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New Vizient Networks survey findings suggest health systems have made significant progress in building enterprise pharmacy capabilities. The next challenge is creating the governance, financial visibility, and executive alignment needed to manage them as an integrated business.
Consider what sits under health system pharmacy umbrellas today. It isn’t just inpatient pharmacy. For many, they oversee a collection of initiatives including specialty and retail pharmacy, ambulatory and home infusion, medication access, and 340B programs that reach well beyond the hospital.
But the infrastructure surrounding the pharmacy enterprise hasn’t evolved at the same pace.
A new Vizient Networks Pharmacy Services Corporate Structure Survey of 50 health systems captures the disconnect. Eighty-eight percent of all respondents operate centralized or hybrid enterprise pharmacy models. Among the smaller subset of respondents with separate pharmacy entities, however, only 22% reported a fully consolidated enterprise pharmacy P&L—suggesting that even among organizations that have pursued legal restructuring, financial integration remains variable.
The survey insights came to life during a recent Vizient Networks C-suite Exchange webinar, where pharmacy and finance leaders from Fairview Health Services and Novant Health shared how their organizations are navigating many of these same questions—from governance and financial visibility to growth and demonstrating value.
Together, the survey findings and their experiences offer a window into where enterprise pharmacy is today and what comes next.
Survey spotlight: 88% of health systems operate centralized or hybrid enterprise pharmacy models.
The breadth of pharmacy oversight among survey respondents shows how much the business has changed. Enterprise pharmacy is no longer primarily about coordinating medication management across hospitals. It now connects patients to medications and services across care settings, giving pharmacy a growing role in access, continuity of care, and organizational sustainability.
That reach also creates an opportunity closer to home: better connecting patients already receiving care within the health system to its pharmacy services. Integrating pharmacy services and coordinating touchpoints across ambulatory, infusion, and other settings can help maintain continuity as patients move through their care journey while retaining prescriptions that might otherwise leave the organization.
The discussion also surfaced an often-overlooked competitive advantage: health systems already sustain patient relationships, provider connections, and community trust that outside pharmacy competitors must spend heavily to build.
Survey spotlight: 18% of organizations have established a separate legal entity for pharmacy services.
While 88% of respondents operate centralized or hybrid enterprise pharmacy models, only 18% have established a separate legal entity like a Limited Liability Company (LLC) for pharmacy services.
That gap doesn't suggest health systems need more pharmacy LLCs, but does point to a broader governance question: Does the current structure support what the organization is trying to accomplish?
For some organizations, a separate entity may provide greater flexibility for growth, partnerships, or financial management. Others may be able to achieve the same objectives within an integrated model.
The important distinction is between structure and strategy. Legal structure can support an enterprise pharmacy strategy, but it isn't a measure of its maturity.
Survey spotlight: 78% cited revenue growth as a primary driver for creating a separate pharmacy entity. Forty-nine percent cited 340B considerations as a primary reason not to.
Understanding why health systems choose different structures may be more revealing than the structures themselves.
Among respondents that established separate pharmacy entities, 78% cited revenue growth or diversification as a primary driver, with strategic partnerships and market agility also factoring into their decisions. Among organizations not pursuing a separate entity, 49% cited 340B considerations or risk tolerance; other frequently cited factors included organizational priorities, unclear ROI, legal/tax/compliance considerations, and complexity. Together, the findings show the strategic tension facing executive teams: Pharmacy offers new avenues for sustainable growth, but pursuing them requires organizations to weigh opportunity against regulatory, operational, and financial risk—and determine the structure best aligned with broader enterprise strategy.
Infusion demonstrates the opportunity. Fairview Health Services and Novant Health illustrated different approaches to infusion growth, including home and ambulatory infusion, with opportunities to improve access and move appropriate care to lower-cost settings. Capturing that opportunity, however, requires organizations to consider how new services fit with existing clinical operations, patient pathways, and investment priorities.
Survey spotlight: 22% report a fully consolidated enterprise pharmacy profit and loss (P&L) statement.
Perhaps the clearest governance gap revealed by the survey is financial visibility.
Among respondents with separate pharmacy entities, 22% reported a fully consolidated enterprise pharmacy P&L. Even among organizations operating separate entities, approaches to financial reporting and accountability vary, while pharmacy investments continue to compete within broader enterprise capital processes.
For executive leaders, the issue is practical: Can they see how pharmacy is performing across the enterprise?
Without that visibility, it becomes harder to identify where pharmacy is creating value, where margin is being lost, and which opportunities warrant further investment. At Novant Health, separating retail and specialty pharmacy performance within financial reporting helped leaders more clearly see those businesses and their growth potential.
Visibility, however, is only part of the equation. C-suite Exchange leaders also emphasized revenue-cycle discipline as a core enterprise pharmacy capability. At Fairview Health Services, pharmacy's ability to capture the resources generated from its operations has a significant impact on the bottom line.
But managing pharmacy as an enterprise also requires more than financial discipline. Ensuring that pharmacy leaders have a voice in decisions about investment, risk, and growth are made are key. The client examples suggest that executive representation can align pharmacy strategy with broader enterprise priorities and enable cross-service-line investment and integration.
For a business of this scale, revenue integrity isn't simply an administrative function. It's part of managing pharmacy performance. Financial visibility, disciplined revenue cycle processes, and a pharmacy voice in enterprise decision-making give leaders a clearer picture of pharmacy's contribution and a stronger foundation for deciding where to invest next.
The survey doesn't point to an ideal legal structure, nor does it suggest every health system should create a separate pharmacy entity. But it does show that structure follows strategy.
Health systems have spent years expanding pharmacy's reach across the continuum. In many organizations, that work has produced a sophisticated collection of businesses and clinical capabilities that would have been difficult to imagine under the traditional hospital pharmacy model.
Now the management infrastructure must catch up. For CFOs, chief pharmacy executives, and other health system leaders, that means asking a different set of questions:
The next phase of pharmacy transformation may not be defined by how many new services health systems add, but by whether they can fully see, govern, and operationalize the enterprise they've already built.
Learn more about Vizient Networks with—12 C-level networks including pharmacy and financial leaders—that drive healthcare performance improvement to help hospital and healthcare leadership teams accelerate their high-performance journeys.
Associate Vice President
Sybil Thomas, PharmD, MBA, is Associate Vice President, Vizient Networks at Vizient. She leads the Chief Pharmacy Executives Network, bringing together senior pharmacy executives from health systems across the country for peer learning, strategic collaboration, and problem-solving.
Associate Vice President, Networks
Jordan Peck is Associate Vice President, Networks for Vizient. He is a subject matter expert on strategy, operations, and facilitation responsible for the Vizient Chief Financial Officer, Chief Operations Officer, and payer strategy executive networks.
