In 2025, hospital pharmacies continue to navigate the complex web of challenges and persistent evolution that reshapes the healthcare industry. While many of the issues hospital pharmacies faced in 2024 have lingered into this new year, we are taking a look at the top four issues facing hospital pharmacy in 2025.
Drug Shortages
As of December 2024, 270 drugs were reported as experiencing a shortage. While this was a decrease from 2023 to 2024, many commonly used drug products remain scarce. Most recently a number of common injectable fluids, such as normal saline, became critically short due to the impacts of The IV fluid shortage has required many facilities to change protocols, postpone procedures, and even revert to utilizing oral hydrating agents when appropriate. The drug shortage issue has been ongoing and shows no signs of ending soon.
What you can do:
To try and minimize the impact of drug shortages, hospitals can take steps such as consolidating stock locations for scarce items and revising standing order sets to include therapeutic alternatives.
Discover more ways to prepare and navigate drug shortages.
Pharmacy Workforce
Last year we discussed concerns not only with recruiting and retaining staff, but, also, a new challenge of decreased enrollment rates in pharmacy schools nationwide. While many hospital leaders spent the last couple of years post COVID-19 addressing staffing challenges like burnout through programs like those launched by the CDC, the pharmacy workforce, and it’s challenges, continues to fluctuate.
The job market for pharmacy technicians is expected to increase. With the average growth rate for all occupations at 4% over the next ten years, the projected percent change for pharmacy technician employment is 7% per the U.S. Department of Labor forecast. High demand and mandated minimum wage laws have driven up pharmacy technician wages significantly in the post COVID-19 environment. Competitive wages along with maintaining an engaging work environment will be key factors in retaining technician talent.
The future picture for hospital pharmacist staffing is mixed. Retail pharmacies continue to consolidate. Both CVS and Walgreen’s have announced store closures over the next three years with a shift to centralized mail order services. Short term, hospitals may be able to leverage this change to fill pharmacist vacancies by developing robust training programs to help retail pharmacists make the shift to the hospital environment.
As addressed in our review last year, long term pharmacist availability may be challenging. Pharmacy school enrollments have declined by 23% from 2020 to 2023, while recruitment for pharmacists remain steady. As the current generation of pharmacists retire, the demand for hospital pharmacists is anticipated to increase.
What you can do:
Building relationships with pharmacy schools and maintaining a pharmacy residency program are strategies which can help ensure access to new pharmacy school graduates and support a proactive recruiting strategy.
340B Drug Pricing Program Updates
Like last year, when discussing new and ongoing issues in hospital pharmacy, we cannot help but mention the 340B Drug Pricing Program and its complexities. The 340B Drug Pricing Program is a federal program which was designed to provide significant drug manufacturer discounts for medications used in the outpatient setting to health care organizations that provide care for low income or uninsured patients.
Drug manufacturers claim the program is being applied too broadly in that qualified institutions are applying the discounts to all patients they serve, not just low income or uninsured patients. In 2010, fewer than 1,300 unique locations acted as contract pharmacy locations according to the Drug Channel Institute. As of 2023, the number has ballooned to 33,000 locations1. Subsequently manufacturers have imposed restrictions by limiting the number of contract pharmacies eligible for discounts. Several recent courts of appeals cases have sided with drug manufacturers, however, several other appellate decisions remain pending.
The restrictions imposed by manufacturers have resulted in significant decreases in contract pharmacy revenue which many 340B eligible health care institutions have come to rely on.
What you can do:
Healthcare systems should take measures to ensure that their staff is qualified and up to date on 340B Program requirements. Additionally, contract pharmacies should be reviewed and analyzed for compliance and financial impact. Healthcare systems should also anticipate further manufacturer restrictions as pending lawsuits make their way through the courts.
Looking to better understand the 340B Drug Pricing Program, read our full guide.
Reimbursement Challenges
Hospitals continue to promote outpatient drug treatment when possible. Many outpatient infusion drugs can cost thousands of dollars. To ensure maximum reimbursement requires systems to have a strong pre-authorization process, clean billing data, and effective communication between the pharmacy and infusion site to minimize medication waste and payment delays.
The introduction of biosimilars offered cost effective alternatives to proprietary products, however many institutions are not realizing the savings. Key contributors are a reluctance by some physicians to write for biosimilars. Another is related to reimbursement. In many instances, third party payors have negotiated reimbursement for preferred products. This may require an institution to carry competing products and dispensing the preferred product based on the patient’s insurance.
What you can do:
Hospital pharmacy leaders need to make concerted efforts to educate physicians, patients, and finance on the proper use, selection, and billing of biosimilars. In addition, checking to ensure the pharmacy charge description master is accurate will help to maximize reimbursements and reduce work associated with rebilling rejected claims.
Discover how your pharmacy plays a crucial role in maximizing reimbursement.
While we have shortlisted these top four current issues facing hospital pharmacies, experts at CompleteRx continue to monitor other concerns such as cyber security, AI, 2025 regulatory and compliance updates and many more. Want to review last year’s issues? Check out our complete 2024 list here.
About the Author
Rick Burnett, Pharm. D., FACHE, Chief Operating Officer
Dr. Burnett joined the CompleteRx team in 2011. As COO, Rick leads the day-to-day operations delivery for all CompleteRx customers. His 25+ years in hospital pharmacy management include experience in a variety of sets from small rural hospitals to multi-system academic settings.
Rick started his career as a pharmacy technician. He earned his Pharm. D. from the University of Illinois and completed a residency at the University of Florida. Rick spent most of his career working for a Fortune 20 company where he held various leadership positions in multiple disciplines including pharmacy management, consulting, product development and product management. One of his key achievements was the co-development of a patented method for analyzing data to minimize drug costs. Rick has a hands-on style of leadership and enjoys working in teams with executive leadership, customers, corporate partners, and employees.
Rick is an active member of the American Society of Health System Pharmacists. He was appointed twice to serve on the ASHP strategic advisory for leadership development. He is also a Fellow of the American College of Healthcare Executives.
