Since its inception in 2013, the Defense Health Agency has implemented several strategic initiatives aimed at controlling military healthcare expenditures, including considerable efforts toward reducing pharmaceutical costs. Despite the success of these initiatives at fixed military medical treatment facilities, where pharmacy officers lead the implementation and management of cost-saving strategies, the military services have not made a concerted effort to expand these initiatives to their operational medicine platforms, where the absence of pharmacy officer involvement has led to a gap in institutional knowledge of pharmaceutical inventory management processes. This case study seeks to mitigate this knowledge deficit by describing these processes for a representative shipboard medical department aboard the USS Theodore Roosevelt (CVN 71) to determine the potential for similar cost savings. Using a qualitative process and critical incident analysis, this report identifies potential drivers of inefficiencies in shipboard pharmaceutical inventory management and procurement. These include process variability based on medication type, lack of relevant performance measures, potential mission-material mismatches on authorized medical allowance lists, and the lack of true subject-matter experts in planning and implementation. This review provides a baseline and enables future targeted research to validate findings and implement systemic changes to reduce inefficiencies and costs.