warn it will create significant financial and operational challenges. Rather than receiving discounts at the point of sale, health systems would need to pay full price for medications and wait for reimbursement. This delay strains cash flow, burdens operations, and increases the risk of denials or missed reimbursements.

Pharmacies are already bracing for the impact: additional claims processing, delayed revenue recognition, and mounting pressure on pharmacy and finance teams to manage large reconciliations.

2. Tighter Medicaid Eligibility: New Medicaid eligibility rules and work requirements could reduce the number of low-income patients counted toward a hospital’s disproportionate share percentage, threatening their 340B status. This leads to tighter reimbursement, smaller discounts, and increased volatility—all while the operational burden of managing the 340B program remains the same.

3. Introduction of Medicare Maximum Fair Prices (MFPs): In 2026, Medicare will implement Maximum Fair Prices (MFPs) for ten high-cost drugs, reducing patient out-of-pocket costs, tightening medication reimbursement, and increasing administrative burden for pharmacy team members. This change creates an opportunity for pharmacy to bring new strategic solutions forward to sustain the bottom line, focusing on access, outcomes, and sustainability.

The MFP model caps reimbursement at fair prices, eliminating traditional markups. While this could create cash flow challenges, pharmacies can minimize disruption with proper planning and strengthening their role in cost management.

This new MFP model will heavily impact 340B hospitals. Historically, these hospitals purchase these drugs at deep discounts and bill Medicare at standard reimbursement. The MFP model will introduce three overlapping threats to 340B savings:

• Reimbursement Capped: Medicare will pay only the MFP, collapsing the margin between discounted 340B purchase prices and standard reimbursement.
• Shrinking Discounts: The MFP will become the new “Best Price” under Medicaid, potentially raising the 340B ceiling price and increasing costs for covered entities.
• Falling List Prices: Drug manufacturers may lower list prices to avoid inflation penalties, but this could reduce 340B discounts, raising ceiling prices and further shrinking margins.

Bridging the Gap with Finance & IT Improves Outcomes For All

The role of pharmacy is expanding, which means pharmacy’s reliance on finance and IT teams is increasing as well. Whether it’s building data infrastructure for tracking drug costs, ensuring revenue integrity for infusions and specialty therapies, or scaling pharmacy-led services, success depends on coordinated investment and support.

Historically, pharmacy was treated as a downstream function and left to retrofit solutions after broader decisions were made. However, in the current landscape, that is no longer the approach. In the most successful health systems, pharmacy leaders are now routinely involved upstream and are equipped with the resources needed to deliver on their roles’ growing expectations.

Internal Silos Undermine Medication Access & Infusion Strategy

Medication access programs, infusion services, and specialty workflows are often fragmented within health systems. When teams operate in silos, roles are unclear and patients fall through the cracks.

These siloed teams result in slower therapy initiation, revenue leakage, and avoidable patient frustration. This gives pharmacy leaders the opportunity to create a coordinated, pharmacy-led system!

“A dedicated pharmacy-based medication access team is crucial for streamlining the process, ensuring that both providers and patients receive the support they need without the back-and-forth delays. When the right team is in place, the focus shifts back to what matters most: patient care,” states Dale Drizd, Managing Director at Visante.

There’s an Opportunity to Strengthen Our Revenue Cycle & Contracting Ties

Today, pharmacy is inseparable from revenue cycle management and payer contracting. Every specialty drug, infusion, and pre-authorization requires precision billing and alignment with payer agreements.

Despite this interdependence, pharmacy leaders often don’t have a seat at the table during contracting discussions or backend reimbursement processes. Incorporating pharmacy leaders as true partners on the health system’s revenue cycle and payer contracting teams is a major opportunity to optimize financial performance, improve operational efficiency, and strengthen strategic alignment across the organization.

The Pharmacy Workforce Crisis Is Real, But We Can Turn It Around

Pharmacy technicians are the foundation of safe and efficient medication management. Unfortunately, health systems are experiencing high vacancy and turnover rates in technician roles, leading to service disruptions and strain on pharmacists.

To solve this, health systems and pharmacists alike must realize the importance of recruitment, training, and role redesign. They must also elevate technician compensation to recognize the growing complexity of work they perform. By investing in these areas and fostering a supportive work environment, health systems can stabilize their workforce, improve operational efficiency, and ensure the delivery of high-quality patient care.

The Bottom Line: Pharmacy is Ready to Lead. Let It.

Pharmacy is quickly becoming one of the most valuable strategic assets in healthcare, with growing influence across cost, quality, and innovation. Leading organizations are recognizing this by bringing pharmacy into enterprise-level planning.

This expanded role positions pharmacy to drive system-wide impact—if supported with the right resources. That means investing in centralized medication access programs and involving pharmacy in revenue cycle performance and payer contracting.

With reimbursement shifts, therapeutic innovation, and 340B volatility ahead, pharmacy leaders are looking for partnership. Now is the time to engage a forward-thinking partner like Visante to help accelerate innovation and long-term growth.

Subject Matter Experts: Steve Rough & Dave Hager