340B reform and drug shortages are among hospital pharmacy concerns, survey finds

Drug shortages, staffing issues, 340B and drug spending are the top issues on the minds of hospital pharmacy professionals, according to a new survey from Bluesight, an intelligence firm for hospitals.

The survey was done with 437 hospital pharmacy professionals and conducted in January 2026 and February 2026. This report examines the mounting challenges hospital pharmacies face and how leading teams are moving beyond reactive operations toward technology-driven automation.

Drug shortages top the list of challenges for the seventh consecutive year, cited by 78.3% of respondents, while staffing pressures and drug spend management challenges persist.

“Drug shortages persist because most solutions react to them when they hit, instead of fixing their root causes,” Alex (AJ) Rivosecchi, product director at Bluesight, told Managed Healthcare Executive. “True resolution requires coordinated demand planning and insight into supply pipelines across the entire medication lifecycle, from manufacturers to hospitals. Until those fundamentals are addressed, hospitals will remain stuck reacting to supply disruptions.”

Among survey respondents, 60% said they were managing more than 10 active shortages, and almost a quarter of respondents said they were managing more than 20 active shortages. Managing these shortages takes a significant amount of time, with 47.3% of respondents saying they spend between three hours and 10 hours a week managing shortages and 19.1% saying they spend 11 hours to 20 hours a week. Almost 10% said they spend more than 30 hours a week managing drug shortages.

But many pharmacy professionals still rely on spreadsheets and manual tracking as the primary tools used for shortage management (69.7%), with dedicated shortage management software adoption remaining low (16.5%). Of respondents, 48.5% now use AI for data synthesis and 56% said they want machine learning to help predict shortages. “With labor, supply, and technology as three core cost drivers, the real opportunity is to use proven and scalable technology to reduce manual burden and enable existing staff to focus on value-added services that don't make sense for automation,” Rivosecchi said.

The report notes drug procurement is a fragmented marketplace. The survey found that the majority of hospitals are managing multiple vendor relationships, with 80% using four or more vendors and 79.1% of respondents looking for over $250,000 in cost savings this year.

340B concerns

Possible changes to the 340 program have hospital pharmacy professionals concerned about the implications for their programs. In the Bluesight survey, 66.7% of pharmacy leaders responsible for 340B management identify the transition to a rebate model as their most pressing concern.

The 340B program allows qualifying hospitals and other providers, such as federally qualified health centers, to purchase medications at discounted rates from drug manufacturers and use the difference between the discounted price and the reimbursement from commercial insurers and other payers to fund patient care services. Since its implementation in 1992, the 340B program has grown to two-thirds of all nonprofit hospitals in the United States.

“Healthcare organizations are now fighting a three-front battle in 340B compliance: navigating the stalled rebate pilot, new complexities from Inflation Reduction Act pricing and Maximum Fair Price requirements, and escalating pressure from manufacturers demanding claims data while threatening to revoke 340B pricing,” Rivosecchi said.

The Health Resources & Services Administration (HRSA), which oversees the 340B program, is currently reviewing comments and determining next steps for a pilot 340B rebate program for drugs that were part of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. That effort, however, was halted by the courts. The agency had sought additional comments about the collection of data for use to determine rebates.

The Bluesight survey found that 53.8% of hospital pharmacy respondents were concerned about addressing manufacturer restrictions or rebate-related charges, 51.3% were concerned about ensuring accurate split billing and inventory management and 48.7% were worried about audit preparation and HRSA compliance.

More than half of the organizations surveyed expected that their third-party administrator or vendor would handle the transition to the rebate model. Bluesight officials said in their report that organizations will have to focus on automated, real-time auditing to ensure that claims are in compliance.

“At the center of it all is a growing demand for data, which is overshadowing a number of other compliance requirements. With evolving rulemaking, legal challenges, and unresolved questions around rebate models and deduplication, the next six to nine months will be defined by uncertainty, leaving organizations unsure where to focus in an increasingly complex landscape,” Rivosecchi said.