Abstract Health-system pharmacy services are growing amid an aging population, rising chronic disease, and high-cost therapies, while constrained primary care capacity creates additional demand for pharmacist-provided medication management. Workforce challenges, however, are not uniform. Shortages are concentrated among pharmacy technicians, experienced and specialized pharmacists, and pharmacy leaders. Gaps in access to health care cluster in rural areas and pharmacy deserts, and some staffing gaps reflect how work is distributed rather than an absolute shortage of pharmacists. This commentary argues that the future pharmacy workforce cannot simply be a larger version of today’s workforce. Drawing on the published literature and on presentations at a 2025 National Academies of Sciences, Engineering, and Medicine workshop entitled “Innovations in Pharmacy Training and Sustainable Practice to Advance Patient Care,” this commentary aims to: (1) describe where workforce demand is growing, distinguishing pharmacist from technician needs; (2) propose a framework for redistributing medication-related work among pharmacists, technicians, technology, centralized services, and other team members; and (3) offer recommendations, organized by problem type and stakeholder, that address technician career pathways and advanced roles, leadership development and succession planning, technology integration, education and pipeline development for pharmacists and technicians, and sustainable financing. In many health systems, technician capacity is the principal lever for expanding pharmacist clinical capacity. The commentary also identifies pharmacist backfill of technician work as a costly, largely unmeasured staffing model and proposes that health systems track the pharmacist hours it consumes.
