3 Moves Every Pharmacy Should Make Now to Regain Operational Control

Shortage management can consume as much as 25% of a pharmacy team's purchasing time when the full scope of NDC changes, reimbursement validation and vendor outreach is accounted for. That is time not spent on patient care.

Drug Costs and Margin Pressure are Not Relenting

Approximately 870 brand-name medications saw a median price increase of 4% in early 2026, even as policy efforts aimed at containing costs continue to work through the system. The Inflation Reduction Act's price negotiation provisions are beginning to affect Medicare pricing on 10 high-spend drugs, with reimbursement impacts that many pharmacies are still working to understand and model. Meanwhile, generic deflation continues but creates its own risks: as manufacturers exit generic markets, remaining suppliers gain pricing power and supply reliability deteriorates.

Biologics and specialty medications present a newer challenge. With individual products sometimes costing tens of thousands of dollars per unit, the inventory carrying costs are enormous and getting the timing of purchasing right has a direct impact on cash flow.

Payer Pressure and Compliance Scrutiny are Intensifying

PBMs continue to reshape pharmacy economics through prior authorization requirements, quantity limits, step therapy protocols and retroactive adjustments that make point-of-sale margin prediction increasingly difficult. At the same time, compliance requirements under DSCSA have been fully implemented and state and federal audits are ongoing. Pharmacies that have not built systematic compliance infrastructure into their receiving and purchasing workflows face real exposure.

Staffing Capacity Has Not Recovered

Pharmacy enrollment and technician pipelines remain constrained post-COVID and turnover rates have stayed elevated. The answer cannot be simply adding headcount. Margins do not support it and the people are not available. The answer has to be technology. As Cruse put it directly:

01 Tighten Cost of Goods with a Single Source of Truth

Cost of goods is the single largest expense in pharmacy operations and the most direct lever available to improve profitability. Yet most pharmacies manage their purchasing across fragmented systems with limited visibility into true dead-net cost after rebates, compliance incentives and source product agreements are factored in.

The complexity is real. Primary vendor agreements carry compliance targets that, if missed, affect cost-minus pricing. Incentives tied to compliance or source product purchasing compound the calculation further. Secondary distributors, sometimes owned by the same parent companies as primary wholesalers, may count toward compliance in certain contracts. Without a consolidated view, pharmacy buyers are making purchasing decisions without seeing the full picture, and money is consistently left on the table.

The move here is to consolidate all vendor data, contract terms and pricing into a single platform so that every purchasing decision is made with complete information. This means knowing not just invoice cost but dead-net cost with rebates applied, understanding compliance standing against primary agreement targets in real time and identifying opportunities to capture better pricing from secondary sources without undermining primary vendor relationships.

Cruse described the operational discipline her team has built around this:

The goal is simple: more margin from the same spend and better visibility to act on every dollar.

02 Automate Inventory to Match True Demand

Traditional inventory management in long-term care and retail pharmacy was built on physical counts, manual reorder decisions and safety stock buffers that may have made sense when drugs cost $10 a bottle. They do not make sense when a single specialty or biologic product represents thousands of dollars of tied-up capital.

Demand-based, just-in-time replenishment replaces those manual processes with systems that monitor actual utilization, calculate reorder timing automatically and trigger replenishment before a stockout occurs rather than after. The result is tighter inventory, better turns and significantly less cash sitting on shelves.

There is an important nuance here for pharmacies managing product groups rather than individual NDCs. When a shortage forces a substitution from one NDC to another, a linear reorder model treating each NDC independently will misread demand. A system that manages replenishment at the product group level, recognizing that demand for a therapeutic equivalent should inform inventory decisions for the entire group, makes dramatically more accurate recommendations.

For multi-location operations, the opportunity extends further: having real-time visibility across locations means that excess inventory at one site can be transferred to meet demand at another rather than triggering a new purchase at full cost.

Cruse has seen the results firsthand at AmPharm:

When asked how accurate her perpetual inventory needs to be for the system to be trusted, Cruse set the bar clearly:

“I think it's more of a 90/10. All of these reordering logics need to be working at 90%.
If they're not, people are just going to go back to manual work."

03 Get Ahead of Shortages with Predictive Intelligence

The reactive shortage response cycle is one of the most expensive and disruptive patterns in pharmacy operations. A shortage is declared, staff pivot from other tasks to source alternatives, a more expensive product is purchased under time pressure, clinical teams are notified of substitutions, and facilities or patients may experience disruption. Then it happens again.

The cost of reactive purchasing is well documented: replacement products sourced during a shortage typically cost 88% to 250% more than products purchased under normal market conditions. For a business already operating on thin margins, that premium is not sustainable.

The alternative is detecting shortage signals early, before they become official declarations, and taking action while lower-cost options are still available and clinical teams can be engaged proactively rather than reactively.

SureCost Drug Shortage InsightsTM does this by aggregating FDA data, wholesaler inventory signals and anonymized network-wide purchasing patterns into a predictive engine that identifies shortage risk at greater than 90% accuracy up to two months in advance. For each at-risk item, the platform provides a risk score, a confidence level and an estimated resolution timeline alongside equivalent NDCs and alternative vendor availability with current pricing.

This changes the decision entirely. The question is no longer "how do I find this product today" but rather "do I need to act now, or does my team have time to evaluate alternatives and communicate with prescribers before this becomes an issue?" As Cruse explained, the eighty/twenty framework applies here too:

The Case for Formularies in LTC and Specialty Settings

One underutilized tool that Cruse has made central to AmPharm's operations is the facility formulary. In long-term care settings, where pharmacies often serve a defined patient population with a relatively stable prescriber base, formularies allow pharmacy teams to align purchasing with clinical reality rather than reacting to every individual order.

The operational benefit is significant: high-volume formulary items can be stocked with confidence and managed through automated replenishment. Lower-volume non-formulary items are ordered only after payer validation, avoiding unnecessary inventory exposure. The result is a leaner operation with less tied-up capital and fewer stockouts on the drugs that matter most.

The Technology Imperative

Running through all three moves is a single thread: technology is no longer optional. The margin environment does not support adding staff to solve operational problems manually and the problems themselves have grown too complex for spreadsheets and manual workflows to address reliably.

The pharmacies that are building durable operational advantages today are the ones investing in integrated platforms that connect purchasing, inventory and compliance data in one place and that use that data actively to drive better decisions. They are not replacing clinical judgment with automation. They are freeing their teams from low-value manual work so that clinical judgment can be applied where it actually matters.

Cruse framed the cultural challenge plainly: