The contributions of a pharmaceutical outcomes approach to therapeutic decision-making and the budgetary process are explored. In the new health care climate, pharmacists can no longer look at a pharmaceutical product or service strictly on the basis of clinical outcomes but must consider the economic and humanistic outcomes as well. Today, pharmacists as effective outcomes managers must ask, Will the drug therapy work? What will be the overall cost? What effect will the treatment have on the patient's quality of life? Some newly developed agents, while they may have a high acquisition cost, can reduce suffering and bottom-line costs by avoiding unnecessary hospitalizations. There needs to be a movement from individual departmental budgets to shared budgets. Another approach to the budgetary system is cost shifting among the various patient care settings. Reimbursement strategies should be in place to ensure recovery of costs. Hospital decision-makers should have a comprehensive knowledge of institutional payer mix, pharmaceutical, formulary decisions, financial planning, and the availability of indigent care programs. Pharmaceutical outcomes must become an important factor in therapeutic decisions. Pharmacy directors must present a strategic financial plan to hospital administration that positions the pharmacy as a solution to cost issues.