5 Defining Themes from Asembia AXS26: Specialty Pharmacy’s Next Chapter Is Already Here

After attending the Asembia AXS26 conference, one thing is clear: the industry is no longer preparing for transformation—it’s operating within it.

Across three days of sessions, conversations moved beyond “what’s coming next” to “what must change now.” From the expanding role of pharmacists to the rapid acceleration of AI and mounting pressure on reimbursement models, pharmacy leaders are navigating a landscape that is more complex—and more opportunity-rich—than ever before.

Here are the five defining themes that stood out most.

1. The Pharmacist Is Moving to the Front Door of Care

One of the most consistent messages across sessions: pharmacists are no longer positioned at the end of the care journey—they’re becoming an entry point.

Driven by primary care shortages, consumer demand for convenience, and high levels of patient trust, pharmacists are increasingly stepping into care delivery roles. Mechanisms like Collaborative Practice Agreements (CPAs), statewide standing orders, and expanding independent prescribing authority are making this shift possible.

We’re seeing real momentum in areas like:

• Hormonal therapy
• Tobacco cessation
• Naloxone distribution
• PrEP/PEP
• Point-of-care testing

At the same time, new consumer-facing models—such as direct-to-consumer telepharmacy and cash-pay prescribing services—are emerging rapidly.

But this evolution isn’t frictionless. Variability in state regulations, lack of federal provider status under Medicare Part B, and ongoing reimbursement ambiguity continue to slow progress.

The takeaway: The clinical role of the pharmacist is expanding rapidly—but sustainable scale will depend on regulatory alignment and payment reform.

2. Innovation, Policy Change, and Operational Modernization Are Converging

During the keynote general session, Luke Greenwalt from IQVIA described today’s healthcare environment as “Everything Everywhere All at Once”—a fitting characterization for a pharmacy market experiencing rapid growth upwards of $1 trillion in U.S. drug spend, expanding therapeutic innovation, and significant policy evolution.

The specialty pharmacy industry is entering a new era fueled by:

• Mega-blockbuster therapies
• Accelerating GLP-1 adoption
• Continued advancement in cell and gene therapies

At the same time, the market is evolving under the combined influence of:

• The Inflation Reduction Act (IRA)
• Most Favored Nation (MFN) pricing pressures
• 340B expansion (now ~$81billion annually)

These forces are reshaping how manufacturers, payers, providers, and specialty pharmacies collaborate to deliver care and manage cost.

The takeaway: Specialty pharmacies that modernize operations, strengthen reimbursement strategies, and embrace automation and AI-enabled efficiencies will be well-positioned to thrive in this next phase of growth.

3. AI Has Moved from Experimentation to Enterprise Utility

If 2025 was about AI exploration, 2026 is about AI execution.

Adoption rates tell the story:

• 80% of providers are using AI
• 92% of payors
• 95% of pharmaceutical companies

What’s changed is how AI is being applied. The focus has shifted to practical, high-impact use cases:

• Clinical documentation (ranked #1 by providers)
• Workflow optimization and administrative efficiency
• Patient journey orchestration
• Evidence generation for prior authorization

New platforms are emerging that unify claims, clinical data, billing, and patient engagement into a single, AI-enabled ecosystem—bringing intelligence to every step of the pharmacy workflow.

At the same time, there’s growing recognition that AI’s real value isn’t just automation—it’s augmentation. The goal is to free pharmacists from administrative burden so they can operate at the top of their license.

The takeaway: AI is no longer a future differentiator—it’s becoming a baseline capability for operational efficiency and care delivery.

4. Direct-to-Patient Models and Consumer Expectations Are Reshaping Delivery

The rise of direct-to-patient pharmacy models was impossible to ignore.

Patients increasingly expect:

• Faster therapy starts
• Seamless digital engagement
• Personalized care experiences
• Flexible communication channels

In response, pharmacy leaders are rethinking traditional operating models. Future-state visions discussed at Asembia included:

• 24-hour turnaround times for specialty medications
• AI-driven personalization based on patient behavior and lifestyle
• Greater use of automation and robotics in dispensing
• Pharmacists focusing on monitoring outcomes—not filling scripts

Formulary design itself may evolve to reflect individual patient needs rather than broad population assumptions.

The takeaway: The pharmacy experience is becoming more consumer-driven, and organizations that fail to adapt risk losing relevance.

5. Value-Based Care Is Elevating Pharmacy’s Strategic Role

Pharmacy’s role in value-based care (VBC) continues to expand—and real-world results are backing it up.

Health system specialty pharmacies are increasingly acting as care management hubs, integrating with providers to improve outcomes and reduce costs. Case studies shared at Asembia highlighted meaningful impact:

• Reduced hospital admissions
• Lower overall medical costs
• Improved clinical markers (e.g., A1c reductions)

At the same time, the pipeline of high-cost therapies—particularly in rare disease and cell and gene therapy—is forcing payors to rethink risk models. When treatments can cost millions per patient, outcomes-based agreements and performance guarantees are becoming essential.

Pharmacies are uniquely positioned to:

• Monitor adherence and outcomes
• Provide clinical interventions
• Support data collection for value-based contracts

However, reimbursement models have not fully kept pace with this expanded role.

The takeaway: Pharmacy is becoming a critical enabler of value-based care—but financial alignment is still lagging behind clinical reality.

Final Thoughts: The Future Will Reward Those Who Operationalize Change

Asembia AXS26 made one thing abundantly clear: the winners in pharmacy won’t just be those who recognize change—they’ll be the ones who operationalize it.

Across every theme—scope of practice, economics, AI, consumerism, and value-based care—the common thread is execution. The ideas are here. The technology is here. The need is undeniable.

What remains is the ability to:

• Redesign workflows
• Align reimbursement strategies
• Invest in scalable technology
• Empower pharmacists to practice at the top of their license

For retail, specialty, and hospital outpatient pharmacy leaders alike, the path forward isn’t about waiting for clarity—it’s about building capabilities that can adapt to continuous change.

The transformation of pharmacy is no longer on the horizon. It’s already underway.

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