Heart failure has no shortage of effective medications. The harder problem is getting the right patient onto the right therapies, moving those therapies toward appropriate doses, keeping treatment affordable, and making sure the regimen survives after the patient leaves the hospital.
Stanford Health Care is showing what pharmacy can look like when pharmacists help own that process from beginning to end.
At Stanford, pharmacists are embedded across several stages of the heart-failure journey. They participate during hospitalization, provide transitions-of-care services around discharge, and receive referrals into a pharmacist-run cardiometabolic service that manages patients with heart failure, lipid disorders, and other cardiometabolic needs. Protected pharmacist clinic access also allows patients to receive follow-up more frequently than typical cardiology schedules may allow.
The model is important because it moves beyond a familiar version of clinical pharmacy.
The pharmacist does not simply identify a medication problem, make a recommendation, and disappear from the patient’s journey. Instead, the pharmacy team can remain involved as treatment moves from hospital initiation to discharge, follow-up, continued optimization, and measurement of whether patients actually stay on therapy.
That is a much larger role.
It may also offer a preview of where pharmacy practice is heading.
Heart failure shows why prescribing the right drug is only the beginning
Modern heart-failure treatment has become increasingly sophisticated. Multiple medication classes can reduce morbidity, mortality, and hospitalization risk when used in appropriate patients.
Yet the existence of an effective therapy does not guarantee that patients receive it.
Someone has to recognize eligibility. The medication has to get started. Clinicians need to monitor laboratory values, blood pressure, symptoms, tolerability, and volume status. Doses may need adjustment. Cost and access barriers can interrupt treatment.
Then the patient has to continue taking the therapy after leaving the hospital.
Those steps create a gap between what clinical guidelines recommend and what patients actually receive.
The recent review “Pharmacist-Led Medication Titration for Cardiometabolic Disease: Evidence, Equity, and Scale” describes this problem as a continuum. Dashboards, registries, electronic alerts, and inpatient initiation can identify patients who are undertreated. However, those tools alone do not create the infrastructure needed for ongoing dose adjustment, monitoring, adherence support, and medication-access navigation. Pharmacist-led team models operate at the active end of that continuum.
That distinction is fundamental.
Healthcare does not only need to know that a therapy gap exists.
Someone has to close it.
Stanford puts pharmacists across the patient journey
Cody Parsons, PharmD, APh, BCCCP, director of clinical operations in cardiovascular health at Stanford, described pharmacists as embedded at each major phase of heart-failure care.
Inside the hospital, unit-based pharmacists participate through order verification, proactive medication-profile review, and multidisciplinary bedside rounds. Patients expected to receive a primary heart-failure diagnosis-related group also automatically receive transitions-of-care pharmacy services. Those services include medication review, patient education, discharge reconciliation, and an updated after-visit medication summary.
The team also looks for opportunities to use therapies with established benefits for morbidity, mortality, and readmission. When medication access becomes a barrier, pharmacists work with social work and case-management teams to address it.
The relationship can continue after discharge.
Stanford’s cardiology pharmacy training structure includes rotations in heart-failure transitions of care and a heart-failure and cardiometabolic ambulatory clinic. The health system also lists dedicated ambulatory-care and transitions-of-care pharmacists within the program.
The result is not one pharmacist intervention.
It is pharmacy infrastructure built around the medication journey.
Protected access may be one of the most important parts of the model
One detail deserves more attention than it may initially receive.
Stanford’s pharmacist-run cardiometabolic service has protected pharmacist access. Parsons said this allows patients to be seen much more frequently than typical cardiology clinic availability would permit.
That matters because medication optimization often requires time.
A physician may select the right therapy during a visit, but the patient may need follow-up two weeks later. Blood pressure could change. Kidney function may need reassessment. A patient might develop dizziness. Another may never start the drug because the copay was too high.
Waiting several months for the next traditional appointment can slow the entire treatment process.
A pharmacist with dedicated follow-up capacity creates another option.
The cardiologist can establish the broader treatment strategy while the pharmacist helps manage the medication-intensive work that follows.
That does not reduce the physician’s role.
It allows each professional to spend more time on the work where their expertise creates the most value.
The future pharmacist may own a process, not just make a recommendation
This is where the Stanford model becomes especially interesting for the future of pharmacy.
Traditional clinical pharmacy often emphasizes identifying medication-related problems and recommending changes.
That creates value.
However, a recommendation is only one point in the care journey.
