When Joseph Pinto talks about the future of pharmacy at New York City-based Mount Sinai Health System, he starts with infrastructure.
“Pharmacy sits at the intersection of clinical care, digital innovation and financial stewardship,” Mr. Pinto, vice president of pharmacy operations at Mount Sinai, told Becker’s. “We’re increasingly expected to lead across all three.”
That expectation is reshaping how Mount Sinai views pharmacy’s role at one of the nation’s largest academic health systems. As AI, specialty therapies and gene-based medicines proliferate, Mr. Pinto sees pharmacy less as a support function and more as where the organization either gains the ability to scale or begins to fracture.
“Technology and therapeutics are moving faster than traditional operating models,” he said. “We need to figure out how pharmacy scales responsibly.”
That approach drove one of Mount Sinai’s most consequential moves this past year: a systemwide rebuild of its pharmacy operating model before aggressively pursuing growth. Rather than layering new specialty programs on top of aging workflows, Mr. Pinto led a modernization effort that tied together supply chain redesign, automation and digital workflow integration, anchored by a major wholesaler transition.
The goal was not simply to save money.
“It was reliability,” he said. “We focused on improving resiliency, medication availability and predictability for our front-line teams.”
Mount Sinai expanded IV robotics, upgraded dispensing automation and tightened Epic integration to reduce manual work and operational friction. The effort produced measurable results — cost savings, faster turnaround times and fewer disruptions. But its deeper impact was structural, creating what Mr. Pinto described as “a more scalable pharmacy platform that positions us for future growth in specialty and advanced therapies.”
That foundation matters because the next wave of healthcare innovation likely will not be incremental. Cell and gene therapies are arriving with extraordinary clinical promise — and considerable challenges.
“These therapies are transformational in treating patients, but operationally very complex,” he said. “We need infrastructure — clinical, financial and digital — to safely and sustainably support them.”
AI is a key part of that infrastructure. For Mr. Pinto, AI and automation are force multipliers — but only if the foundation is strong enough to support them.
“This is not about replacing clinicians,” he said. “It’s about removing the low-value cognitive work so they can focus on our patients. As leaders, we have to strengthen our core inpatient operations — medication safety, workforce stability, digital infrastructure — so growth elsewhere is sustainable.”
Those decisions are unfolding amid financial and regulatory uncertainty, particularly around pending changes to the 340B drug pricing program and the downstream effects of the Inflation Reduction Act, which are reshaping how and when value flows back to health systems.
“These shifts are changing how and when value flows back to the health system, and that impacts how we fund services, technology investments and staffing models,” he said.
At Mount Sinai, that uncertainty has reinforced the importance of transparency and long-term planning.
“We explain the why, show how ideas fit into a broader road map and reinforce prioritization,” Mr. Pinto said. “When teams see decisions are thoughtful and aligned to patient care and sustainability, engagement stays high.”
Pharmacy is no longer simply where medications are managed. It is where clinical complexity, digital transformation and financial risk converge — making it one of the few parts of a health system capable of holding all three at once.
“Growth isn’t just about volume,” Mr. Pinto said. “It’s about building a strong pharmacy enterprise that’s resilient, data-driven and prepared for what’s next.”
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