Expanding pharmacy's strategic footprint: Leading beyond traditional boundaries

Building strategic influence: The "why pharmacy?" question 

When evaluating potential adjacencies, Curtis starts with a fundamental question: "Why pharmacy?" She advocates for clear articulation of pharmacy's unique value proposition rather than assuming pharmacy should lead simply because medications are involved. 

At St. Luke's, Curtis identified infusion services as a high-value target when eight different departments were touching the service with no unified ownership. The result: patients arriving for treatment with no drug ready and revenue hidden in wrong budgets. After pharmacy took ownership, St. Luke's transformed pharmacy from a cost center to a key contributor to health system financial sustainability leveraging four key pillars: infusion, retail, specialty pharmacy, and 340B optimization. 

From pharmacy expansion to enterprise integration  

Reichard describes successful adjacency leadership as finding "the thread that connects" pharmacy to broader organizational initiatives. At UNC, pharmacy leaders have supported programs and/or moved into roles traditionally outside pharmacy's scope, including virtual care services, home infusion, and ambulatory medical group operations.  

Both leaders emphasize that entering adjacency spaces isn't about asserting dominance. Curtis describes the approach as "not taking over but partnering," approaching colleagues with "I need your help" rather than "Give me your turf." Reichard reinforces this with practical coalition-building tactics: start with frustrated frontline staff who understand the operational pain points, deliver small tactical wins to build executive trust, and tailor your message to the audience. Cost savings for CFOs, therapy expertise for clinical leaders, organizational goals for the C-suite. 

Financial complexity and operational realities  

The financial complexity extends beyond traditional pharmacy metrics. Data challenges consistently emerge as barriers to adjacency leadership. The financial models for retail pharmacy operations differ fundamentally from acute care DRG-based billing. Curtis describes the disconnect: "We're running our business like a hospital, and we're not just a hospital business." As an example, the average infusion claim denial rate of 5% to 10%¹ represents significant revenue leakage, particularly for high-cost specialty therapies where coding errors and billing complexity compound. 

To address these challenges, both organizations created specialized roles. Curtis identified the need for a pharmacy-specific finance director who understands the unique economics of pharmacy operations across retail, specialty, and acute care settings. Reichard emphasizes what he calls a "maturation mindset": demonstrating both immediate ROI through formulary optimization and supply chain efficiency while articulating long-term sophistication value. At UNC, this approach enabled building a large, sophisticated pharmacy chain centralization strategy that created buy-in across the organization. The focus on system-wide inventory and distribution management demonstrated pharmacy's ability to contain costs and optimize operations at an enterprise level. 

A framework for adjacency decisions  

The experiences from St. Luke's and UNC Health suggest a systematic approach to evaluating adjacencies. When Curtis assessed infusion services, she asked: Does a legitimate gap exist in governance or execution that pharmacy is uniquely positioned to fill? The answer was clear: eight departments, no unified owner, patients arriving without drugs ready. Can pharmacy demonstrate measurable value through data and outcomes? Yes, they had data on revenue leakage and patient delays. Does the adjacency align with pharmacy's broader strategic direction? Yes, infusion connected to their specialty pharmacy and 340B strategies.

Reichard applies this similar discipline at UNC. When pharmacy leaders took ownership and/or moved into areas such as home infusion, these roles connected to UNC's distribution strategy and positioned pharmacy to demonstrate value through strategic operational leadership.

This discipline underscores why strategic planning matters. Organizations moving forward without adequate infrastructure, staffing, or expertise will struggle to deliver on adjacency commitments. 

The path forward 

The trajectory of pharmacy leadership points toward continued integration with broader health system strategy. Pharmacy leaders who can navigate blurred departmental lines position themselves as enterprise leaders rather than functional heads. This evolution requires different skills than those that built successful pharmacy departments. Political acumen, relationship building, and the ability to create value for other departments' objectives become as important as clinical and operational excellence.

 St. Luke's and UNC demonstrate what successful adjacency expansion looks like. St. Luke's built governance structures that unified pharmacy operations across the system, breaking down silos that had fragmented retail, specialty, and acute care pharmacy. Both organizations measure success by organizational impact— expanded service capacity, elevated multi-disciplinary patient care, and total cost of care reduction—rather than departmental growth. Organizations that pursue adjacencies with this same discipline position pharmacy for sustained relevance in a healthcare landscape where integration increasingly determines success. 

This article is based on a panel discussion at Cencora's Health Systems National Summit. St. Luke's Health System and UNC Health are both Accelerate Pharmacy Solutions customers navigating adjacency expansion. Accelerate Pharmacy Solutions works with health system pharmacy leaders across specialty drug management, revenue cycle optimization, and patient access programs. For more information, visit Accelerate Pharmacy Solutions.

¹ 1 MD Clarity. "Claim Denial Rate - RCM Metrics." Accessed November 2025. https://www.mdclarity.com/rcm-metrics/claim-denial-rate