A larger model asks whether the pharmacist can remain responsible for helping move the patient from the current regimen toward an optimized one, within the authority and collaborative structures available in that practice environment.
The workflow begins to look different.
The pharmacist identifies a gap, helps initiate or adjust therapy when authorized, monitors the patient’s response, follows up, addresses adherence and access barriers, and continues optimizing treatment. The team then measures whether patients remained on therapy and whether the broader care model improved outcomes.
This is closer to medication-management ownership.
The pharmacist is no longer simply the person who notices that something should change.
They become part of the system responsible for making sure the change actually happens.
The difference between a medication expert and a medication-management owner is follow-through
Pharmacists have long been described as medication experts.
That phrase is accurate, but it can be incomplete.
Expertise describes what someone knows.
Ownership describes what they are responsible for accomplishing.
A medication expert can recognize that a patient with heart failure is missing an evidence-based therapy.
A medication-management owner helps close the gap.
They determine what barrier exists. They help move the treatment forward within their scope. They monitor tolerability. They make sure the patient can obtain the medication. They follow what happens next.
That shift becomes increasingly important as medication regimens become more complicated.
Healthcare already has growing amounts of clinical information. Decision-support systems can identify care gaps. AI can eventually make that process even faster.
However, identifying a problem is not the same as resolving it.
Someone still has to act.
That may become one of the pharmacist’s most valuable roles.
AI can find the patient. Someone still has to manage the therapy
The recent cardiometabolic review makes this point directly.
Registries, dashboards, alerts, and AI-enabled systems can help identify patients who are not receiving optimal treatment. Yet the authors argue that identification alone does not provide the infrastructure for medication titration, monitoring, adherence support, or access navigation.
That is an important lesson as healthcare invests heavily in artificial intelligence.
Imagine an AI system that scans thousands of records and finds 500 patients whose heart-failure therapy could potentially be optimized.
The technology has created a list.
It has not created care.
Someone still has to review the patient, determine whether the recommendation fits, communicate with them, adjust treatment when appropriate, monitor the response, address side effects, resolve coverage problems, and decide what happens next.
That is where pharmacist expertise becomes complementary to technology rather than threatened by it.
The machine can help find the opportunity.
The pharmacist can help turn the opportunity into an outcome.
Heart failure is particularly suited to this type of pharmacist involvement
Heart failure highlights the difference between choosing a treatment and managing a treatment over time.
Several therapies may need to work together. Patients can have changes in renal function, potassium, blood pressure, symptoms, and fluid status. Access to newer medications can create another barrier.
Stanford’s outpatient cardiometabolic service manages both heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. It also manages lipid therapies and GLP-1 treatments. The program includes proactive diuretic management, which Parsons said may help prevent admissions or readmissions.
The broader evidence base also supports looking beyond simple care-gap alerts.
The 2026 review found the strongest evidence for pharmacist-led cardiometabolic titration in hypertension, where pharmacist-led models have produced meaningful blood-pressure reductions. In heart failure, interdisciplinary titration programs more directly address progress toward target doses than passive alerts or decision-support systems alone. Evidence is also emerging across diabetes, lipid management, and obesity.
That suggests the Stanford model belongs to a broader trend.
Medication-intensive chronic disease may be an especially natural place for pharmacists to take greater longitudinal responsibility.
Starting the medication is not enough if the patient stops it later
Stanford is also measuring something pharmacy programs sometimes overlook: persistence.
Parsons emphasized that getting the patient onto therapy at discharge is only the beginning. Stanford tracks whether patients remain on treatment, and the AHA’s IMPLEMENT-EF initiative examines medication measures both during hospitalization and after discharge.
Post-acute measures include whether patients remain on therapy at 30 days and six months. Stanford also follows an optimal medical therapy score that reflects which medication pillars patients receive and how close they are to target doses.
This changes how pharmacist value gets measured.
A traditional metric might ask whether the pharmacist made an intervention.
A stronger metric asks what happened because of it.
Was the patient still taking the therapy six months later? Did the regimen move closer to optimal treatment? Were hospitalizations or readmissions affected?
Those questions move pharmacy from documenting activity toward demonstrating outcomes.
That shift will become increasingly important if pharmacist services are expected to earn sustainable reimbursement.
The framework is simple: embed, measure, sustain
Parsons described Stanford’s broader strategy in three words: embed, measure, and sustain.
First, place pharmacists where medication management is difficult.
Second, measure what changes.
Third, create a financial model that allows the service to continue.
