This article provides a comprehensive scientific analysis of the institutional, economic, and professional effectiveness of ongoing reforms in pharmaceutical services in Uzbekistan. The study demonstrates that under conditions where commercial logic dominates pharmaceutical service provision, the social functions of pharmacy services are institutionally constrained. Based on a comparative analysis of international social welfare state experiences, the article argues that ensuring the social function of pharmaceutical services cannot be achieved through administrative restrictions alone, but requires service-based remuneration, reimbursement, and economic compensation mechanisms. The study substantiates the necessity of functional differentiation between social pharmacy services and commercial pharmacies, the introduction of public–private partnerships in social pharmacy services, reform of centralized procurement and socially mandated wholesale distribution, and the development of in-pharmacy compounding systems. The research explains why current reforms have not resulted in the expected social outcomes in access to medicines and proposes practical, system-oriented institutional and economic solutions adapted to the conditions of Uzbekistan.