From Dispensing to Decision-Making: How Pharmacists Are Redefining Leadership in Oncology Care

The Clinical Pathways Congress and Cancer Care Business Exchange (CPC+CBEx) session titled “The Evolution of Pharmacist Leadership Across the Oncology Care Spectrum,” brought together 5 pharmacy leaders to reflect on how their roles have grown beyond medication dispensing into critical functions at the intersection of science, business, and patient care. The discussion highlighted personal career trajectories, the increasing complexity of oncology treatments, the importance of pathways and tools, and the evolving responsibilities pharmacists will face over the next decade.

Each panelist began by sharing their journey into leadership. Lisa Raff, PharmD, vice president of oncology services at OneOncology, emphasized lifelong learning and adaptability, explaining how stepping into unexpected responsibilities allowed her to expand from clinical practice into operational leadership. James Gilmore, PharmD, chief pharmacy and clinical services officer at the American Oncology Network, recounted starting in hospital pharmacy before moving into clinical research and eventually executive leadership, stressing how on-the-job learning in business and operations became just as important as clinical expertise. Josh Howell, PharmD, senior vice president, pharmacy and clinical programs at US Oncology/McKesson, discussed his traditional training through residency and oncology specialization. He also highlighted how his career at large health systems and McKesson evolved toward building cross-disciplinary teams and developing pharmacy-led clinical programs. Finally, Jorge Garcia, PharmD, assistant vice president at Baptist Health South Florida, described a career shaped by curiosity and adaptability, stressing that innovation and curiosity helped him lead teams and influence broader organizational decisions. Across all stories, a consistent theme was that pharmacy school and even residency left gaps, especially in business and management, which these leaders had to fill through experience.

The conversation then shifted to how pharmacists now shape clinical pathways and tools. Gilmore described how his organization’s Pharmacy & Therapeutics (P&T) committee—pharmacist-driven but physician-chaired—provides governance for clinical protocols, evaluates drugs based on efficacy, tolerability, and value, and empowers pharmacists with authority to intervene directly in patient care. Raff outlined her experience launching dozens of pathways for community oncology, ensuring that physicians in smaller or rural practices can access decision support to keep pace with rapidly expanding approvals and biomarkers. Her team developed digital tools with embedded notes, regimen support, and therapeutic interchange capabilities, always prioritizing clinical evidence over economics, with financial discussions handled separately. Garcia emphasized utilization management, especially with biosimilars and emerging therapies, underscoring how pathways can align economics with clinical quality. Howell highlighted partnerships with the National Comprehensive Cancer Network (NCCN) in building value pathways and the need to standardize tools across varied practice sizes. A shared consensus emerged: pharmacists’ leadership in pathways is critical for guiding safe, evidence-based, and cost-effective therapy decisions, particularly as payers exert more influence.

Tools and technology were another focus during the session. Howell noted that electronic health records (EHRs) still require better integration, with decision-making often spread across multiple platforms. He envisioned artificial intelligence (AI) and ambient data extraction as keys to more contextual, real-time alerts for physicians. Raff shared the importance of analytics, drug substitution tools, and payer-aligned decision support to relieve physicians of administrative burdens while ensuring appropriate therapy selection. Gilmore described investing in a data company to deliver payer- and patient-specific guidance directly within the EHR, reflecting the movement toward data-driven decision-making at the point of care. The panelists agreed that while progress has been made, challenges remain with payer requirements, drug coding, and the complexity of emerging drug classes like 505(b)(2)s and novel biosimilars.

Looking toward the future, panelists envisioned both technological and therapeutic shifts. Garcia emphasized the potential for AI to help identify patients with rare diseases earlier and support timely interventions. Howell envisioned seamless health record integration, elimination of outdated systems such as fax machines, and a stronger role for pharmacists in contextualizing care decisions. Gilmore predicted payer- and patient-specific treatment recommendations becoming routine, reducing the administrative burden of prior authorizations. Raff expressed enthusiasm for expanding access to advanced therapies like CAR T-cell therapy and bispecifics in community practices, ensuring patients can receive cutting-edge treatments closer to home. All agreed that pharmacists will need to continually pivot, expanding into new therapeutic areas and mastering increasingly complex care models.

The discussion also addressed the qualities needed for emerging leaders. Panelists stressed active learning, innovation, resilience, and professional networking. Raff shared her pursuit of a master’s in personalized medicine to adapt to genomic-driven prescribing, underscoring the need for ongoing education. Garcia and Howell emphasized the value of curiosity and carving out time for exploration beyond daily tasks. Gilmore and Garcia highlighted the importance of building professional networks and, where possible, gaining business training early. Collectively, they advised aspiring leaders to embrace discomfort, pursue interdisciplinary collaboration, and recognize peers as allies rather than competitors.

The panel closed with reflections on evidence and policy. Real-world evidence was seen as increasingly valuable, while reliance on surrogate endpoints like overall response rate was considered less persuasive without long-term outcomes. The leaders called for stronger pharmacoeconomic studies and emphasized revisiting accelerated approvals to ensure drugs truly meet their promise. On the policy front, they discussed uncertainties around federal initiatives like the Inflation Reduction Act and shifts in Medicare and Medicaid, noting that advocacy is essential, but strategies remain challenging without clear guidance. They stressed the importance of staying engaged with legislators and preparing multiple scenarios for reimbursement changes.

In conclusion, the panel demonstrated how oncology pharmacists have moved from behind-the-scenes roles into essential leaders shaping clinical, operational, and financial aspects of care. Their ability to bridge disciplines, adopt new technologies, manage complex therapies, and advocate for sustainable care models will only grow in importance as the oncology landscape continues to evolve. The unifying message was that leadership in pharmacy is about constant learning, innovation, and collaboration—qualities that will define the profession for the decade ahead.

Reference

Chavez N, Garcia J, Howell J, Gilmore J, Raff L. The evolution of pharmacist leadership across the oncology care spectrum. Presented at the Clinical Pathways Congress; September 5, 2025; Boston, MA.