At Stanford, the team tracks measures such as prescribing, optimal medical therapy scores, therapy persistence, admissions, and readmissions. Parsons also said the cardiometabolic service has tracked improvement in ejection fraction and observed benefit compared with standard cardiology care, although Pharmacy Times reported this as his description of Stanford’s internal experience rather than as the results of a separately presented randomized trial.
The financial piece matters just as much.
Stanford’s cardiometabolic clinic currently bills incident to physicians for pharmacist services. Parsons noted that this arrangement is not universal, but it gives the clinic a mechanism to support the work financially.
That may be the most practical lesson for health systems.
A great pharmacy service still needs a business model.
Sustainable pharmacy practice requires proving both clinical and economic value
Pharmacists have spent years demonstrating that they can improve medication use.
Scaling those services requires another step.
Someone has to pay for them.
That can mean billing mechanisms, value-based arrangements, health-system investment, payer contracts, or another model that connects pharmacist activity with measurable value.
The cardiometabolic review reaches a similar conclusion. Its authors argue that sustainable reimbursement is one of the requirements for scaling pharmacist-led medication titration. They also point to value-based care as a potential payment framework because organizations operating under those models have a financial reason to improve outcomes and reduce avoidable utilization.
That creates an important shift in pharmacy thinking.
The goal cannot simply be to prove that pharmacists are capable of managing medications.
The profession must show which outcomes improve, how much improvement occurs, and who benefits economically.
That is how a successful pilot becomes infrastructure.
This model depends on a team, not a pharmacist working alone
It would be a mistake to interpret Stanford’s approach as pharmacists replacing cardiologists or independently taking over heart-failure care.
The model works because pharmacy is embedded in a broader team.
Inpatient pharmacists participate with multidisciplinary teams. During transitions of care, they coordinate with social work and case management when medication access becomes a problem. Providers refer patients into the outpatient cardiometabolic service. Meanwhile, Stanford’s broader heart-failure program includes specialized cardiology expertise and advanced therapies such as devices, mechanical circulatory support, and transplantation.
Scope also matters.
Exactly which medications a pharmacist can initiate, adjust, or manage depends on state law, pharmacist credentials, institutional protocols, collaborative arrangements, and the specific care model.
The larger lesson is therefore not that every pharmacist should independently manage heart failure.
It is that pharmacists can take deeper responsibility for medication management when healthcare deliberately builds the authority, workflow, staffing, and accountability around them.
That infrastructure makes the difference.
Practicing at the top of your license may mean owning the medication outcome
The phrase “practice at the top of your license” gets used frequently in pharmacy.
Sometimes it becomes another vague way of saying pharmacists should do more.
Stanford’s model offers a more concrete interpretation.
The pharmacist is positioned where medication decisions become difficult.
They help identify the appropriate treatment. They support the transition from hospital to home. They help patients overcome medication-access barriers. They remain available for more frequent follow-up and influence therapy optimization across inpatient, discharge, and outpatient care.
That is not simply adding more tasks.
It is shifting responsibility.
The pharmacist becomes accountable for helping the medication plan move toward a better outcome.
That is a more meaningful version of expanded scope because it connects authority with responsibility and measurement.
The opportunity extends well beyond heart failure
Heart failure is only one example.
The same logic can apply wherever medication management requires repeated decisions over time.
Hypertension requires titration and monitoring. Diabetes requires treatment adjustment, adherence support, and interpretation of glucose data. Lipid management often requires repeated follow-up before patients reach therapeutic goals.
Obesity treatment increasingly involves medication selection, dose escalation, adverse-effect management, access barriers, and long-term persistence.
The 2026 cardiometabolic review specifically describes pharmacist-led longitudinal management across hypertension, heart failure, diabetes, lipidology, and obesity.
That creates a broader future-of-pharmacy opportunity.
Pharmacists could increasingly become the professionals who manage the medication-intensive portion of chronic disease while working alongside physicians and other members of the care team.
Healthcare already knows how to discover more therapies.
The harder challenge is making sure patients actually receive their full benefit.
The real bottleneck may be implementation
Medicine continues to produce better treatments.
That does not automatically create better outcomes.
A new heart-failure therapy can reduce risk in a clinical trial, yet the patient receives no benefit if nobody starts it.
The correct medication can be prescribed, yet the result disappears if cost prevents the patient from filling it.
A clinician can initiate therapy, but the patient may remain on a low dose because nobody has the capacity to follow up and titrate.
This creates a different way to think about medication expertise.
The next major improvement in healthcare does not always need to come from discovering another molecule.
