Most pharmacy operations have dashboards. Very few have a data-driven culture. The difference is not the sophistication of the reporting. It is whether the data actually changes a decision. A dispensing supervisor who catches a drop-in fill rate for a critical specialty drug at 9 am is operating in a data-driven environment. One who finds out at the end-of-month operations review is not, regardless of how many metrics are on the screen.
Hansil Kalaria, Chief People Officer at CAN Community Health and a pharmacy operations leader who has overseen 18 locations across six states, has a single test he applies to every organization he works with. “What decision did data change last week?” Kalaria asks. “If no one can answer that, you have a reporting infrastructure, not a data-driven culture.”
Three Reports That Reveal What Roll-Up Numbers Hide
Aggregate financials are designed to be reassuring. The problems that compound into crises almost always live one level below them. Kalaria identifies three reports from direct experience that consistently surface what leadership would have missed at the consolidated level:
1. Site-level gross margin by drug category. While overseeing 18 pharmacy locations across six states, aggregate financials appeared acceptable until margin decomposition by drug category at the site level revealed two locations running a negative margin on specific infusion drugs, because negotiated rates had not been updated following contract renewal. The problem was invisible at the roll-up.
2. Dispense-to-claim reconciliation in 340B programs. Surfacing the gap between what was dispensed under a 340B-eligible encounter and what was actually captured and billed correctly frequently reveals an 8% to 15% uncaptured opportunity that nobody is actively managing, a direct hit to the bottom line.
3. Patient throughput and abandonment rates by therapeutic category and insurance type. A 30% prior-authorization denial rate appears to be a payer issue. Disaggregating by drug and payer class and overlaying with intake submission timing often reveals an underlying process failure that the surface metric was masking entirely.
The Trust Problem Is Definitional
Post-acquisition data integration cannot shortcut what Kalaria calls the data archaeology phase. Before consolidating anything, leaders must understand what each legacy system actually tracks versus what it is supposed to track, because those are rarely the same. Acquired organizations carry workarounds, shadow spreadsheets, and tribal knowledge baked into reporting formats that formal systems never captured. Rushing toward a unified data warehouse while carrying inconsistent definitions does not solve the problem. It launders bad data into a cleaner-looking system.
The right first step is a data inventory audit, not a technology audit. Identify source systems, ownership, dependencies, and where manual interventions exist in the data flow. Definition standardization must precede platform consolidation. In one integration, building a reliable unified view of inventory workflows and staffing ratios across sites revealed where capital was trapped and where labor was misaligned with patient volume.
The outcome was a turnaround from negative to positive earnings before interest, taxes, depreciation, and amortization (EBITDA), driven not by cutting programs but by reducing excess inventory, streamlining dispensing workflows, and right-sizing human capital deployment across the network. None of it was visible at the consolidated level. It took building the data foundation first.
340B and Medicare Drug Price Negotiation: An Interconnected Data and Cash Flow Problem
The intersection of the IRA’s Medicare Drug Price Negotiation Program and the 340B program is the most operationally complex challenge facing covered entities right now, and many pharmacy leaders are still underestimating its scope. The “lesser of” logic is the starting point. When a drug has both a 340B ceiling price and a negotiated Maximum Fair Price (MFP), manufacturers provide only the lower of the two; they are not additive. For 2026, 340B ceiling prices remain lower than the MFP for 85 percent of negotiated National Drug Code (NDCs), meaning 340B still wins on most drugs today. That math will shift as more drugs enter negotiation cycles, and covered entities need to be modeling their formulary exposure now.
MTF enrollment is mandatory for participation in any Medicare Part D network as of January 2026, introducing new data accuracy requirements between third-party administrators (TPAs) and dispensing partners. The 340B rebate model pilot creates a direct cash-flow challenge that covered entities must purchase selected drugs at wholesale acquisition cost upfront and wait for a post-purchase rebate, with no opt-out, creating a liquidity problem for high-cost specialty drugs that pharmacy, finance, and the covered entity must solve together.
Finally, the Centers for Medicare & Medicaid Services (CMS) introduced a voluntary 340B claims data repository in the 2026 fee schedule with clear signals toward mandatory reporting as early as 2027 for Federally Qualified Health Centers (FQHCs), critical access hospitals, and hospitals participating in the Inpatient Prospective Payment System (IPPS). Organizations treating this as optional today will be scrambling to build interfaces under mandatory deadlines. The leaders positioned well are those who treat this as an interconnected data-and-cash-flow challenge requiring pharmacy operations, finance, and IT to collaborate immediately, not sequentially.
Follow Hansil Kalaria on LinkedIn for more insights on pharmacy operations, healthcare data strategy, and building the reporting foundations that drive measurable outcomes.
