Why Pharmacy Matters for Health-System Sustainability and Growth

Pharmacy represents a significant expense line for health systems due to high drug costs, but revenue contributions are often obscured by bundled payments, downstream charges, or other payer complexities, according to Lubna Mazin, pharmacy executive at Vizient and former pharmacy revenue cycle manager at Children's Hospital Colorado.

“To change that narrative, pharmacists must learn to quantify and clearly communicate pharmacy’s financial value,” Mazin said.

Mazin is a presenter at Viva Lost Revenue: Strategies for Advanced Players, a session at the upcoming 2025 Midyear Clinical Meeting & Exhibition. She and a co-presenter, Felix Lam, director of pharmacy business services at UK HealthCare, provided ASHP News Center a preview of their session. Other presenters include consultant Michael Storey and Arslan Ali, pharmacy business manager for Nationwide Children’s Hospital in Ohio.

Historically, pharmacy departments have outsourced revenue cycle details to hospital finance departments. But growing costs and complexity of medications require pharmacy to take ownership, they said.

“If we understand everything on the front end — how to get a drug, how to deliver it, and how to get it approved by insurance — maybe we also need to be involved in the behind-the-scenes of what’s happening in the system to make sure we’re charging for it? Who’s touching it behind the scenes to make sure it's coded and accurate before it goes to the payer?” Lam said.

And that’s not just administrative paperwork. Lost revenue, billing errors, and payer denials are a direct result of failing to translate clinical work into accurate billing language, Mazin said.

“The impact extends far beyond finance. It limits a hospital’s ability to reinvest in staff, programs, and medications that directly serve patients,” Mazin said. “For pharmacists, understanding the revenue cycle reframes what might appear as administrative work into an extension of clinical stewardship, making sure that the care we provide is both clinically appropriate and financially acknowledged.”

Presenters will share approaches to several critical components of revenue management, including reimbursement analysis, that have often been outsourced to other departments.

Lam said presenters will also break down efforts to charge accurately and seek reimbursement by using real-world cases and understandable concepts — no MBA required.

“We’ll provide a broad overview of what the revenue cycle is, where pharmacy plays a part now and where they should try to be,” Lam said. “There’s nothing more advanced than what an average pharmacist knows in terms of research analytics they might do as part of say a formulary review.”

Presenters will help participants understand charging patterns and develop electronic health record tools to recognize anomalies, Lam said.

“When the pattern is broken, that is the opportunity to find missing charges or undercharges,” he said.

Special emphasis is on popular topics, including drug waste, and increasingly important therapies, such as advanced gene therapies and radiopharmaceuticals.

Mazin also plans to explore the unique billing aspects of pediatric hospitals. Most patients are covered under Medicaid or the Children’s Health Insurance Program, which requires more state-specific efforts. Weight-based dosing adds another layer of variability to billing because of the high potential for waste, she said.

“In pediatrics, we also deal with compounded preparations, investigational therapies, and emerging gene and cell therapies, each with unique billing pathways and payer requirements,” Mazin said. “My goal is to demystify those complexities so pharmacists can see how their interventions upstream influence billing accuracy and reimbursement downstream.”