Sometimes it comes from building a system that delivers the evidence we already have more reliably.
Pharmacists may be especially valuable in that implementation gap.
Ask whether you are identifying problems or owning their resolution
There is a useful career exercise inside Stanford’s model.
Think about the medication-related work you do today.
How often do you identify a problem?
Then ask what happens after you identify it.
Do you recommend a change and hand the problem back to someone else? Do you have the authority and infrastructure to follow the patient? Can you monitor the response? Can you determine whether the intervention worked?
There is nothing wrong with consultation. Many pharmacy roles appropriately operate that way.
However, the distinction reveals where pharmacy practice can continue expanding.
The future opportunity may be moving from identifying medication problems toward owning more of the process required to resolve them.
That requires more than expanded scope.
It requires staffing, technology, referral pathways, collaborative relationships, documentation, measurement, and payment.
Stanford’s experience shows how those pieces can begin fitting together.
Medication expertise becomes more valuable when healthcare gives it somewhere to go
The American Heart Association’s IMPLEMENT-EF initiative offers a useful wider context.
The three-year initiative involves 40 hospitals and multidisciplinary teams working to identify gaps in heart-failure care and develop stronger implementation models. Pharmacists are part of those teams, and dedicated pharmacist rounding with medication and disease education was identified as one of the workflows within an ideal care model.
That is an important signal.
The future of pharmacy may depend less on proving pharmacists know medications and more on designing systems that turn that knowledge into action.
Stanford has pharmacists involved during admission.
It keeps pharmacy involved during discharge.
Patients can move into a pharmacist-run cardiometabolic service after they leave.
The team measures whether therapy improves and persists.
Then it uses a billing mechanism to help sustain the service.
Embed.
Measure.
Sustain.
That framework may be more important than any one clinical program.
The future pharmacist may be a medication-management owner
For years, pharmacy has emphasized the phrase medication expert.
The next phase may require another identity.
Medication-management owner.
An expert can tell you what should happen.
An owner helps make sure it happens.
That does not mean pharmacists work independently from the rest of healthcare. The opposite is true. Models like Stanford’s work because pharmacists become more deeply integrated into the team.
Their responsibility simply extends further along the patient journey.
The pharmacist can help move the patient from an incomplete regimen toward evidence-based therapy. They can help maintain treatment after discharge, manage medication-related barriers, and create more opportunities for follow-up.
Then the organization can measure whether any of it worked.
That is a fundamentally larger vision for pharmacy practice.
The future pharmacist does not only know the medication.
They increasingly may own more of what happens because of it.
Resources & Citations
- Pharmacy Times. “How Stanford Pharmacists Help Close Heart Failure Therapy Gaps.” November 7, 2026. Cody Parsons, PharmD, APh, BCCCP, of Stanford Health Care describes pharmacist involvement across inpatient care, transitions of care, and a pharmacist-run outpatient cardiometabolic service. The interview also describes automatic transitions-of-care pharmacy services for patients with a primary heart-failure DRG and protected outpatient pharmacist access.
- Pharmacy Times. “Embed, Measure, Sustain: A Model for Heart Failure Pharmacy Care.” November 9, 2026. Parsons describes Stanford’s approach to tracking optimal medical therapy scores, prescribing, persistence at 30 days and six months, and admissions and readmissions. He also explains that Stanford’s cardiometabolic clinic bills incident to physicians as one mechanism for supporting the service financially.
- Yarlagadda S, Blood AJ. “Pharmacist-Led Medication Titration for Cardiometabolic Disease: Evidence, Equity, and Scale.” Current Cardiology Reports. Published online October 26, 2026. The review describes cardiometabolic medication optimization as a continuum from passive care-gap identification to active longitudinal management and concludes that scaling pharmacist-led titration requires appropriate staffing, population-health infrastructure, equitable implementation, and sustainable reimbursement.
- American Heart Association. “IMPLEMENT-EF.” The three-year initiative includes 40 hospitals and multidisciplinary teams working to improve heart-failure care by identifying patient-journey gaps and developing implementation models. The program uses Get With The Guidelines–Heart Failure data and includes pharmacists in medication optimization and evidence-based therapy implementation.
- Stanford Health Care. “PGY-2 Residency in Cardiology Pharmacy Practice” and residency program personnel. Stanford’s current cardiology pharmacy training includes heart-failure inpatient care, cardiology transitions of care, clinical research, and a heart-failure/cardiometabolic ambulatory clinic. Stanford also lists dedicated ambulatory-care and transitions-of-care pharmacists in the program.