Janjri Desai, Pharm.D., on pharmacy value, billing parity and workforce | HSES 2026

Health system pharmacy can drive both clinical excellence and financial performance, but limits on billing for pharmacist services are holding back its growth, according to Janjri Desai, Pharm.D., MBA, DPLA, vice president of pharmacy services at Stanford Health Care. Desai spoke with Managed Healthcare Executive at the 2026 Health System Executive Summit.

Transitions of care pharmacy is one example, Desai said. These teams have improved readmissions and patient satisfaction scores and, in many cases when paired with meds-to-beds programs, length of stay. But they can’t bill for those services, which makes expansion harder to justify, especially in an inpatient setting with capitated payment models. Quantifying the impact of a prevented readmission or a saved inpatient day is how pharmacy makes the financial case, she said.

In ambulatory care, clinical pharmacists in specialty pharmacy and chronic disease management have clearly improved patient outcomes. Specialty pharmacy has a financial component that makes it easier to justify, she said, but in California pharmacists can’t bill for ambulatory clinical services, which makes those programs harder to grow. “I think advocacy at the national and state level to have billing parity will be essential to move the needle forward,” Desai said.

What keeps her up at night is balance. Healthcare is changing rapidly, she said, with emerging cell and gene therapies, a growing drug pipeline and the clinical use of AI, while health systems face serious financial challenges. Leaders need to balance the pace of innovation with “going back to basics” and a strong core foundation, and find ways to fold innovation into existing structures so costs don’t climb over time.

With pharmacy staffing gaps expected to grow, Desai said the answer can’t only be hiring. Innovative care models matter, especially as new graduates look for better work-life balance, and virtual care models that expanded after COVID-19 can help health systems retain staff. Technology also has a role, provided the return on investment is proven. Robotics could take on tasks such as delivering medications throughout the health system, freeing staff to be upskilled for higher-level work. “I’m not saying AI or robotics should take over everything,” she said, but leaders should look for “natural connection points” where technology can help.

In this video, Desai discusses where pharmacy’s value is showing up, what’s getting in the way and how health systems can ease workforce strain.