Recapping 2025 ASHP Midyear: Expanding the Pharmacist’s Role in Patient Care, Technology, and Health System Resilience

Pharmacists are increasingly at the forefront of transforming health care delivery, according to presentations from the American Society of Health-System Pharmacists (ASHP) 2025 Midyear Clinical Meeting and Exhibition. From authorizing medication refills, addressing drug shortages, integrating emerging technologies, and supporting rural and underserved communities, pharmacists are uniquely positioned to optimize patient care, enhance workflow efficiency, ensure medication safety, and serve as essential collaborators in a rapidly evolving health care landscape.^1-6

Empowering Pharmacists to Authorize Refills Improves Outpatient Care

Pharmacist-led refill authorization models have shown significant promise in reducing provider workload and improving patient care, according to data presented by Richie A. Romaniszyn, PharmD, BCPS, operations coordinator at University Hospitals in Cleveland, Ohio. In response to persistent physician burnout and growing refill backlogs in high-volume outpatient clinics, University Hospitals in Cleveland, Ohio, implemented a centralized model in which pharmacists assumed responsibility for processing medication refill requests. By triaging refills through a structured appropriateness, safety, and efficacy review, pharmacists were able to ensure timely medication access, identify clinical concerns, and provide adherence support—tasks often difficult for health care providers to complete amid heavy inbox and visit burdens. This shift not only improved operational efficiency but also strengthened patient-provider relationships by reducing delays and frustration associated with medication access.¹

Over a 12-month period, 2 pharmacists processed more than 14,000 refill authorizations across endocrinology and primary care, conducted over 1000 telehealth visits for chronic disease management, and proactively addressed clinical issues under collaborative practice agreements, according to Romaniszyn. Health care professionals expressed strong support for the model, noting reductions in administrative strain and improvements in workflow. Although pharmacists represent a higher personnel cost, Romaniszyn explained several strategies to sustain the program, including converting patient concerns into referrals and routing prescriptions to internal pharmaciess. Ultimately, he emphasized that refill authorization should be viewed not as clerical work but as a clinical opportunity—one that allows pharmacists to enhance safety and continuity of care while enabling physicians to focus on more complex patient needs.¹

Rural Hospitals Face Mounting Pressures and Closures

Rural hospitals in the US are facing a growing crisis marked by accelerating closures, severe financial strain, and widening gaps in access to care—conditions that Brock Slabach, MPH, FACHE, chief operations officer of the National Rural Health Association, detailed during the Small and Rural Keynote session. With 153 rural hospitals closed since 2010 and more than 400 considered “vulnerable” in 2025, many communities—particularly those in the Midwest and Southeast—are at heightened risk because of high poverty rates, chronic disease, and limited local health infrastructure. Federal policy changes under the One Big Beautiful Bill Act have intensified these challenges, introducing deep cuts to rural health spending, reducing Medicaid funding, increasing insurance premiums, and straining patient eligibility systems. Although the new federal Rural Health Transformation Program provides $50 billion for modernization, the support is far outweighed by the broader financial losses, leaving state systems, hospitals, and families struggling to absorb the impact.²

Amid these pressures, pharmacists stand out as essential and stable health care providers uniquely positioned to support rural communities. During the session, Slabach emphasized that pharmacists often return to and remain in rural practice, making them critical in areas such as chronic disease management, medication safety, antimicrobial stewardship, and transitions of care—all of which are central to quality and access in resource-limited settings. Pharmacy services are also eligible for targeted funding under the Rural Health Transformation Program, and Slabach urged states to incorporate pharmacist-led initiatives into their proposals.²

Pharmacist Strategies for Managing Comorbid Depression and Diabetes

Diabetes and depression share a deeply intertwined, bidirectional relationship, with each condition increasing the risk and complicating the management of the other. In their presentation, Kathleen Vest, PharmD, BCACP, CDE, professor of pharmacy practice at Midwestern University Chicago College of Pharmacy; and Sarah Grady, PharmD, associate professor of pharmacy practice at Drake College of Pharmacy and Health Sciences, emphasized that many hallmark symptoms of depression (eg, fatigue, sleep disturbances, appetite changes, and difficulty concentrating) can also stem from uncontrolled diabetes, making diagnosis challenging. Similarly, treatments for diabetes, including glucagon-like peptide-1 (GLP-1) receptor agonists, may cause weight loss or other changes that overlap with depressive symptoms. Conversely, depression can hinder a patient’s capacity to manage diabetes by reducing motivation to monitor glucose, exercise, or adhere to medication regimens. Together, these overlapping factors create a complex clinical landscape in which each condition can worsen the other without coordinated care.³

The presenters highlighted that treatments for depression introduce additional challenges, as many antidepressants and antipsychotics can affect glucose metabolism, weight, and appetite; increase diabetes risk; or complicate glycemic control. Because these comorbidities frequently intersect with issues such as substance use disorder, pharmacists are uniquely positioned to intervene. Vest and Grady underscored the importance of pharmacist-led screening, medication monitoring, patient education, and cross-specialty collaboration to ensure therapies are safe, effective, and individualized.³

A Cup of Coffee or Lifesaving Drugs: Shifting Decision-Making Practices in Health Care

Michael Ganio, PharmD, MS, BCPS, BCSCP, FASHP, senior director of pharmacy practice and quality at ASHP, highlighted the paradox of sterile injectable drug shortages, noting that many lifesaving drugs cost less than a cup of coffee yet remain in limited supply. Despite the overall number of drug shortages being at a 7-year low, sterile injectables remain disproportionately affected. The root causes are largely economic: Manufacturers have little incentive to produce low-profit drugs, health care professionals prioritize the lowest cost over supplier quality, and regulatory or logistical barriers slow market recovery. The experts emphasized the fragility of the supply chain, where disruptions at any point can ripple across the system. One likened health systems’ hoarding behaviors during crises to a “prisoner’s dilemma” that exacerbates shortages.⁴

