Health-system Pharmacy leaders are being asked to solve a margin problem and it is costing hospitals | HSES 2026

Affordability doesn’t just impact patients, it can strain payers, hospitals, and the staff that make them run. In particularly hospital pharmacy about 12,500 openings for pharmacists are projected each year, on average staff are being faced with a conundrum: provide top notch care while managing the hospital’s tight margins. Pharmacy leaders are being asked to manage cost pressures, protect or grow margin, and justify their programs in dollars-and-cents terms rather than purely clinical ones.

According to the US Bureau of Labor Statistics (BLS) between 2025-2035 there will be about 12,500 openings for pharmacists are projected each year, on average. However, experts estimate that only around 8,000 PharmD students will graduate in 2026, and some of them may not even enter the actual industry but instead work as researchers and take on similar roles in drug companies and more. The situation leads to burnout and a lack of innovation— coupled with the prices of drugs and supplies themselves straining margins, pharmacists are being asked to do the near impossible. They are being asked to deliver clinical value while directly shoring up the system’s bottom line, a shift that reframes pharmacy from cost center to financial-sustainability partner.

In a panel discussion at the Health System Executive Summit, moderator Jose Guzman Garcia, PharmD, MHA, BCCCP, associate chief pharmacy officer at UC Davis Health, was joined by panelists Hyesoo Chae, PharmD, MBA, BCPS Director of Pharmacy UCSF Health and Taher Hegab, PharmD, PhD, MBA, director of pharmacy at Alta Bates Medical Center, part of Sutter Health, to discuss financial sustainability from a pharmacy leadership perspective.

Why pharmacy leaders are being pulled into financial strategy

Chae defined financial sustainability as the ability to deliver high-quality, safe medication care at a cost a health system can sustain year after year, breaking it down into three “C’s.”

“One of the ways we can define financial sustainability is the ability to provide high-quality, safe medication care at a cost that we can sustain, maintain, or afford year after year. I think we can capture it in three words that start with C: cost, capture, and capacity,” said Chae

Hegab framed it at the level of the hospital’s single profit-and-loss statement: every department’s budget is ultimately a negotiation over the same bottom line, so pharmacy’s job is optimizing its share of those resources rather than simply asking for more.

He pointed to 340B, infusion centers, study pharmacy, and ambulatory surgical centers as pharmacy’s most visible financial levers — but said those gains eventually plateau, pushing leaders to quantify less obvious value: a shorter length of stay, a lower readmission rate, a charge that would otherwise go uncaptured.

Both described moving away from treating pharmaceutical spend as a single line item on an executive dashboard. Chae said she now separates “good spend” from “bad spend” for her executives — a high-cost drug that avoids a costlier hospitalization isn’t the same problem as unmanaged waste.

Hegab agreed, adding that when a non-formulary drug request comes in, the real question isn’t the price tag alone but the total cost of care; avoided nursing hours, consults or extra hospital days.

The staffing gap behind pharmacy’s margin problem

Chae’s “capacity” piece of that framework speaks directly to the pipeline pressure described above: pharmacy leaders are being asked to do more with the people they already have, since growing headcount isn’t always available as a lever.

That tension became explicit for Hegab’s team in 2025, when staff feedback told him he was moving too fast — “too many initiatives, too many changes.”

His response wasn’t to ask for more people; it was to invest in the ones he had, building an internal leadership-training track for managers and individual contributors so staff understood the purpose behind the pace of change, not just its mechanics.

Chae described a similar approach to sustaining momentum: designing new processes with the people who’ll run them day to day, measuring the metrics that matter so staff can see progress, and deliberately celebrating wins — small and large — to keep teams engaged through constant change.

Panelists also pointed to trust-building with finance, supply chain, nursing, and medical leadership as a substitute for simply growing pharmacy’s own staff. Hegab said that track record is what let him successfully push back when outside reviewers proposed budget cuts to his department; Chae said aligning early on metrics other departments actually care about is what turns those relationships into durable partnerships rather than one-off asks.