Nishaminy Kasbekar is a pharmacist through and through. Her career started in high school, when she worked in a local drugstore, and has since blossomed into several leadership roles at esteemed organizations, including president for the American Society of Health-System Pharmacists (ASHP) and her current role as vice president and chief pharmacy officer for the University of Pennsylvania Health System. During her career, Kasbekar has seen the role of a pharmacist transform from “behind the counter” to “boots on the ground.” Now, she sees pharmacists’ role as care providers and business partners as more valuable than ever.
In this episode of McKinsey on Healthcare, Kasbekar sits down with McKinsey Senior Partner Pooja Kumar to discuss the pivotal role of the pharmacist within health systems and, as ambulatory care becomes more prevalent, in communities. They discuss how pharmacists can harness AI to extend their reach to patients, how they can become central partners for both patient care and health system value creation, and how they can navigate the volatile healthcare environment. Kasbekar also shares her philosophy on leadership and outlines how pharmacist leaders can position themselves to be central parts of a health system’s ecosystem.
An edited version of their conversation follows.
Being part of the change
Pooja Kumar: Tell me a little bit about yourself and what brought you into the world of pharmacy.
Nishaminy Kasbekar: I’m a child of immigrant parents, so growing up, change was a constant. Embracing change became something I valued. I worked at an independent drugstore in high school and found that, although I liked the pharmacy aspect, I was troubled by the fact that patients would come to the counter, take their medications, and then leave, so I never saw them again. I didn’t know how the medication affected their disease state.
I worked in a hospital pharmacy as a pharmacy intern, and that experience opened my eyes to the breadth and depth of the pharmacy practice. I rotated through a lot of areas—retail pharmacy, home infusion pharmacy, and compounding pharmacy—and realized the impact that these pharmacists made. They balanced demanding careers with their family lives and extracurricular activities and were actively involved in the profession. That shaped my career as a pharmacist and who I wanted to be, personally and professionally.
Pooja Kumar: One of the highlights of your career was your role as president at ASHP. Your inaugural address was titled “Be the Change.” What does that phrase mean to you?
Nishaminy Kasbekar: For me, it was tremendously motivating to know that I could be the change I wanted to see in the world. It was about being active in the profession, being a part of the change, and not sitting back and letting others advocate for me without my participation.
The pharmacist as a core part of the patient care team
Pooja Kumar: You’ve been at Penn Medicine for 30 years. How have you seen the pharmacy’s role within the health system evolve over time?
Nishaminy Kasbekar: When I started my career, I was the only pharmacist on the floor. Pharmacists were seen as behind-the-counter medication dispensers—ancillary to the healthcare team. So they didn’t have a huge presence on hospital floors or in acute care areas.
Today, the PharmD degree gives pharmacists a background in clinical training and positions the profession for more patient-centered roles. Now, pharmacists are frontline healthcare professionals involved in prescribing, diagnostic activity, and medication therapy management, and they optimize drug regimens for patients.
Pharmacists are now integral to the patient care team, along with nurses and doctors, and patients are seeing them as providers. I’ve seen pharmacists do amazing work with medication safety, medication reconciliation, preventing adverse events, helping patients transition from an inpatient to an outpatient setting, or getting involved in chronic disease management. We’re also starting to see pharmacists engage in whole-person care, such as nutrition, lifestyle changes, and mental health support. These are efforts that can make a patient more adherent to their medications and will make their disease states better.
Pharmacists, even in small community hospitals, are on the floor doing rounds within acute care services, such as the emergency department, critical care, or antibiotic stewardship. That has shifted the impression of where pharmacists serve and what they can do. The medical community is starting to see that improving medication safety makes patients more adherent, and enhancing care coordination by making sure patients leave with medications in hand can reduce hospital readmissions. So in addition to the expertise in pharmacotherapy that is critical for patient care, there’s also a tremendous financial advantage. Pharmacists are best suited to talk to patients about what may be beneficial to them as far as, for example, meeting a financial need or deprescribing unnecessary medication. They’re looking out for the patient and finding ways to lower healthcare costs and out-of-pocket costs.
Pharmacy as a strategic business asset
Pooja Kumar: How do you think health system executives more broadly see the value of pharmacy for the system as a whole?
Nishaminy Kasbekar: More pharmacy leaders are being titled chief pharmacy officers or vice presidents of pharmacy. So I think health system executives are starting to see pharmacy as a strategic asset that is essential for improving patient outcomes, reducing costs, and driving innovation. Pharmacy has always played a role in cost containment, but now it is having an impact on enterprise strategies in terms of revenue generation. Pharmacies play a role in determining how to respond to policy issues that affect patients, and they are influencing AI-driven initiatives and leveraging data for popular health initiatives. Pharmacy is at the intersection of clinical care with financial stewardship, operational efficiency, and revenue generation.
There’s tremendous benefit to health system pharmacies. They’re part of the enterprise, so they have visibility into the inpatient side. They can manage critically ill patients in the hospital and then transition them from the hospital to retail pharmacies. I think more health systems are going to acquire retail pharmacies, because care is shifting to ambulatory settings. A health system–acquired retail pharmacy allows us to interact with our providers, get access to EMRs [electronic medical records], and connect the dots so we can see what’s happening with the patient. We can see where a prior authorization is, whether a patient received their medication, and whether a technician followed up about it. It’s a seamless way for pharmacies and pharmacy leaders to interact with their patients in a community setting.
