Hospital pharmacy leaders are heading into 2026 at a critical inflection point. Escalating care complexity, sustained workforce shortages, rising drug and operational costs, and increasing regulatory expectations are converging to reshape how hospital pharmacies operate. What once could be managed incrementally now demands proactive, strategic action.
Today’s hospital pharmacy is no longer just a support function. It is a core driver of patient safety, financial stewardship, and system-wide performance. When pharmacy operations are aligned with organizational goals and supported by experienced expertise, they can strengthen care delivery and mitigate risk. When they are not, the impact can ripple across the entire hospital.
To succeed in the year ahead, executive teams and pharmacy leaders must work together to understand the challenges and respond intentionally.
CompleteRx has compiled a list of the top three challenges hospital pharmacies should consider as they plan for the rest of 2026, along with practical steps hospitals can take to address them.
1. Persistent Drug Shortages and Supply Chain Fragility
Drug shortages remain one of the most disruptive issues affecting hospital pharmacies. Sterile injectables and specialty drugs are the medications most affected, and regardless of years of attention, shortages continue to impact many others. According to recent industry surveys, three out of four hospital pharmacy teams list drug shortages as their top operational concern, and overall shortage volume remains high.
The effect of shortages goes well beyond procurement. Pharmacy staff spend significant time identifying alternatives, communicating with clinical teams, and managing manual workarounds. These efforts divert attention from higher-value clinical activities and increase the risk of error. In many cases, medication shortages can delay procedures, extend patient length of stay, and create avoidable strain across care teams.
Key impacts of ongoing drug shortages include:
- Increased staff time spent finding alternatives and managing workarounds
- Delays to procedures and extended patient length of stay
- Higher acquisition costs driven by reliance on secondary distributors
From a financial standpoint, shortages often force hospitals to make non-contract purchases at premium prices. What may appear to be a supply issue quickly becomes a labor, safety, and margin problem.
The challenge is made much worse by limited visibility. Many hospitals lack software that could identify factors such as where drugs are used most heavily, which patient-care areas are most affected, and which inventory levels could be better balanced. Without this insight, pharmacy teams are left to react rather than plan.
There is also a structural issue in procurement. Many hospitals lack a dedicated pharmacy buyer, and when the role exists, it is often unsupported by formal training in procurement and inventory management principles.
Steps hospitals can take to reduce the impact of shortages include:
- Improving product-level visibility through inventory analytics
- Allocating scarce drugs to patient care areas with the highest utilization
- Making formal training available for pharmacy buyers
These measures do not eliminate shortages, but they significantly reduce disruption and operational strain.
2. Workforce Strain and Burnout
These workforce challenges in hospital pharmacy settings are by no means new; however, they are getting worse. Plenty of hospitals are still reporting shortages of frontline pharmacists and pharmacy technicians, with technician vacancies proving particularly difficult to fill. This is resulting in pharmacists taking on duties outside their core clinical roles at an increasing rate.
The result of all this pressure is more extended hours and heavier workloads; in turn, stress levels rise, increasing the risk of burnout and staff turnover. This can create a difficult-to-break cycle.
As more experienced staff leave, remaining team members take on more responsibilities. The risk of error is dramatically increased, not to mention overall fatigue.
Why workforce strain matters for hospitals:
- Growing demand for advanced clinical services without commensurate staffing
- Burnout rates among pharmacy staff are higher than those in many other clinical roles
- Compensation compression affecting pharmacy technician retention
The effect that an unstable workforce can have on service consistency and morale cannot be understated. Furthermore, it can delay strategic initiatives and impede a hospital’s ability to expand clinical pharmacy services. There is also much more pressure placed on those leading the pharmacy who are trying their best to manage.
Many organizations still base pharmacy staffing models on historical patterns, adjusting only in response to external triggers such as consultant reviews or mandated reductions. This reactive approach leaves little room for proactive planning or optimization.
