Outpatient care continues to expand rapidly across the U.S., driven by patient preferences, reimbursement incentives and the migration of complex services into non‑acute settings. According to the Advisory Board, outpatient volumes are expected to grow more than 10% over the next five years as services such as infusion therapy, orthopedics and cardiovascular care increasingly move outside the hospital setting.
While this shift improves access and convenience for patients, it also introduces new layers of complexity for pharmacy leaders. Non‑acute settings often manage a wider variety of medications, diverse therapeutic regimens and specialty treatments across multiple locations. Without the right structures in place, organizations risk fragmented purchasing, inconsistent formularies and missed opportunities to manage cost and margin effectively.
HealthTrust’s Pharmacy 360 Report highlights non‑acute pharmacy as a growing area of operational and financial exposure, and opportunity, for health systems navigating expansion.
Addressing formulary & purchasing complexities
Pharmacy formularies are inherently complex, shaped by ongoing drug shortages, physician preferences, reimbursement variability and the introduction of ultra‑high‑cost therapies. In non‑acute environments, these challenges are often amplified. Outpatient networks may span multiple specialties and locations, each with distinct clinical needs and payer mixes, making standardization difficult.
In many cases, outpatient facilities lack a centralized pharmacy leader responsible for governing purchases or maintaining a formulary. As a result, drug selection and purchasing decisions may occur in silos, leading to variation, inefficiencies and limited visibility into spend.
Despite these challenges, formularies remain essential. Establishing and maintaining a formulary helps ensure access to safe, effective and affordable treatments while creating guardrails for cost control and consistency. For outpatient providers navigating rapid expansion, a structured formulary approach can support greater standardization, operational efficiency and long‑term sustainability.
Prioritizing system‑level governance
As hospitals expand into cancer infusion centers, ambulatory surgery centers and other outpatient sites, drug utilization continues to rise. For many health systems today, more than half of total drug spend now occurs in outpatient care environments, a significant shift from prior benchmarks.
This transition creates substantial opportunity to apply system‑level oversight to outpatient pharmacy operations. However, the diversity of facilities, specialties and patient populations across networks can make governance challenging.
Best practices begin with establishing a clear playbook for outpatient pharmacy management. This includes defining standardized processes for evaluating drugs, monitoring utilization and adjusting formularies over time. Assigning a point person, or small governance group, to oversee purchasing trends and maintain consistency can further reduce variation and improve coordination.
Regular monitoring and reporting are also essential. Reviewing drug spend and utilization trends at least quarterly helps organizations plan for shortages, identify standardization opportunities and evaluate reimbursement implications across drug categories.
Reshaping non-acute care with specialty therapies
The pace of pharmaceutical innovation continues to accelerate, particularly in biologics, biosimilars, gene therapies and other specialty treatments. While these therapies represent a growing share of drug spend, they are often reimbursed separately in outpatient settings, making them more accessible and financially viable for specific services.
To capture this value, providers must intentionally position pharmacy as a revenue driver rather than a cost center. Defined formulary and agile decision‑making processes are critical to managing high‑cost specialty therapies effectively. Rapid review committees can help organizations evaluate new drugs, assess safety and determine financial impact before adoption.
Equally important is assessing operational readiness. Specialty drugs often require specific storage, handling and training, and outpatient locations may face challenges related to canceled appointments or low utilization. Understanding patient populations, anticipated volumes and reimbursement dynamics helps organizations make informed procurement decisions and avoid unnecessary waste
YOUR TURN
Download the Pharmacy 360 Report or email the HealthTrust team at pharmacy360@healthtrustpg.com to discuss how you can enhance your organization’s pharmacy program.
