The Role of Pharmacy Leadership in Oncology Strategy
Oncology strategy increasingly runs through the pharmacy department, not around it. Pharmacy leaders now shape payer negotiations, site-of-service decisions, and the adoption of high-cost therapies, and health systems that still treat pharmacy as a back-office medication function are working from an outdated org chart.
Why Pharmacy Has Moved to the Center of Oncology Strategy
Pharmacy's influence in oncology now reaches well past dispensing, into managed care negotiations, payer strategy, and the C-suite itself.
At THMA's Spring 2026 Oncology Forum, oncology service line leaders named pharmacy leadership as a strategic lever that many organizations still underuse. Attendees pointed to pharmacy's growing reach across managed care negotiations, oral oncolytics management, and payer strategy, alongside a broader trend: more pharmacy leaders are advancing into CEO and other C-suite roles. Several leaders described pharmacy teams successfully pushing back on payer denials that would otherwise have limited patient access to newly approved therapies, a sign of how much operational weight pharmacy now carries in oncology decision-making.
That weight extends to conversations about site-of-service shifts and high-cost therapies, where Forum attendees identified pharmacy as a critical voice, not a downstream reviewer brought in after the strategy is set. Part of that credibility comes from pharmacy's real-time visibility into clinical oncology trends, from how quickly a new drug class moves from infusion to oral administration to how payers respond once it's approved.
Oral Oncolytics and the Shift to Outpatient Care Are Raising Pharmacy's Profile
As treatment for the most common cancers, including prostate, lung, breast, and colorectal cancer, moves toward oral regimens and outpatient settings, pharmacy leadership becomes central to site-of-service strategy.
Prostate cancer remains the most common cancer among men in the United States, with an estimated 300,000 new diagnoses in 2024, according to the American Cancer Society. Breast cancer is the most common invasive cancer among women worldwide. Colorectal cancer produced an estimated 1.8 million new diagnoses worldwide in 2018, and bladder cancer, the sixth most common cancer in the U.S., added more than 80,000 new diagnoses in 2024. Across these and other common cancer types, expanding treatment options and targeted therapies mean that care once confined to an infusion chair increasingly happens at home or in a lower-acuity setting, whether the diagnosis is early-stage or advanced disease.
At the Oncology Forum, health system leaders described the resulting tension directly. Facility and staffing decisions that once unfolded over the past decade now compress into a single year. Organizations investing heavily in large infusion centers are, at the same time, questioning whether home infusion and oral oncolytics will make some of that capacity obsolete within three to five years. That uncertainty puts pharmacy leadership squarely inside facility and site-of-service planning, because pharmacy is often the function best positioned to track how fast a given cancer type is migrating toward oral, at-home, or lower-acuity delivery.
The practical response attendees converged on was a flexible, open-floor-plan facility design built to be repurposed as care delivery models continue to shift, rather than a single model locked in years ahead of need.
High-Cost Cell and Gene Therapies Are Pulling Pharmacy Into Payer Strategy and Ethics
As cell and gene therapies reach patients with advanced disease and rare cancers, pharmacy leaders are increasingly drawn into legal, ethics, and payer-strategy conversations that used to stay purely clinical.
A recurring theme at the recent Oncology Forum was how quickly a single high-cost therapy decision can escalate beyond the clinical team. Leaders described presenting an emerging cell or gene therapy program to senior leadership and watching the conversation shift away from operational readiness and toward reputational and ethical risk, with legal and ethics teams pulled in before any clinical decision was finalized. Health equity was named directly as part of that risk: declining to offer a curative therapy carries stakes that reach well beyond the treatment room.
Attendees also noted that payers are changing how they respond to these therapies. Cases that used to be handled one at a time are becoming a recurring strategic category, which several leaders said calls for dedicated operational and payer frameworks rather than ad hoc decisions. Research into treatments for resistant tumors and rare cancers will keep expanding this category, and pharmacy leadership is positioned to translate that research pipeline into a repeatable process for cancer care instead of a fresh crisis each time a new therapy is approved.
What This Means for Industry Partners Building Oncology Strategy Around Pharmacy Leadership
For pharma and biotech companies developing targeted therapies, pharmacy leadership belongs in market access strategy from the start, not only at formulary review.
The economics make the case on their own. A widely cited JAMA Internal Medicine analysis put the median cost to bring a single cancer drug to market at $648 million. Pfizer has said it wants to double the number of patients treated with its cancer medicines by 2030, backed by more than 50 oncology programs in clinical development focused on breast, blood, genitourinary, and thoracic cancers. Bayer has built its pipeline around targeted therapies, next-generation immunotherapy, and global partnerships, pairing internal research with external collaborations to reach patient populations faster. Cutting-edge science is only as valuable as a health system's ability to deliver it, and companies making that scale of investment in clinical trials and drug development need health system partners who can move a therapy from approval to patient access without friction. Pharmacy leadership increasingly controls that path.
Precision oncology adds another layer. Treatment decisions now depend on genomic testing and biomarker identification, in line with guidance from organizations such as the European Society for Medical Oncology, because each tumor's unique characteristics determine how it responds to a given therapy. Industry partners that bring pharmacy leadership into early conversations about companion diagnostics, site-of-service logistics, and payer strategy will move new therapies through health systems faster than those that treat pharmacy as a late-stage checkpoint, improving health outcomes and strengthening the strategic partnerships that make future innovation in cancer care possible.
Building an Oncology Strategy That Puts Pharmacy at the Table
A pharmacy-informed oncology strategy tends to share a few concrete features:
A standing seat in managed care and payer negotiations, not a review role added after contracts are set.
Site-of-service and facility planning that treats oral oncolytics and home infusion as near-term realities rather than distant possibilities.
A defined governance path for cell and gene therapy decisions that brings legal, ethics, and payer strategy in early, before a single case forces the issue.
Career pathways that let pharmacy talent grow into emerging areas like cell and gene therapy, paired with patient support programs built for a world where more treatment happens outside the hospital.
Partnership structures with industry, payers, and precision oncology platform companies built around shared risk, not transactional contracts.
None of this works as a bolt-on. A successful oncology strategy integrates clinical care, research, and patient-centered decision-making, and pharmacy leadership is one of the few functions with a direct line into all three, for the benefit of cancer patients and the families making these decisions alongside them.
These are the exact conversations senior oncology service line leaders and industry executives have behind closed doors at THMA's Oncology Forum, a twice-a-year gathering built on a strict 1:1 health system-to-industry ratio. Explore the Oncology Forum to see how these discussions are shaping oncology strategy across the industry.