John Karwoski, RPh, MBA, President and Founder, JDJ Consulting, LLC
Medication management in the ambulatory surgery center has evolved well beyond purchasing medications and maintaining a formulary. Drug shortages, rising acquisition costs, automation, controlled substance oversight, new pharmaceutical technologies and increasingly sophisticated regulatory expectations have made pharmacy management an important operational and financial issue for ASC leadership.
For approximately a decade, JDJ Consulting has collected benchmarking information from ambulatory surgery centers to identify changes in medication acquisition costs and pharmacy practices. The 2026 ASC Drug Cost and Emerging Technologies Benchmarking Report surveyed approximately 375 surgery centers and hospitals nationwide and received 103 responses. The report estimates that sample to provide a 95%confi dence level with a margin of error of approximately +/-7-8%.
The longitudinal data, combined with new questions examining technology and operational practices, point to 10 trends ASC executives should be watching.
1. Drug cost management has become a strategic function
ASC leaders should no longer view pharmaceutical purchasing simply as a supply-chain responsibility. Ten years of benchmarking demonstrate how dramatically the acquisition cost of commonly used medications can change. Propofol, midazolam, ondansetron, glycopyrrolate and other medications have experienced periods of substantial price movement.
Propofol 20 mL, for example, reached an average reported price of $4.89 in 2023 before declining to $2.38 in 2026. Ondansetron averaged $1.86 in 2022 compared with $0.49 in 2026.
For executives, the lesson is straightforward: drug acquisition costs should be measured, benchmarked and periodically reported to leadership rather than assumed to be fixed operating expenses.
2. Lower prices in some categories do not mean medication inflation is over
Several high-volume medications have become significantly less expensive, but the overall picture remains uneven. One of the most striking examples is glycopyrrolate. The 1 mL vial declined from $10.98 in 2016 to an average of $1.27 in 2026.
At the same time, fentanyl has moved in the opposite direction. The reported average price increased from
$1.18 in 2020 to $2.57 in 2026, with the report identifying production limitations and other supply pressures as contributing factors.
Executives should therefore be cautious about using overall pharmacy spending alone as a performance measure. Drug-level trends can reveal opportunities – and vulnerabilities – hidden within the total pharmacy budget.
3. GPO participation is becoming the ASC standard
Group purchasing has become deeply embedded in ASC pharmacy procurement. In the 2026 survey, 87% of respondents reported participation in a group purchasing organization, an increase of four percentage points compared with 2024.
But simply belonging to a GPO does not guarantee the best acquisition cost. The benchmarking data demonstrate meaningful differences in reported prices among GPOs and wholesalers for the same medications.
That creates an important executive question: Is the ASC merely enrolled in a GPO, or is management actively measuring whether the contract is producing competitive pricing?
4. Drug shortages have become an operational risk, not simply a pharmacy problem
Shortages can affect scheduling, anesthesia protocols, emergency preparedness, inventory levels and ultimately the ability of an ASC to safely perform procedures. That elevates shortage management to the executive level.
An effective ASC shortage strategy should identify critical medications, establish alternative products and suppliers, document mitigation efforts and defi ne an escalation process when a critical medication becomes unavailable. The JDJ benchmarking report’s shortage model calls for weekly evaluation of critical shortages and documentation of the shortage, attempts to obtain the medication, potential alternatives and resolution.
For senior leadership, medication availability should increasingly be considered part of business continuity planning.
5. Controlled substance management is rapidly becoming electronic
The migration from paper DEA Form 222 ordering to the DEA Controlled Substance Ordering System represents one of the clearest examples of pharmacy automation. Seventy-one percent of 2026 respondents reported using CSOS, and the survey found CSOS adoption had increased by almost 60%. The system provides electronic controlled-substance ordering while improving transaction speed, accuracy and administrative efficiency.
For ASC leadership, controlled-substance technology should be evaluated not only from a compliance perspective but also for its ability to improve security, accountability, documentation and staff efficiency.
