Health-system pharmacists gathered Dec. 9 at the Midyear Clinical Meeting and Exhibition in Las Vegas, Nevada, to discuss the newly released 2026 ASHP/ASHP Foundation Pharmacy Forecast and how pharmacists can use the report’s insights to position themselves for success in the future.
Pharmacy Forecast, now in its 14th edition, draws its findings from a survey of nearly 300 U.S. pharmacy leaders on key topics impacting health systems.
“Each year, I gain a better understanding of the changes that we’re all seeing in our healthcare environment,” said longtime Pharmacy Forecast Editor Joseph T. DiPiro, professor emeritus at Virginia Commonwealth University, adding that any individual practitioner’s perspective “can be greatly expanded with the combined wisdom of our colleagues.”
A project of ASHP and the ASHP Foundation, the annual Pharmacy Forecast gauges the likelihood that certain environmental trends will affect pharmacy practice in the coming five years, as well as how prepared health-system pharmacists feel to meet those challenges. The report also offers analysis and recommendations to inform pharmacy leaders’ strategic planning.
ASHP Senior Consultant Toni Fera presented a few of the trends that pharmacists might encounter by 2030, including:
- All pharmaceutical manufacturers will require a rebate-based model for 340B covered entities — 60% of survey respondents said this was somewhat or very likely, but only 41% considered themselves prepared.
- The growth of theranostics will expand beyond oncology indications, driving broader and more common use among health systems — 76% said this was likely, but only 33% felt prepared.
- Respondents expected that 75% of health systems will see a significant increase in uncompensated care due to an increase in patients who are uninsured or underinsured — 85% said it was likely, but only 45% felt prepared.
- As a priority, health-system pharmacies will purchase medications with less environmental impact (e.g., more efficient packaging, inhaler devices with a lower carbon footprint) — this was a rare area where respondents’ sense of preparedness (44%) exceeded predicted likelihood (30%).
In a panel discussion, Pharmacy Forecast contributors reflected on the results and how pharmacy leaders might act on them, especially given the common theme of uncertainty.
Bracing for 340B disruption
The 340B Drug Pricing Program was a major topic of discussion, as anticipated restrictions could reshape how health systems manage costs and deliver care. Healthcare and pharmacy are headed toward “significant financial headwinds” if 340B shifts toward a rebate model, noted Tom Kraus, ASHP vice president of government relations.
Any change to 340B is likely to be slow as it works its way through the federal system. “This is where the market is going. I think people know this is coming … even if we don’t know what it’s going to be like,” Kraus said. “We'll have time to figure it out.”
Rena A. Gosser, assistant director of specialty pharmacy services and medication access at University of Washington Medicine, encouraged Midyear attendees to always remember the patients whose healthcare access depends on the 340B program. “Thinking clinically, what does that [policy change] do for our patients, and how can we support all of that?” she posed.
New vs. tried-and-true
According to the Forecast, advanced therapeutics are very likely to place new demands on the health-system pharmacy workforce in the next five years. Tanya Fabian, director of pharmacy research and pharmacy services at University of Pittsburgh Medical Center Western Psychiatric Hospital, celebrated the potential of new therapies and digital health technology to help diagnose patients’ health conditions more accurately and intervene sooner.
Pharmacists must help determine whether and when to adopt these treatments within their practice sites, balancing health outcomes, access, and financial stewardship. Tried-and-true treatments may be the best overall choice, she argued — at least until newer ones gain a firmer foothold.
“We’re excited about those advancements, but we have to figure out how to move forward in small steps so that we can improve access and operational efficiency,” Fabian said.
Redefining safety
Safety remains paramount, but its exact definition may be shifting as health systems embrace a proactive rather than reactive stance. It’s not enough to report medication errors, for instance, argued Rick Couldry, vice president of pharmacy and health professions at the University of Kansas Health System. Leaders must foster a safety culture that celebrates good catches and encourages frontline staff to speak up.
His health system holds daily team huddles that ask: Have you seen any unsafe conditions today? “I feel it’s distinctly the responsibility of leaders to make safety a priority. That huddle structure creates communication and new norms, and gives people a forum,” Couldry said.
Pharmacists are well-suited to help their organizations navigate the many challenges facing healthcare, he added. Few other professions combine subject-matter expertise, project management, leadership, and a passion for patient care.
“You have to have a natural professional who has all those pieces,” he said. “And that’s what we [as pharmacists] do.”
The Pharmacy Forecast is published online ahead of print and will appear in print in the Jan. 15, 2026, issue of AJHP. All editions are freely accessible online.