A more sustainable strategy starts with regular reviews of staffing levels, role mix, and workflows. Cross-training can help teams cover gaps more effectively, while expanded technician roles and clear career pathways can reduce turnover. Leadership development is equally important. Pharmacy leaders frequently receive limited formal training in people management, despite its clear link to engagement and retention.
Why These Challenges Are Converging
While each of these challenges is large and impactful on its own, the bigger risk for hospital pharmacies is how they loosely connect. Drug shortages, workforce strain, and financial pressure do not work alone. In reality, they compound one another, worsening operational stress across the whole organization.
One example is ongoing drug shortages, which increase the workload for already-stretched pharmacy teams. The time spent sourcing alternatives, adjusting protocols, and communicating changes to clinical staff has a knock-on effect on the capacity for clinical reviews and optimization. Over time, fatigue and disengagement worsen, particularly when team morale is low, and they feel they are constantly firefighting rather than improving systems.
This instability in the workforce creates financial pressure. High staff turnover increases recruitment and onboarding costs. Also, limited staffing capacity can delay reimbursement reviews, slow prior authorization processes, and allow missed charges to accumulate. Gaps like this aren’t an issue on their own, but they accumulate quietly month after month.
There are solutions to address these issues, such as technology upgrades, analytics tools, and leadership development. However, the knock-on effect of financial pressure means that these are postponed, even though they are precisely what enable long-term control and resilience. This creates a cycle in which short-term cost-containment decisions undermine long-term stability.
For pharmacy leaders and hospital executives, seeing this link is critical. Addressing one challenge without accounting for the others often leads to disappointing results. To implement improvements that can be sustained, planning must consider people, processes, and financial impact together rather than in silos.
Hospitals that acknowledge these interdependencies are in a much better position to use initiatives and allocate resources effectively. This, in turn, supports pharmacy teams in moving from reactive problem-solving to structured, forward-looking management.
3. Cost Pressures and Reimbursement Complexity
Financial pressure continues to grow across hospital systems. Pharmacy is at the center of the squeeze, as drug costs now account for an ever-growing share of hospital spending. Unfortunately, reimbursement often fails to keep pace. Rising denials and prior authorization requirements, coupled with patient affordability concerns, add further complexity.
At the same time, regulatory oversight continues to increase. Programs such as 340B pricing require careful compliance and monitoring, while changes in reimbursement models demand closer coordination among pharmacy, finance, and revenue cycle teams.
Why cost and reimbursement pressure cannot be ignored:
- Margin compression is limiting investment in staffing and technology
- Increased compliance risk tied to regulatory oversight requirements
- Lost or delayed reimbursement for medications
In many hospitals, medication reimbursement is not consistently reviewed, allowing underpayments or missed charges to continue unnoticed. These gaps can result in significant financial leakage over an extended period.
Addressing cost pressure requires a shift from reactive control to active management. Ongoing reimbursement reviews help ensure appropriate payment for care delivered, while proactive regulatory planning and self-audits reduce compliance risk. Investment in analytics supports better purchasing decisions, inventory management, waste reduction, formulary optimization, and targeted clinical interventions aligned with treatment guidelines.
Looking Ahead with CompleteRx
The challenges facing hospital pharmacies in 2026 are deeply interconnected—drug shortages strain staff. Workforce shortages increase cost and risk. Financial pressure limits the ability to invest in solutions, and addressing these issues in isolation rarely yields results that are sustainable over the long term.
Hospitals that treat pharmacy as a strategic function, backed by data and planning and supported by leadership development, will be better positioned to manage uncertainties and protect patient care. Simply waiting for conditions to improve is not a plan. The organizations that succeed will be those that accurately assess their pharmacy operations, act honestly, and act before these increasing pressures become systemic problems.
Ready to move from reactive problem-solving to strategic pharmacy leadership? CompleteRx helps hospitals assess risk, optimize operations, and build resilient pharmacy programs that protect patient care. Start the conversation today and contact us.
