For years, hospital pharmacy supply chains were built around one central assumption: reliability. Manufacturers would produce, wholesalers would deliver, and health systems could operate with minimal inventory on shelves.
That model no longer holds.
As shortages of generic injectables, oncology drugs, anesthetics and IV fluids continue to ripple through healthcare, pharmacy leaders told Becker’s they are redesigning their supply chains not for efficiency, but for survival.
Here are five ways health systems are rebuilding pharmacy supply chains to withstand persistent disruption.
1. Moving away from just-in-time inventory
One of the most fundamental shifts pharmacy leaders are making is abandoning just-in-time inventory models for critical medications.
At Signature Healthcare, based in Brockton, Mass., Vice President of Pharmacy Operations David Young said that although multi-sourcing and clinical substitution protocols helped, they were insufficient when shortages dragged on.
“Our just-in-time inventory model and limited supply chain visibility beyond immediate suppliers left us dangerously exposed to extended disruptions,” he said.
The organization has since moved toward risk-stratified inventory management, expanded safety stock for essential drugs, and predictive analytics to anticipate shortages earlier — even if it means carrying more inventory.
Baptist Health South Florida, based in Coral Gables, has made a similar shift. Chief Pharmacy Officer Madeline Camejo, PharmD, said true resilience requires a fundamental change in priorities.
“This means moving away from a just-in-time inventory approach toward diversified sourcing, increased transparency and robust buffer stocks,” she said.
2. Locking in supply through direct manufacturing partnerships
Rather than relying solely on traditional wholesalers, some health systems are now securing supply upstream.
Baptist Health South Florida’s partnership with Civica Rx has become a core part of its resilience strategy.
“By contracting directly with hospitals and bypassing traditional middlemen, Civica Rx ensures a stable supply of essential, often-scarce generic injectable medications,” Dr. Camejo said.
Civica’s new manufacturing facility in Virginia, which produces sterile injectables and insulin, also reduces dependence on fragile global supply chains — an increasingly important hedge as geopolitical and quality-related manufacturing disruptions continue.
Indianapolis-based Indiana University Health has embraced a similar approach. Executive Director of Pharmacy Supply Chain Derek Imars, PharmD, said multisource manufacturing is critical for long-term stability.
“A single manufacturer’s compliance failure should not result in a total supply chain collapse,” he said.
3. Centralizing purchasing and shortage response
Another major shift is organizational. Health systems are moving away from decentralized buying and reactive scrambling toward centralized command centers for pharmacy supply.
At Indiana University Health, pharmacy supply chain teams now operate through a centralized service center with real-time dashboards, weekly shortage calls and dedicated purchasing staff.
“We’ve shifted the focus from what is on hand to the velocity of consumption,” Dr. Imars said. “That allows us to accurately calculate days-on-hand supply and trigger contingency protocols with meaningful lead time.”
Even smaller systems are formalizing this structure. Singing River Health System, based in Ocean Springs, Miss., now assigns a dedicated pharmacy buyer to each site and holds routine meetings focused solely on supply and allocation.
“Consistent inventory, close attention to allocations and preventing drug shortages are the primary goals,” Executive Director of Pharmacy Lisa Fratesi said.
4. Using data to see shortages before they hit patients
Visibility — or the lack thereof — has emerged as one of the biggest constraints pharmacy leaders face.
MedStar Health, based in Columbia, Md., has leaned heavily on collaboration and therapeutic substitution to keep care moving. But Vice President of Pharmacy Services Bonnie Levin, PharmD, said early warning remains a challenge.
“Limitations include dependency on single-source supplies and challenges with early warning systems,” she said. MedStar is now implementing third-party software to provide virtual visibility across its inventories.
Other systems are also turning to data to get ahead of shortages. At Indiana University Health, real-time dashboards help teams monitor consumption trends and adjust sourcing before shortages occur. And at HCA Florida North Florida Hospital, part of Nashville, Tenn.-based HCA Healthcare, Director of Pharmacy Bickkie Solomon, PharmD, said analytics — particularly AI — will increasingly shape this work when applied responsibly.
“AI, applied ethically with governance, stakeholder engagement and validated data, can transform predictability, inventory management and decision-making,” she said.
5. Treating shortages as a financial risk, not just a clinical one
Perhaps the most important change pharmacy leaders are making is how they talk about shortages to the C-suite.
Dr. Imars said pharmacy teams must translate disruptions into measurable financial events to secure the investment needed for resilience.
“By quantifying the hidden cost of shortage — including the operational drag of manual EHR updates, the procurement variance of high-cost alternatives and the clinical risks inherent in breaking the norm — we provide the data necessary for leaders to fund and support robust mitigation strategies,” he said.
That reframing is turning pharmacy supply chain from a back-office function into a strategic priority tied directly to patient safety, labor burden and financial performance. From diversified manufacturing partnerships and centralized purchasing to predictive analytics and buffer stock, pharmacy leaders are building supply chains meant not just to function, but to endure.
As Jason Baldwin, PharmaD, director of pharmacy at Tampa General Hospital-Brooksville (Fla.), put it: “The supply chain is more fragile than we would like, which means that we have to be prepared to adapt quickly.”
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