By Lari Harding
Pharmacy executives across the country increasingly recognize that the industry has entered a period of extraordinary turbulence. Long-standing assumptions about reimbursement, drug pricing and even the role of the pharmacist are being challenged at the same time. Reimbursement models are shifting, policy makers are rewriting drug pricing rules, and new technologies are transforming health care operations. For many leaders, the question is no longer whether change is coming — it is whether these forces represent temporary disruption or a deeper structural transformation of the pharmacy business.
A useful framework for understanding moments like this comes from geopolitical strategist George Friedman. In The Storm Before the Calm, Friedman argues that the United States periodically moves through two long cycles of change: an approximately 80-year institutional cycle and a 50-year socioeconomic cycle. The institutional cycle reflects moments when the country’s governing structures — laws, regulatory frameworks and policy priorities — reset. The socioeconomic cycle reflects deeper shifts in technology, demographics and economic organization that redefine how industries create value and how work itself is performed. Historically these cycles occurred at different times, but in the 2020s they appear to be converging — creating a period of disruption that ultimately produces a new equilibrium.
The pharmacy sector appears to be experiencing precisely that convergence. Government policy is redefining how drugs are priced, while technology and demographics are redefining how pharmacy creates value.
The institutional cycle is visible in the wave of federal reforms reshaping the pharmaceutical supply chain. Policy makers have intensified efforts to reduce prescription drug costs and increase transparency across health care. The Inflation Reduction Act (IRA) introduced Medicare drug price negotiation and inflation penalties, with up to 100 Part D and Part B drugs potentially subject to negotiated prices by 2031. The Centers for Medicare and Medicaid’s (CMS’) GUARD (Part D) and GLOBE (Part B) models add an international reference pricing layer through Most Favored Nation (MFN) benchmarking, while direct-to-patient demonstrations such as TrumpRx aim to bypass traditional intermediaries and align U.S. prices more closely with those in peer countries. Together, these policies introduce multiple pricing constraints — negotiated prices, inflation penalties and international price comparisons — significantly expanding the federal government’s role in shaping drug prices.
Additional policy pressure is emerging within the pharmaceutical supply chain. The Consolidated Appropriations Act of 2026 includes PBM reforms designed to increase transparency and reduce rebate-driven incentives. Beginning in 2028 for Medicare Part D and around 2029 for commercial plans, PBMs must pass through 100% of manufacturer rebates and delink their compensation from drug prices, shifting toward fixed service fees and expanded reporting requirements. At the same time, the Federal Trade Commission has filed lawsuits against the three largest PBMs alleging anticompetitive practices that inflated insulin prices and disadvantaged independent pharmacies, with one settlement reached to date.
Combined, these developments reflect an institutional cycle reset — a moment when the country’s governing structures are being reshaped to redefine how prescription drug prices are set and regulated in the United States.
While policy makers reshape the rules governing pharmaceutical pricing, deeper structural forces are concurrently redefining how pharmacy creates value.
The socioeconomic cycle reflects shifts in technology, demographics and economic organization that transform how industries operate and how work is performed. In pharmacy, this cycle is unfolding at a time when the economics of dispensing are increasingly fragile.
At the same time that pharmacy economics face pressure, technological and demographic forces are reshaping the profession. Automation and artificial intelligence are transforming workflows. The rising consumer focus on health and wellness has transformed retail pharmacies into accessible health care hubs that provide preventive services, wellness products and health advice.
Demographic trends are accelerating this shift. An aging population with rising chronic disease, combined with a growing shortage of primary care providers, is expanding demand for accessible health care services. As a result, pharmacists are increasingly positioned as frontline health care providers, supported by expanded scope-of-practice laws and initiatives such as ECAPS that broaden pharmacists’ ability to deliver clinical services.
Together with the health care system’s shift toward value-based care, these forces are reshaping pharmacy — from a model centered primarily on dispensing medications to one focused on clinical services, population health management and integrated care delivery.
The combination of policy reform, technological innovation and demographic change suggests that the pharmacy business model itself is evolving. Rather than depending primarily on drug-price spreads, the next phase of pharmacy economics may revolve around a more diversified set of revenue streams tied to clinical care, patient engagement and outcomes improvement.
When viewed through Friedman’s lens, these developments begin to look less like isolated disruptions and more like the early stages of a structural reset.
If Friedman’s cycles are indeed converging, the turbulence facing pharmacy today should not be viewed simply as disruption — it should be understood as transition. The economic model of the past is being challenged at the same time that new opportunities for clinical care, technology-enabled services and population health are emerging. Periods like this rarely feel comfortable in the moment, but they are often when industries redefine their long-term role.
The current decade may represent the storm — a period in which long-standing assumptions about reimbursement, pricing and the pharmacist’s role are being challenged simultaneously. Yet storms are typically followed by calmer conditions as new systems stabilize and industries adapt to new economic realities.
For pharmacy executives, the strategic challenge lies in navigating this transition. The leaders who succeed will likely be those who view today’s disruption not as a threat but as an opportunity to reposition their organizations for the next phase of health care delivery — investing in clinical capabilities, capitalizing on wellness as a business, embracing technologies that enhance operational efficiency and preparing for reimbursement models that reward measurable value rather than opaque pricing spreads.
If these cycles are indeed converging, the turbulence currently reshaping pharmacy may ultimately lead to a more sustainable and integrated role for the profession within the health care system. The calm that follows the storm could be a pharmacy sector in which pharmacists are recognized as highly credentialed health care professionals and essential providers of accessible, technology-enabled care.
Lari Harding is senior vice president of health care industry affairs and strategic partnerships at Inmar Intelligence.