We have infusion centers that have pharmacists at bedsides, not just dispensing but also providing clinical care. We have pharmacists embedded in physician clinics who are scheduling patients, seeing patients, and helping patients with medication adherence or medication education. Pharmacy has grown from what the public sees as “behind the counter” to practicing at the top of their license. You’re not isolated in one area; you have the ability to stretch and do many different things.
Pooja Kumar: Patients have always needed to come into care settings for medications of different types. Biomedical innovation over the past several decades has produced an array of treatments available to patients. How do you think about the pipeline coming in the next few years, and how does that affect the role of pharmacy as a strategic partner?
Nishaminy Kasbekar: There’s a lot to consider. For example, value-based care: How does a pharmacist impact popular health strategies or risk stratification? There are issues with medication access and affordability, so how do we make sure that our vulnerable populations are getting the drugs they need? Every hospital pharmacy is dealing with drug shortages, so how do we create resilience in our supply chain and our procurement strategies? These are enterprise strategies that will affect how we meet patients where they are rather than making them come to us—the hospital versus the “homepital.”
Pharmacies of the future will be access points for patients to get diagnostic treatments. Pharmacists could work under collaborative practice agreements or as providers, within protocols, and give patients therapies related to the diagnostics that they’re running. I see the pharmacy of the future as a strategic area where we can meet the needs of patients in their home or as a place where we can help resolve any kind of medication issue and be central to chronic disease management.
Reducing disruption in a volatile environment
Pooja Kumar: With tariffs and inflation affecting supply chains, how should pharmacy leaders be thinking about resilience and procurement strategy?
Nishaminy Kasbekar: There’s concern about the global supply chain and its volatility and how tariffs will affect it. Considering where drugs are coming from, do we need to invest in domestic partnerships and reshoring to make more-resilient supply chains? Do we need more advocacy in this area? In this financial market, it’s hard for pharmacies in health systems to maintain a three-month supply of medications. So we have to find ways to build a buffer and make sure there are enough medications across our enterprises and health systems. Pharmacy teams are looking at any predictive analytics that can forecast spikes or changes and allow them to adjust inventory accordingly.
Pooja Kumar: Are there other types of disruptions that pharmacists and health system leaders should be thinking about?
Nishaminy Kasbekar: There’s uncertainty about a lot of things right now, including labor expenses, inflation, cuts to Medicaid, the Inflation Reduction Act, and pharmacy benefit manager transparency. Everything is causing pharmacies to look at margin compression, which has resulted in recent closures of independent drugstores, as well as a big chain.
Pharmacies need to start looking at new reimbursement structures and cash flow dynamics and work exclusively with the C-suite to find ways to reduce out-of-pocket costs for patients. How do we decrease the total cost of care for patients and reduce health system budgets?
AI as augmented intelligence
Pooja Kumar: Is the training pipeline keeping up with the changing responsibilities of pharmacists?
Nishaminy Kasbekar: High school students are no longer going into pharmacy, so in the next couple of years, we’re going to see a significant workforce shortage. We are already seeing one for pharmacy technicians.
Residency programs are changing their training methods as medications become more complex and as medicine changes with precision medicine, personalized medicine, and a move from treatment to prevention. I think we’ll also see pharmacists getting more data analytics training as the use of AI, machine learning, and data increases.
Pooja Kumar: In 2025, the McKinsey Health Institute published a report on the global healthcare worker shortage.1 One of the findings was that there will be a shortage of at least ten billion workers by 2030, and closing that shortage could avert 189 million years of life lost to early death and disability.
One of our takeaways is that we can do all we can to boost the supply of healthcare workers, but there might never be enough. So how do we make the job easier so we can leverage each pharmacist to the best of their ability? Do you think AI has the potential to significantly remove waste from the pharmacist’s role to truly make them more effective?
Nishaminy Kasbekar: You’ve probably heard the saying, “We need to work smarter, not harder.” Ambient listening can help us do this, for example. Providers take hours to document interactions with patients. Ambient listening, which is embedded in our ambulatory care clinics, decreases the need for transcription and allows pharmacists to get some time back and use it wisely. These tools, if used appropriately, may reduce burnout in the future and allow people a work–life balance.
AI will also improve accuracy. If something you’ve tested gives you 100 percent accuracy, it could have an impact on many different therapeutic areas.
I always get asked if AI will eliminate the need for pharmacists or pharmacy technicians, and the easy answer is no. To me, this is augmented intelligence, not artificial. It’s augmented in the sense that it needs a human touch to assist it, analyze it, and make sure it’s working appropriately. So we’ll always need that interconnectivity.
A pharmacy leader within the ecosystem
Pooja Kumar: Let’s say you have a colleague who’s stepping into the chief pharmacy officer role for a health system. What are the top three things they should be thinking about?
Nishaminy Kasbekar: The first thing would be to find a way to stabilize the pharmacy workforce, whether it’s through flexible working models, career development pathways, or wellness initiatives. Find ways to reduce staffing shortages and burnout.
The second thing is to look at how you’re going to manage revenue-generating areas. So look at ultra-high-cost drugs, precision therapy, cell and gene therapy, expanding retail specialty pharmacies, and infusion pharmacies. As the demand for ambulatory services increases, make sure that you have the capabilities needed to work across different disciplines across your entity.
The last thing would be to leverage technology and AI. Sometimes, pharmacy teams are late to the party. A lot of these discussions have already started in the hospital setting. So find ways to embrace this technology and figure out ways that it will influence and automate the workflow.
