The focus on optimizing just acute care spend has long overshadowed a critical reality: nearly half of all pharmacy savings opportunities exist in non-acute settings. As healthcare delivery continues to diversify across multiple care environments, pharmacy leaders who limit their optimization efforts to the acute class of trade alone are missing substantial financial opportunities.
The Growing Weight of Non-Acute Pharmacy Spend
Pharmacy services are increasingly delivered in ambulatory and outpatient settings — and those settings are absorbing a growing share of total pharmacy costs. Outpatient pharmacy costs are rising faster than other categories, with outpatient pharmaceutical spending projected to grow significantly more than hospital pharmacy spending. In one study, outpatient clinic pharmaceutical spending was projected to expand 11–13% in 2025, outpacing hospital spending that was expected to grow only 2–4%.
At the same time, specialty medications — many of which are infused or dispensed in outpatient or ambulatory settings — now account for more than half of total prescription drug costs, despite treating a relatively small portion of patients. Together, these trends are reshaping how and where pharmacy dollars are spent.
These cost shifts are being reinforced by broader site-of-care changes. Outpatient settings, including ambulatory surgery centers, physician offices, and ambulatory infusion sites, continue to expand as payers steer care towards lower-cost settings and patients seek more convenient options. As care moves out of the hospital, pharmacy spend follows.
Health systems that broaden visibility and spend optimization across care settings — from inpatient to outpatient and specialty services — are better positioned to manage this growth and maintain control over rising pharmacy costs.
The Real Savings Potential Beyond Acute Care
Bluesight data shows that 48% of spend optimization opportunities for U.S. hospitals and health systems exist outside the acute setting. As of January 2026, those non-acute opportunities break down as follows:
- 17.4% Retail Pharmacy
- 9.3% Contract Pharmacy
- 8.5% Specialty
- 7.5% Ambulatory
- 5.2% Clinic
While these figures represent potential savings, recent case studies illustrate what’s achievable when health systems have clear visibility across all classes of trade. In two separate examples, health systems that used procurement optimization tools to reduce annual pharmacy spend by $1M and $3.5M, respectively, realized nearly 30% of their total pharmacy savings from non-acute settings.
The challenge is that many spend optimization tools still focus primarily on acute care. When technology doesn’t account for all classes of trade, pharmacy teams are effectively working with an incomplete picture — and missing nearly half of their potential savings.
Enterprise Pharmacy Spend Management
Whether overseeing a multi-regional IDN or a single hospital with acute, retail, and specialty services, pharmacy leaders need a unified view of spend and savings across the organization.
CostCheck was built to support spend optimization across all classes of trade. And now, with the addition of CostCheck’s System Spend Hierarchy functionality, health systems can structure views that reflect how their organization actually operates — from regions and business units to class-of-trade groupings.
Through the new System Spend Hierarchy, CostCheck customers can:
- Customize Views: Build a multi-tier hierarchy that matches your system or IDN structure — from regional divisions to class-of-trade groups, while keeping a clear, enterprise-wide view.
- Track Performance: Roll up metrics across your organization, then drill down by groups – quickly tracking performance including savings and outstanding recommendations.
- Drive More Savings: View opportunities and make consolidated purchasing decisions across all organizational units, enabling standardization across regions and facilities.
By moving beyond acute care cost management alone and optimizing across classes of trade, pharmacy leaders can reduce overall spend and improve standardization across the entire organization.
To learn more about how CostCheck’s can help your organization optimize spend across all classes of trade, download the one page overview or request a CostCheck demo.