Heading into 2026, pharmacy leaders expect to see operations transformed, including shifts in Medicare pricing reform, artificial intelligence and expanding clinical responsibilities.

Here are responses from five pharmacy leaders who were asked: How do you anticipate your pharmacy functions will evolve in the next year?

Note: Responses were lightly edited for length and clarity.

Chad Alvarez, PharmD. System Pharmacy Director at Carilion Clinic (Roanoke, Va.): Pharmacy will continue to evolve through digital transformation and AI tools designed to enhance the patient experience and improve efficiencies in workflow. To improve these efficiencies, we must continue to advance and expand our pharmacy technician workforce assisted with innovation in technology. Expect pharmacy to lead the way on cost-effective care and expand core clinical service to fill the gap in a declining physician population. This will also lead pharmacy to assist with access and throughput and address the emergence of ultra-cost therapeutics.

Gregory Eilinger, PharmD. Director of Pharmacy at Bergen New Bridge Medical Center (Paramus, N.J.): Our pharmacy, as well as the entire medical center, will be heavily engaged with projects to enhance and unify our IT systems across care areas. By standardizing our software between our inpatient, retail and long-term care divisions, we hope to leverage data analytics, both AI powered and traditional, to promote pharmacy services. The improved health information management will power pharmacist-led, and pharmacy supported initiatives in chronic disease management, transitions of care coordination, and improving effectiveness of preventative care. These are all areas of need for our community, and areas where the pharmacy can play an outsized role in improving both patient experience and clinical outcomes.

Dave Lacknauth, PharmD. Executive Director of Pharmacy Services at Broward Health (Fort Lauderdale, Fla.): The pharmacy environment is changing at its fastest pace to date. Pharmacy executives are critical for hundreds of millions of dollars in health system medication management; we will see higher cost medications coming into the market place. Understanding the cost, value and access areas that will also become increasingly complex. Knowledge to advance integration of these therapies for effectiveness will be critical and ultimately improve patient outcomes.

Adam Porath, PharmD. Vice President of Pharmacy Services at Renown Health (Reno, Nev.): Pharmacy is on the cusp of significant transformation in 2026, driven by two major forces: Medicare pricing reform and the rise of artificial intelligence.

For the first time, Medicare will directly negotiate drug prices with pharmaceutical manufacturers — a landmark change set to take effect on January 1, 2026. The initial list includes 10 high-impact medications, and both retail and hospital pharmacies will feel the effects.

To receive rebates covering the gap between the actual purchase price and the newly established Maximum Fair Price (MFP), pharmacies must submit detailed data to a newly created Medicare Transaction Facilitator. However, many operational details of this program remain unclear.

Financially, the implications are concerning. Pharmacies dispensing these drugs to Medicare patients will be reimbursed only at the MFP plus a modest dispensing fee. When overhead costs are considered, this model could result in consistent losses per prescription. Consequently, some pharmacies may opt not to stock these medications, potentially jeopardizing patient access and continuity of care.

The second major shift is the accelerating integration of artificial intelligence into pharmacy workflows. A growing number of pharmacy-focused AI vendors are entering the market, and nearly every health system pharmacy leader is actively exploring how to harness AI effectively.

From expediting prior authorizations to automating audits and compliance checks, AI promises to streamline operations and reduce administrative burden. These innovations are poised to redefine the roles of pharmacists and pharmacy technicians, enabling them to focus more on clinical care and patient engagement.

Sandra Salverson, PharmD. Senior Vice President of Pharmacy Services at OSF Healthcare (Peoria, Ill.): I see OSF Health focusing even more on automation and AI with intentional focus on the outcomes outlined in the autonomous pharmacy white paper: zero errors, zero wait, zero waste and minimal human touches. For OSF, this means evaluating and implementing automation to help with medication access in the rural communities we serve. We need to use telepharmacy tools to help bring pharmacists to patients. We’ll focus on how to highlight patients/care teams who can benefit from pharmacist support around drug-related problems and compliance. It’s about creating a pharmacy without walls or dispensing.

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