Pharmacy's Next Growth Model Will Not Be Built from Yesterday's Levers
Why complexity should be treated as a source of new value - not simply another cost to absorb
PHARMACY PERSPECTIVES
Steady State Advisors Inc | September 2026
The pharmacy market does not have a shortage of pressure. It has a shortage of models designed for the market that is emerging. |
The industry is not facing one disruption
Pharmacy leaders are navigating a collision of forces: increasing regulatory complexity, reimbursement pressure, rapid growth in GLP-1 utilization, global supply concentration, persistent product availability risk, slow and uneven U.S. biosimilar adoption, PBM scrutiny and reform, evolving Medicare economics, cost-plus models, manufacturer direct-to-consumer channels, direct-to-employer arrangements, and growing consumer expectations for speed, transparency, and access.
Each issue is significant on its own. The larger strategic challenge is that they are not occurring independently. A reimbursement change can alter inventory economics. A new channel can change the value of a network. A supply disruption can reshape patient access, contracting leverage, and brand loyalty at the same time. A therapy with extraordinary demand can expose weaknesses in benefit design, care coordination, fulfillment, and affordability all at once.
When organizations evaluate these forces in separate work-streams, they often miss the value that exists between them.
Managing the old model harder is not a growth strategy
For decades, many pharmacy businesses have relied on familiar financial levers: purchasing improvements, incremental rebate optimization, dispensing volume, labor productivity, network rate negotiations, generic conversion, formulary position, and traditional channel control. These levers still matter. Strong execution will always matter.
But mature levers have limits. They were largely built for a system with more predictable channels, more stable roles, clearer organizational boundaries, and a more linear flow of products, information, and money. That is no longer the system in front of us.
Trying to create tomorrow's growth solely by pressing harder on yesterday's economics can produce temporary improvement while leaving the underlying model unchanged. In some cases, it shifts cost or risk to another participant without creating durable value for the ecosystem or the patient.
The better question is not, “How do we extract more from the current model?” It is, “What can we create because the model is changing?”
Complexity is a source of strategic options
The same forces creating pressure are also opening new spaces for value creation.
GLP-1 demand is not only a drug-cost issue, it is an opportunity to rethink longitudinal care, adherence, nutrition support, employer value, benefit design, fulfillment, persistence, data, and outcomes. The winning model may connect services that have historically sat in different businesses.
Supply risk is not only a procurement problem, it is a reason to build better demand visibility, manufacturer-pharmacy collaboration, therapeutic continuity programs, inventory intelligence, alternate sourcing strategies, and patient communication capabilities.
Biosimilar adoption is not only a price-conversion exercise, it requires aligned incentives, provider and patient confidence, benefit and reimbursement design, operational readiness, channel strategy, education, and a clear way for savings to reach the participants whose behavior must change.
PBM reform is not only a compliance event, it may reshape network strategy, contracting, transparency, employer expectations, pharmacy economics, and the value of integrated assets. Companies that wait for final rules before considering new models may find that others have already defined the market.
Cost-plus and direct channels are not simply competitive threats. They are evidence that customers are willing to reconsider how access, price, convenience, trust, and service are assembled. Incumbents often possess assets that new entrants do not - but those assets create advantage only when they are connected around a better customer proposition.
The next growth opportunities will live across boundaries
Many organizations have more strategic assets than they realize: patient relationships, pharmacists, clinical capabilities, distribution infrastructure, purchasing scale, employer relationships, manufacturing partnerships, specialty expertise, consumer reach, data, technology, real estate, and trusted brands.
The problem is often not the absence of assets. It is that the assets are managed within organizational, contractual, or financial boundaries that were designed for a different era.
That is why the next generation of growth is likely to come from combinations rather than isolated improvements: connecting pharmacy access with employer solutions; linking supply visibility to patient continuity; combining distribution, clinical services, and manufacturer strategy; redesigning contracting around shared outcomes; or using existing customer relationships to build new care and affordability models.
These opportunities are difficult to see from inside a single function or business unit. Every team is understandably accountable for its own economics, objectives, and operating constraints. Yet enterprise value is often created in the spaces no one function fully owns.
A new lens for pharmacy strategy
We believe leaders should pressure-test growth opportunities through five questions:
What market assumption is embedded in our current model - and is it still true?
Which external pressure could become an advantage if we connected assets differently?
Where are incentives misaligned across manufacturers, pharmacies, payers, employers, providers, and patients?
What value could be created for multiple participants rather than transferred from one to another?
Which capabilities do we already own that could become more valuable in combination?
This lens changes the conversation. It moves strategy beyond defending the current profit pool and toward designing new ones. It also puts the patient where the patient belongs: not at the end of the value chain, but at the center of the model.
Why an outside perspective matters
The people closest to a business understand its realities best. They also work inside the structures, incentives, vocabulary, and assumptions that have accumulated over time. An experienced outside perspective can help leaders step back far enough to see a different configuration - while remaining grounded in what can actually be executed.
At Steady State Advisors, we bring together pharmacy operations, manufacturer and wholesaler strategy, procurement, contracting, commercial innovation, and enterprise leadership. We understand what happens at the pharmacy counter and what happens in the boardroom. That range allows us to see connections across the value chain, challenge inherited assumptions, and translate promising ideas into practical operating and economic models.
Our role is not to arrive with a generic playbook. It is to help companies identify the assets, relationships, and capabilities that are uniquely theirs - then determine how those strengths can create new value in a changing market.
The opportunity in front of pharmacy
The pharmacy industry is under real pressure, and the consequences matter. When pharmacies, manufacturers, and healthcare companies are forced into increasingly narrow economics, innovation slows, services contract, and patients feel the impact.
But disruption does not only reduce value. It redistributes value and creates openings for new models.
The companies that lead the next era of pharmacy will not be those that preserve every boundary of the old system. They will be the ones willing to look across those boundaries, combine capabilities in new ways, align incentives around shared outcomes, and build models that work better for companies and patients.
The old levers can help improve today's business. A new perspective is how we build tomorrow's.
BRING US THE HARD PROBLEMS. Steady State Advisors helps healthcare organizations connect strategy, operations, economics, and partnerships to create new paths to growth. |
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