By Jill Costa

For years, pharmacy procurement teams have had the same goals: minimize drug spend, negotiate better contracts, and find cheaper alternatives.

In fact, roughly 72% of pharmacy leaders list reducing drug spend as a top priority, and among organizations with defined cost-savings targets, about 79% are expected to find at least $250,000 in savings this year. 

In the midst of persistent cost-saving pressure, a fundamental shift is underway that demands pharmacy leaders think beyond acquisition cost alone.

The hidden revenue side of every purchase

A topic that often goes unaddressed is the fact that each pharmacy purchasing decision is also a revenue decision, with the potential to generate revenue through drug administration, infusion services, and outpatient dispensing. And with outpatient care projected to grow by 18% over the next decade (significantly outpacing the 5% growth expected in inpatient settings), the revenue implications of procurement choices are becoming increasingly apparent.

One significant challenge is that acquisition cost and reimbursement data typically sit in silos. Drug procurement tools show what a drug costs to buy, while reimbursement information lives in an entirely different system (i.e., payer portals or finance spreadsheets). 

Unless teams manually cross-reference these sources, there is little visibility into both sides of the margin equation. As a result, pharmacy teams end up relying on the data they have immediately available — cost data — which can misguide purchasing decisions.

The margin paradox in specialty drugs

This visibility gap creates particularly acute challenges in specialty medications and biosimilars, where the financial stakes are highest. Industry analyses suggest that margin swings between interchangeable biosimilar products can range from a $550 net loss to a $1,500 net gain per vial, depending on which option is selected.

Two drugs may be clinically equivalent and satisfy the same therapeutic need, yet deliver vastly different margins. A product that costs slightly more to acquire might reimburse at a meaningfully higher rate, creating a net positive margin impact that a cost-only analysis would miss entirely.

Three types of procurement opportunities

Forward-thinking pharmacy departments recognize the limitations of cost-only analyses and are expanding the scope of their purchasing decisions using tools that surface three types of opportunities. These include:

• Cost savings: A therapeutically appropriate alternative lowers acquisition cost while reimbursement remains constant.
• Revenue potential: A similarly priced alternative reimburses at a higher rate, increasing margin without raising upfront spend.
• Double win: A single switch delivers both lower acquisition cost and higher reimbursement.

By embedding reimbursement data directly into purchasing workflows, procurement teams can identify revenue opportunities and double wins that would otherwise remain invisible.

A new value proposition

As reimbursement pressures intensify — with site-neutral payment policies expected to reduce outpatient drug administration payments by roughly $290 million in 2026, and a proposed 2027 rule threatening to cut 340B reimbursement rates by nearly 40% — pharmacy leaders who master margin-aware procurement gain a strategic advantage for their hospital.

This shift in decision-making repositions pharmacy from a department that minimizes losses to one that actively contributes to health system financial sustainability.

References

Bluesight. (2026). 12th Annual Hospital Pharmacy Operations Report.

Bluesight. (2026). Bluesight launches revenue optimization capabilities, expanding margin insights for hospital pharmacies [press release].

Vizient. (2025). Sg2 forecasts 18% growth in outpatient care, 5% inpatient care [press release].