Hospitals in the USA face a crisis, with closures and mergers threatening their stability, particularly in rural areas. The economic fallout from the COVID-19 pandemic has exacerbated these challenges, increasing costs and workforce shortages. Anesthesiologists play a crucial role in clinical care, but their expertise in pharmacology and patient management offers additional value in hospital operations. By engaging with hospital pharmacists, anesthesiologists can enhance patient care, safety, and their department’s standing with hospital leadership. Effective collaboration with pharmacy services is essential, as drug costs are a significant non-labor expense, and maintaining a formulary is a complex process due to supply chain disruptions, drug shortages, and ever-increasing requests for new drugs from the hospitals’ medical staff. Anesthesiologists’ involvement with hospital pharmacists in formulary management and drug inventory control can mitigate conflicts and improve hospital efficiency, highlighting the importance of perioperative physicians beyond anesthesia care.