Drug shortages significantly impact pharmacy practice by increasing labor and operational costs, as well as posing ethical dilemmas regarding drug allocation. The speakers recommended collaborative strategies among suppliers, health systems, and pharmacies to enhance resilience. Best practices include rewarding suppliers for quality and reliability, even if it means higher short-term costs, and implementing standardized metrics to assess organizational preparedness. The Healthcare Industry Resilience Collaborative’s assessment program, which evaluates hospitals’ capabilities and provides a “resiliency badge” to signal investment in risk mitigation, was also highlighted. These coordinated efforts aim to create a more sustainable, equitable, and resilient drug supply ecosystem.⁴

ASHP Framework Shows How to Embrace AI

Steven Smoke, PharmD, clinical informatics pharmacist at RWJ Barnabas Health, emphasized that artificial intelligence (AI) is becoming a permanent part of pharmacy practice, offering capabilities beyond common expectations. He distinguished between AI hype, which refers to high-quality AI applications such as those used in drug development or diagnostic tools, and AI slop, which refers to low-quality or risky uses that can introduce bias or unsafe recommendations. Smoke highlighted the wide range of perceptions among pharmacists—from regular users to cautious skeptics—and framed AI’s potential in terms of both its transformative opportunities and its limitations.⁵

To guide pharmacists in evaluating AI, Smoke introduced a 2-dimensional framework based on whether AI is generating “original” content or providing predictive outputs and whether it operates near or far from the patient. From this, he suggested that predictive AI, drawing on large data sets, is well suited for operational tasks (eg, inventory management), whereas generative AI requires professional oversight for tasks (eg, drafting medical notes).⁵

Experts Weigh In on GLP-1 Agonist Use in Pediatric Patients With Obesity

Norman E. Fenn, III, PharmD, BCPPS, BCPS, FASHP, clinical associate professor at Manchester University College of Pharmacy, and Kelly L. Matson, PharmD, BCPPS, clinical professor at University of Rhode Island, engaged in a spirited debate over the use of GLP-1 agonists in pediatric obesity. Matson argued that these drugs are highly effective at reducing weight in children and adolescents, citing clinical trials and noting that lifestyle programs, although important, face significant practical barriers such as limited access, time, and insurance coverage. She emphasized that GLP-1 agonists should be used as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) for patients older than 12 years with high body mass index or obesity-related comorbidities, pointing to their rapid and sustained results compared with metformin or other approved therapies.⁶

Fenn countered with concerns about the lack of long-term data on safety, growth, puberty, and weight regain after discontinuation. He stressed that IHBLT should remain the cornerstone of pediatric obesity therapy and highlighted social determinants of health, patient readiness, and family support as critical factors in success. Fenn also raised issues of cost and insurance coverage, arguing that long-term pharmacotherapy could be burdensome and potentially unnecessary for children. The debate highlighted the ethical and clinical complexities pharmacists face when balancing immediate treatment benefits with long-term health risks, underscoring the need for multifaceted, individualized approaches to pediatric obesity management.⁶

The Pharmacist’s Role Amid Future Directions

Amid these evolving challenges and innovations in health care, pharmacists are increasingly positioned as essential clinical leaders who can bridge gaps in patient care, optimize medication management, and support health system resilience. By assuming responsibilities such as refill authorization, pharmacists reduce provider workload while ensuring timely access to medications and identifying clinical concerns, transforming what might traditionally be considered clerical tasks into opportunities for direct patient impact. In rural or resource-limited settings, pharmacists serve as stable, accessible providers, managing chronic diseases, monitoring medication safety, and facilitating transitions of care where other health care access is limited.^1-6

Pharmacists also play a critical role in navigating complex clinical landscapes, such as managing comorbid conditions like diabetes and depression or overseeing pediatric obesity therapies, including GLP-1 agonists, where ethical, safety, and long-term considerations are paramount. Their oversight extends to adapting new technologies, including AI, to enhance operational efficiency, predictive analytics, and clinical decision-making. Additionally, pharmacists are integral to system-level strategies addressing drug shortages, leveraging collaborative frameworks to ensure supply chain reliability and equitable patient access. Across these domains, pharmacists act as clinical experts and patient advocates, enabling safer, more effective, and more resilient health care delivery.^1-6

REFERENCES

1. Silvius L. Case study: empowering pharmacists to authorize refills improves outpatient care. Pharmacy Times. December 8, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/case-study-empowering-pharmacists-to-authorize-refills-improves-outpatient-care

2. Silvius L. Rural hospitals face mounting pressures, closures. Pharmacy Times. December 8, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/rural-hospitals-face-mounting-pressures-closures

3. Silvius L. Pharmacist strategies for managing comorbid depression and diabetes. Pharmacy Times. December 8, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/pharmacist-strategies-for-managing-comorbid-depression-and-diabetes

4. Silvius L. A cup of coffee or lifesaving drugs: shifting decision-making practices in health care. Pharmacy Times. December 9, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/a-cup-of-coffee-or-life-saving-drugs-shifting-decision-making-practices-in-health-care

5. Silvius L. Pharmacists, don’t fear AI: ASHP framework shows how to embrace AI. Pharmacy Times. December 9, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/pharmacists-don-t-fear-ai-ashp-framework-shows-how-to-embrace-ai

6. Silvius L. Experts weigh in on GLP-1 agonist use in pediatric patients with obesity. Pharmacy Times. December 10, 2025. Accessed December 10, 2025. https://www.pharmacytimes.com/view/experts-weigh-in-on-glp-1-agonist-use-in-pediatric-patients-with-obesity