6. Pharmacy automation is beginning to replace manual processes
Many ASCs still rely on monthly inspections, paper logs, visual inspections and spreadsheets for medication inventory management. But the transition has begun.
The 2026 benchmarking study found 18% of respondents using automated medication inventory management systems. The report also anticipates continued migration of non-patient-care administrative functions toward automated platforms.
Expiration-date surveillance, inventory management, regulatory documentation and medication tracking are repetitive processes particularly well suited for automation. The executive question is becoming less about whether these processes will be automated and more about when the return on investment justifies implementation.
7. Electronic monitoring is becoming the expectation for medication storage
Refrigerator and freezer monitoring illustrates how inexpensive technology can improve both compliance and risk management. Fifty-seven percent of respondents reported using Wi-Fi temperature monitoring in 2026. These systems can provide continuous 24/7/365 temperature information for medications requiring controlled storage conditions.
Compared with manually documenting a refrigerator temperature once or twice daily, continuous monitoring provides a substantially more complete record of storage conditions. For ASC executives, this is a relatively low-cost technology capable of reducing both regulatory risk and potential medication loss.
8. The ASC is becoming an increasingly digital medication environment
Electronic medical records are also becoming more prevalent. Sixty-four percent of respondents reported using an EMR system, with facilities identifying numerous platforms currently in use.
The significance extends beyond eliminating paper charts. As medication inventory, allergy documentation, controlled-substance ordering, temperature monitoring and clinical documentation become electronic, ASCs have an opportunity to create a more connected medication management infrastructure.
The long-term opportunity is integration – reducing the number of isolated manual systems used to manage medications.
9. Formulary decisions increasingly affect efficiency, cost and patient experience
The ASC formulary is changing as new medications and new clinical strategies enter outpatient surgery. The 2026 survey found continued adoption of rocuronium and sugammadex, with 17% of respondents reporting adding the combination to their formularies.
Ophthalmology provides another example. The survey found a 22% increase in the use of intracameral triamcinolone-moxifloxacin associated with “dropless” cataract approaches. The strategy may reduce dependence on complex postoperative eye-drop regimens, although the report emphasizes appropriate due diligence when compounded products are used.
Formulary review should therefore include more than acquisition price. Executives should consider clinical outcomes, staffing efficiency, workflow, reimbursement and the total cost of care.
10. Pharmacy performance belongs on the executive dashboard
Perhaps the most important trend is organizational rather than pharmaceutical. Medication management touches fi nance, quality, compliance, patient safety, anesthesia, nursing, supply chain and regulatory readiness. Yet many ASCs still manage these functions independently and report relatively little pharmacy information to senior leadership.
ASC executives should consider a small medication-management dashboard that tracks measures such as drug acquisition costs against benchmarks, critical shortages, medication waste, formulary changes, controlled-substance discrepancies, inventory and expiration losses, and adoption of technologies capable of improving efficiency.
Benchmarking should ultimately answer a simple executive question: How does our ASC compare with its peers, and what are we doing with that information?
Looking Ahead
The pharmacy function within an ASC is becoming more datadriven, automated and strategically important.
The next phase will likely involve greater integration of medication data with clinical and financial information, more automated inventory and compliance systems, and eventually greater use of artificial intelligence to identify purchasing trends, potential shortages, waste and operational opportunities.
The organizations that benefit most will not necessarily be those purchasing every new technology. They will be the ASCs that use reliable data to determine where technology, formulary management and pharmacy oversight can produce measurable improvements.
After approximately a decade of benchmarking medication costs and practices, one message has become increasingly clear: Medication management is no longer simply a clinical support function. It is an opportunity to improve cost control, operational efficiency, regulatory compliance and patient safety – and it deserves the attention of ASC executive leadership.
John Karwoski, RPh, MBA, is President and Founder of JDJ Consulting, LLC, which provides consultant pharmacist and medication-management services to ambulatory surgery centers. JDJ Consulting is celebrating its 25th anniversary in 2026.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
