How FQHCs Can Strengthen Pharmacy Operations to Expand Medication Access
Federally Qualified Health Centers (FQHCs) are being asked to scale impact in an increasingly complex environment shaped by evolving government regulations, workforce constraints, tighter margins, shifting coverage, and expanding compliance expectations — all of which place significant pressure on already-limited resources and staffing capacity[MF1.1]. As these pressures intensify, many FQHCs are recognizing the need to be more intentional about how their pharmacy models are structured within the context of their patient population, operational capacity, community needs, and 340B program strategy.
Medication access is one of the clearest places where those pressures converge. For FQHCs, medication access is rarely a stand-alone issue. It goes hand in hand with supporting better medical outcomes, particularly for patients managing chronic conditions, behavioral health needs, affordability challenges, transportation barriers, and other pressures that can make it difficult to start and stay on therapy.
That is why integrated pharmacy is becoming one of the most practical ways to extend care team capacity and reduce friction for patients. The National Association of Community Health Centers (NACHC) describes pharmacy services as a critical component of care in community health centers, helping ensure timely access to medications, support chronic disease management, provide immunizations, and deliver personalized care as part of an integrated, team-based approach.1
We know that pharmacy belongs in the health center strategy. The question is how to design pharmacy operations so they reliably extend care, support program integrity, and remain resilient as policies and patient needs shift.
Three shifts redefining pharmacy in health centers
1) Pharmacy is becoming more integrated into the care team
In many health centers, pharmacy teams do far more than dispense medications. Pharmacists and pharmacy technicians can help patients understand how to take their medications, address side effects, support chronic disease management, provide immunizations, and coordinate with providers when medication-related issues arise.1
This expanded role is especially important in FQHC settings, where patients may face affordability, transportation, language, health literacy, or access barriers that make it harder to start and stay on therapy. When pharmacy teams are connected to the broader care model, they can help reduce delays in treatment, improve adherence, and give clinical teams additional support between visits.2
In entity-owned pharmacy models, this connection can also support medication adherence by giving care teams greater visibility into refill behavior, access barriers, and opportunities to intervene when patients are at risk of falling off therapy.
NACHC survey data reflects this shift: 91% of health centers reported that pharmacists collaborate with care teams, 80% provide patient care without scheduled visits, 69% provide medication therapy management, and 53% offer chronic disease management.1 In other words, pharmacy services are becoming a practical way for health centers to extend care, support patients more consistently, and make better use of limited clinical capacity.
2) Pharmacy growth requires stronger leadership and clearer workflows
As pharmacy becomes more embedded in clinical operations, health centers need clear ownership and consistent processes to manage it effectively. NACHC survey findings show that 75% of health centers reported having a designated pharmacy leader, with 49% of those leaders holding middle-management roles and 21.5% sitting at the executive level.1
The practical implication: pharmacy performance increasingly depends on governance, consistent workflows, data discipline, and coordination across finance, clinical leadership, compliance, and operations. NACHC notes that dedicated pharmacy leadership can help community health centers align medication management with organizational goals, strengthen compliance with 340B and other federal programs, maximize limited resources, support cost containment, and improve quality.1
Health centers that treat pharmacy as an enterprise function, not just a dispensing site, are better positioned to adapt when guidance changes, audits arise, patient needs shift, or new access challenges emerge.
3) FQHCs often need a mix of pharmacy models to meet patient needs
There is no single pharmacy model that works for every health center or every patient population. Some FQHCs operate entity-owned pharmacies on-site, giving patients immediate access to medications during or after a visit. Others use contract pharmacy relationships to extend access beyond the health center’s physical location and make it easier for patients to fill prescriptions closer to home.2
NACHC survey findings reflect this blended approach: 55.5% of CHCs reported owning and operating a pharmacy within their health center’s four walls, while 65.6% reported using a contract pharmacy outside the health center.2 The survey also notes that only one in five entity-owned CHC pharmacies offer compounded and specialized medications, suggesting that external partnerships may be important for meeting more complex medication needs.2
Proximity and convenience are important access considerations. Patients may choose where to fill prescriptions based on location, transportation, pharmacy hours, delivery options, payer networks, or existing pharmacy relationships. For that reason, some FQHCs with entity-owned pharmacies are also evaluating ways to extend their reach beyond the clinic, including shipping or delivery options that help meet patients where they are.
For FQHCs, this mix of models can improve access, but it also requires stronger coordination. As pharmacy operations expand across on-site locations, contract pharmacies, and specialized medication partners, health centers need clear workflows, reliable data, and strong compliance processes to keep the model working effectively.
When complexity rises, partnership quality matters
As pharmacy becomes more central to the care model, the operational demands around it become more complex. FQHCs must navigate shifting industry dynamics and growing expectations tied to compliance and program integrity.
As Felipe Moreno, Senior Specialist, 340B Grantees at Cencora, wrote in 340B Report: “With limited infrastructure, evolving regulations, upcoming Medicaid cuts, drops in the insured population and declining federal grants, FQHCs must navigate an increasingly complex and challenging environment while striving to remain sustainable.” 3
Moreno also points to the added complexity of contract pharmacy agreements, manufacturer policy restrictions, identifying the right 340B partners, and compliance demands tied to requirements such as the Drug Supply Chain Security Act. 3
The operational reality is that FQHC teams need partners who can help simplify what can be simplified: alignment between stakeholders, consistent processes, strong documentation, data visibility, and workflows that support both patient access and program integrity.
Just as importantly, partners should understand what “good” looks like in the FQHC environment: community-first decision-making, the need for predictable execution, and an approach that strengthens, rather than competes with, the health center’s existing relationships.
As Senior Director, Community 340B Distribution and Services Growth at Cencora, Tisha Campbell works closely with FQHCs and other non-hospital federal grantees. She sees the need for a practical, connected approach that helps community-based providers move from strategy to execution. “Pharmacy strategy has to connect distribution, technology, consulting, and access solutions in a way that supports both program integrity and patient care,” Campbell says.
For health centers, that kind of integration matters because pharmacy strategy does not sit in one function. Distribution, pharmacy partnerships, data visibility, access strategies, and compliance workflows all have to work together if FQHCs are going to reduce fragmentation and build more resilient programs.
What resilient pharmacy operations require
For FQHCs, the opportunity is not simply to add pharmacy capacity. It is to build a pharmacy operating model that can support access, affordability, clinical coordination, and compliance at the same time.
That requires several capabilities working together:
- Strong pharmacy leadership and governance
- Clear workflows across clinical, pharmacy, finance, compliance, and operations teams
- Better visibility into claims, prescriptions, refill behavior, and patient access barriers
- Flexible pharmacy models tailored to community needs
- Reliable partner relationships across entity-owned and contract pharmacy settings
- Data and documentation practices that support 340B program integrity
- Patient engagement strategies that help people start, continue, and adhere to therapy
The goal is not to push a single model. Some FQHCs may be focused on strengthening an entity-owned pharmacy. Others may need to optimize contract pharmacy relationships, expand specialty or infusion access, improve claims visibility, or identify opportunities to keep more eligible prescriptions connected to their care model.
What matters is that the pharmacy strategy fits the community, supports the care team, and can withstand continued change.
References
2. National Association of Community Health Centers. Expanding Access and Supporting Patient Health. 2025 NACHC survey of community health centers with pharmacies.
3. Moreno, Felipe. “FQHCs Face Unique Challenges — Strong Partnerships Can Make All the Difference.” 340B Report. [Sponsored Content.] https://340breport.com/fqhcs-face-unique-challengesstrong-partnerships-can-make-all-the-difference-sponcon-cencora/
