The Preparedness Crisis: A Deep Dive into Pharmacy Forecast 2026

Five contributors to the American Society of Health-System Pharmacists (ASHP) and the ASHP Foundation's Pharmacy Forecast 2026 sounded a warning to the pharmacy industry during a session presentation at ASHP Midyear 2025 Clinical Meeting and Exposition (ASHP Midyear 2025).

The warning consisted mainly of a single theme applicable across several domains: that pharmacists and their health systems are uncertain about the future and unprepared for crises that may arise before the end of the decade.¹

The trend is based on a survey conducted by ASHP of 383 pharmacists, with a 78% response rate (298 total). The survey had 54 questions across 7 themes (domains) covering "the likelihood of those scenarios occurring in the next 5 years within each domain." Respondents were asked to "[assess] preparedness (from 'very unprepared' to 'very prepared') for a subset of 12 statements, 2 from each domain, ... [based] on their firsthand knowledge of current conditions in their region."² Half or more of the respondents considered negative scenarios likely to occur but underestimated their system's preparedness.

That lack of preparation is likely due to the "uncertainty around a lot of these different [subjects]," said Tom Kraus, JD, vice president of Government Relations for ASHP. "I think people know this is coming, but they can also see the sort of freight train coming at them."

The negative scenarios in the document covered several possible impacts on patients, health systems, or pharmacist/pharmacy departments specifically. The questions covered everything from policy effects on their units, such as "Federal government negotiation of drug prices will ... [result] in an overall decrease in health-system pharmacy revenue." In this scenario, 79% considered it somewhat or very likely. Other topics included the impact of artificial intelligence (AI), the future of the 340B Drug Pricing Program, and the growth of uncompensated care due to a lack of or insufficient health insurance. Theranostics, weather-related infrastructure disruptions, and adverse event reporting were also included in the survey and discussed by a panel of authors at ASHP Midyear 2025.

Toni Fera, PharmD, chaired the program and introduced each new section of the discussion with a review of survey responses on that subject.

The "Freight Train" of Policy Changes

Policy-related questions were especially illustrative of a pessimistic view of the future and an underestimation of preparedness. As Facilitator James Hoffman, PharmD, MS, FASHP, pointed out, "These [questions] are written and sent out to panelists in the spring. A lot has changed since the spring."

Kraus agreed and commented on the overall trend of answers to the questions about health-related policy and its impact. "There were very few [areas in the survey] where there was a ... very clear understanding of 'this is a high likelihood' or 'this is a low likelihood.'" The 340B program, the likelihood of millions of Americans losing their health insurance, tariffs, and the financial impact of all this and more on the pharmacy sector were all discussed in the same vein.

Rick Couldry, BSPharm, MS, FASHP, said, "[W]ith all the change and uncertainty and financial challenges, it's easy to get into sort of a negative mindset. I think, as pharmacy leaders, ... when there's a high level of uncertainty, ... you set the direction, and you anchor to what we're here for, and ... make sure you get that mission first." That mission, Hoffman said, is to "take care of patients."

Related to the policy questions was the discussion of stabilizing the drug supply chain by moving the manufacturing of active pharmaceutical ingredients (APIs) to domestic production. According to the survey, about 28% of API production serving the US market is performed domestically. Respondents were asked to predict whether 50% of that production would move to the US by 2030. A majority of respondents, 61%, considered this unlikely. Couldry agreed, saying, "That cost to build [in] the United States [is] much higher than other countries."

Kraus said he expects Congress to debate the issue of drug shortages and that tariffs might have a slight impact, but that the issue "[is] never a priority for Congress until it absolutely is."

His greater fear, though, was over national security and the drug supply chain. "China is potentially preparing to engage in some kind of conflict over Taiwan in 2027," he said. "That's only 13 months away. Policymakers need to be focusing on, can we ensure an adequate supply of APIs and construction materials for products?"

