For pharmacy leaders, the path to growth is no longer defined by volume alone. It hinges on access, speed, automation and trust — especially as reimbursement tightens and regulatory uncertainty mounts.
That reality is shaping strategy at Boise, Idaho-based St. Luke’s Health System, where pharmacy leaders are making early investments in automation, AI-enabled workflows and centralized operations to build what they see as a “future-ready,” “patient-first” pharmacy model.
“We’re trying to make intentional investments now that remove friction from the patient journey,” Josh Weber, PharmD, senior director overseeing ambulatory medication access, retail and specialty pharmacy services at St. Luke’s, said on a recent episode of the “Becker’s Pharmacy Leadership Podcast.”
Designing pharmacy around patient access
St. Luke’s pharmacy operation supports more than 25,000 patients across Southern and Central Idaho, Eastern Oregon and Northern Nevada, dispensing more than 850,000 ambulatory prescriptions annually — a number Dr. Weber said is on track to reach 1 million this year.
Much of the past year for Dr. Weber and St. Luke’s has been focused on redesigning how patients access medications, from eliminating paper-based workflows to reducing delays caused by prior authorizations.
Among the most significant changes: The system fully implemented paperless pharmacy operations across all sites, enabling multilingual and video-based patient education and removing bottlenecks tied to manual verification processes.
At the same time, pharmacy leaders redesigned delivery workflows to increase throughput and reliability, particularly for patients managing chronic and complex conditions.
“These are the kinds of investments that directly translate into faster therapy starts and fewer handoffs for patients,” Dr. Weber said.
Automation and AI as access accelerators
Technology has played a central role in those efforts. St. Luke’s recently implemented AI-enabled prior authorization and appeals workflows across more than 300 clinics, reducing processing time per authorization from 15 to 20 minutes to less than five minutes, according to Dr. Weber.
The system is also preparing to launch the first phase of its central services center fill engine, a foundation for a larger automation investment that will eventually integrate specialty home delivery with true central fill operations in a robotically assisted environment.
“This isn’t just about efficiency,” Dr. Weber said. “Patients don’t experience care in silos; they experience it as one journey.”
On the specialty side, St. Luke’s has expanded access by securing limited distribution drug and payer networks for five additional specialty and rare disease medications, extending coverage to roughly 5,000 additional patients.
Planning for 2026: Growth with restraint
Looking ahead, pharmacy leaders at St. Luke’s are balancing ambitious growth plans with financial and regulatory headwinds — particularly around 340B uncertainty, reimbursement pressure, and shifting Medicaid and Medicare enrollment.
The second phase of the central services center will be a top priority in 2026, bringing specialty home delivery and central fill into a single, conveyor-based production environment, Dr. Weber said.
Workforce retention and career development are also front and center, as leaders focus on sustaining engagement while scaling operations.
“We frame our strategy around what I call the five P’s: people, patients, providers, partners and then the P&L,” Dr. Weber said. “When you get the first four right, the financial performance follows.”
Still, the pressure is real. Regulatory uncertainty in the 340B program, shrinking reimbursement and growing direct-to-patient disruption all complicate long-term financial modeling.
The response, Dr. Weber said, has been building flexibility into capital and labor planning, allowing pharmacy leaders to adapt quickly as conditions change, while positioning pharmacy as a strategic revenue and access driver for the broader organization.
The leadership challenge: Growth without compromise
Perhaps the most difficult task ahead, Dr. Weber said, is balancing accelerated growth with an unwavering commitment to safety, quality and trust.
“Patients don’t measure us by how fast we grow,” he said. “They measure us by how well we show up when they need us most.”
To prepare teams for that challenge, St. Luke’s pharmacy leaders have emphasized listening and engagement — gathering input from system leaders and front-line staff to identify pain points, align priorities and build trust.
Once that foundation is in place, Dr. Weber said, teams are better positioned to rally around a shared purpose: becoming the community’s most trusted partner in health.
Culture as a growth engine
Despite headwinds, Dr. Weber sees opportunity — particularly in building a nimble, adaptable culture that can keep pace with healthcare’s rapid change.
“Healthcare rewards teams that can learn quickly, test thoughtfully and adjust without losing sight of purpose,” he said.
That adaptability, paired with deep community trust, remains St. Luke’s strongest differentiator, he added — and a blueprint for sustainable, patient-centered growth.
“When you combine an agile culture with community trust and a commitment to excellence, you create growth that’s meaningful, not just scalable,” Dr. Weber said.