As global healthcare systems pivot toward value-based care, the traditional role of pharmacists—primarily focused on dispensing and compliance—must evolve to meet the growing demands of cost-effectiveness, therapeutic optimization, and patient-centric outcomes. Integrative pharmacoeconomics emerges as a strategic framework that positions pharmacists at the center of formulary design and resource allocation, bridging the gap between clinical efficacy and economic value. Historically, formulary decisions were driven largely by cost minimization or therapeutic guidelines without real-time economic analysis. However, the rising complexity of drug therapies, budget constraints, and the need for population health equity demand a more dynamic, data-informed approach. This paper explores the paradigm shift in which pharmacists, armed with real-world evidence (RWE), health economic modeling, and outcome-based analytics, contribute actively to formulary decision-making processes. It discusses the integration of cost-utility analysis, quality-adjusted life years (QALYs), and budget impact models into formulary deliberations—tools traditionally reserved for health economists. The study also examines how pharmacists leverage electronic health records (EHRs), clinical decision support systems (CDSS), and machine learning models to evaluate therapeutic alternatives and negotiate drug inclusion based on real-time clinical and financial data. By narrowing the focus to institutional, payer, and national formulary frameworks, the paper emphasizes how pharmacists can drive sustainable access to medications, reduce therapeutic duplication, and align prescribing with value-based reimbursement policies. Ultimately, the integration of pharmacoeconomics into pharmacy practice not only redefines the profession’s strategic relevance but also enhances the overall efficiency and equity of healthcare delivery.