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Commentary|Podcasts|September 3, 2026

Designing the Pharmacy Enterprise of 2035

Key Takeaways

  • Automation let one health system skip an estimated 40 to 50 new hires it could not fill, moving its autonomy score from about 2.9 to nearly 4.0.
  • Artificial intelligence has cut prior authorization from 20 to 25 minutes down to 5 to 7, with refills, 340B audits, and denial prevention next.
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Nilesh Desai, MBA, RPh, on automation, AI, and building the health-system pharmacy enterprise of 2035

Automation did not shrink one health system's pharmacy workforce, but it did spare the system from hiring 40 to 50 more people it could not have found.

That is the case that Nilesh Desai, MBA, RPh, chief pharmacy officer at the University of Miami Health System, made on the first episode of Future-Proofing Pharmacy, a podcast from The American Journal of Managed Care® (AJMC®) hosted by Mark Makhinson, PharmD, MBA, senior director of outpatient and specialty pharmacy at Mount Sinai Health System.

Lessons From a Consolidated Pharmacy Service Center

Before joining the University of Miami, Desai led a pharmacy transformation at Baptist Health, where retail closures, shortened store hours, specialty growth, and inventory spread across 8 hospitals and more than 400 clinics collided with a shrinking workforce. Pharmacy school applicant pools had narrowed from roughly 10 candidates per seat to 1, he said.

His team studied distribution outside health care, touring UPS, Cardinal, and Medline sites, then narrowed about 24 vendors to 8 under a single 8-way nondisclosure agreement. Robotic fill, conveyance, sortation, auto-labeling, and auto-packaging moved the organization from a self-scored 2.8 to 2.9 on a 5-level autonomy scale to close to 4.0.

Winning approval took a business case built on national drug shortages, pharmacy closures, and staffing gaps, paired with a spending analysis, a small pilot, and a return-on-investment case. Desai says leaders should bring back to executives 3 and 6 months later to show delivery.

Where AI Fits Next

Artificial intelligence (AI) has already compressed prior authorization from 20 to 25 minutes to 5 to 7 minutes, Desai said. He sees comparable openings in refill management triggered by lab values, 340B auditing, drug procurement trending, and prepayment claim checks that head off denials, with pharmacists redeployed to patient conversations and medication reconciliation.

“You do patient experience, you do clinical, you do quality, safety, all of that stuff, finance will follow,” Desai said.

Find Future-Proofing Pharmacy on Spotify, Apple Podcasts, Pandora, and TuneIn under AJMC’s Managed Care Cast.

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