Technology, Therapeutic Advances, and Patients

Tanya Fabian, PharmD, PhD, BCPP, said the impact of technology on how pharmacists deliver care to patients is still changing. "When I look at ... the evolving landscape of digital health therapies and digital mental health therapies, it's very exciting," she said. "It really does open a door [and] it provides a new access point."

Rena A. Gosser, PharmD, BCPS, FASHP, FCCP, said her institution, the University of Washington, has looked at how to partner with large corporations and community organizations. She described a pilot program where they set up telehealth stations in libraries, which "tend not to be very full anymore," and the benefits of going to the patients instead of patients going to the doctor. "They're not traveling through Seattle traffic," she said, "They [don't] miss work [or] have to make up work."

The panelists also discussed the juxtaposition of the cost of advanced and emerging "million-dollar therapies," as Couldry said, against $50 preventative medications, and the ethical decisions of deciding whether they should offer, and who should get, access to more expensive therapies such as cell and gene therapies. "How do you decide, 'Okay, there's a $2.4 million therapy that treats 2 patients a year. [Can we] do it? Should we do it?'"

Gosser added that, in looking to the future, pharmacists needed to make sure they could recognize diseases they've likely never seen before, such as measles. "I know, for me, going through pharmacy school, I learned about them, and then it was just, there was no need to have to pull it out of my pocket," she said. But after the outbreak in 2025 that spread across county and state lines, Gosser said addressing these previously eradicated diseases needed to be part of health systems' emergency preparation, just like a fire drill or power outage contingency plan. "[If] you have a patient that shows up and they have measles, how would you identify it? What would you do? How would you treat it? ... Do you have a plan in place?" she challenged.

Environmental Impact, Safety, and Resilience of Health Systems

The panelists also engaged in a long discussion of environmental impact and resilience. Survey results showed these to be areas of concern, but not one where respondents anticipated much change in the next few years.

"Sometimes we just get whatever is most affordable, and [often] the more green product is way more expensive," Gosser said. Yet she argued that the greener options, even if they were more expensive to initiate, would be more cost-effective over time. At the University of Washington she said staff have received patient feedback requesting more environmentally sustainable packaging for pharmacy products. "We've saved money by doing that, because we're not spending as much on packaging," Gosser said.

Couldry said the best way to sell system leadership on environmental options was to frame it as "resilience and efficiency," which he said were a bigger motivator to leadership than environmental impact alone.

The question of safe practices in pharmacy was also a continued concern. The panelists discussed ways to build safety into every aspect of operations and to engage staff in those improvements. They agreed that communication, especially when a change is initiated, is key to success in this space.

Couldry described a process at his workplace, the University of Kansas, where "one of the first questions [that] gets asked every day of the frontline team is, did you see any unsafe conditions or [are there] any safety concerns you have today?" He said staff thought it was "silly" when this first started, but over time people began to engage, and changes were made that benefit everyone.

Ultimately, Pharmacy Forecast 2026 outlines an industry with challenges ahead but without confidence in its readiness to meet them. The themes raised at ASHP Midyear 2025—policy volatility, drug supply fragility, digital transformation, emerging diseases, and environmental resilience—underscore the message from these panelists: that pharmacists must engage with other stakeholders, both within and without their health systems, to ensure their ability to deliver safe, reliable, and equitable care to patients is strong enough to weather any storm.

REFERENCES

1. Fera T, et al. "Pharmacy forecast 2026: Trends that will shape your future." Presented at: American Society of Health-System Pharmacists Midyear 2025 Clinical Meeting and Exposition; December 7-10, 2025; Las Vegas, Nevada.

2. DiPiro, Joseph T, et al. “ASHP and ASHP Foundation Pharmacy Forecast 2026: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems.” American Journal of Health-System Pharmacy, vol. 00, no. 0, 8 Dec. 2025. https://doi.org/10.1093/ajhp/zxaf247 Accessed 10 Dec. 2025.