Breaking Financial Barriers: Pharmacists as Value-Driven Health Care Providers

Pharmacists face challenges in payments and reimbursements, which could present difficulties in pharmacy services. Now more than ever, there is a need for legislative support, standardized billing practices, value-based care approaches, and technological integration to overcome current barriers to pharmacist service reimbursement and recognition as essential health care providers.

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At the National Academies of Sciences’ Innovation in Pharmacy Training and Practice to Advance Patient Care workshop, leading pharmacy experts discussed the critical challenges and opportunities in establishing sustainable financial models for pharmacist-provided health care services. Shared in the session “Exploring Financially Supported Roles for Pharmacists Through Model Programs,” speakers from various health care systems discussed insights into how pharmacists can expand their clinical roles, navigate complex reimbursement landscapes, and demonstrate value through comprehensive medication management, patient care, and innovative practice models.

Challenges in Pharmacy Services and Reimbursement

Mary Ann Kliethermes, PharmD, director of medication safety and quality at American Society of Health-System Pharmacists Inc, set the stage by highlighting the historical context of pharmacists' roles.

"We are here today with pharmacists providing these services [that] really start back when I first started in pharmacy, 1976," she noted, emphasizing the long-standing recognition of pharmacists' potential in clinical therapeutics.

Kliethermes pointed out the staggering number of prescription medications, with over 20,000 prescription medications on the market in the United States right now, along with the persistent challenges of medication management and physician burnout.

Regarding pharmacy reimbursement, Kliethermes highlighted the critical need for laws and regulations that allow it and payment from major payers. She noted that while 44 out of 50 states designate pharmacists as health care providers, payment remains a challenge.

Experts Share Pharmacy Reimbursement Approaches

Comprehensive Medication Management Programs

Each panelist shared unique insights into their organization's approach, starting with Amanda Brummel, PharmD, BCACP, vice president of clinical pharmacy services at Fairview Pharmacy Solutions. Brummel described their comprehensive medication management program (CMM), which saw over 25,000 patients last year and had over 57,000 encounters, demonstrating the potential scale of pharmacist-provided services. Fairview has experienced clinical, economic, and humanistic impact, including a 33% reduction in readmissions for medication therapy management (MTM) patients and a reduction in total annual health expenditures exceeding the cost of providing MTM services by more than 12 to 1. Additionally, in a patient satisfaction survey, 96% of respondents agreed or strongly agreed to recommending their pharmacy services. Brummel noted that looking ahead, Fairview and other health care providers need to continue to advance payment suitability, improved productivity, and population optimization.

Medication Therapy Disease Management

Sharing ambulatory clinical pharmacy program models from Geisinger Health System, Adriene Zook, PharmD, pharmacy manager and ambulatory clinical pharmacy programs, discussed their programs surrounding financial sustainability and value-based care that integrated pharmacists into care teams. This included medication therapy disease management (MTDM) primary care, MTDM specialty care, and non-traditional MTDM.

“It's mission critical for us as a profession to really define, track, and report out these clinical interventions, the outcomes, and the impact that we're able to make. It ties back into demonstrating and showing what we know that we're doing really well in paper form to drive some of these further changes in legislation — really optimize revenue-generating opportunities but not lose focus on patient outcomes,” Zook said in the panel discussion.

Virginia Mason Practice Model

Similar to Geisinger Health System, Laura Hanson, PharmD, MBA, BCPS, from Virginia Mason Franciscan Health Medical Center, discussed their clinic pharmacy model, which has been in place for over 30 years, generating nearly 32,000 visits annually and $7.5 million in revenue. The model includes embedded clinic pharmacists, centralized pharmacy services, and a population health strategy. Additionally, during the pandemic, a centralized team model evolved to allow pharmacists to focus on patient-facing visits. She emphasized the importance of maintaining and updating billing practices to ensure sustainability is emphasized.

“We're talking value-based care; this is really the opportunity, the place that we really haven't maximized our impact. My plan is that we're going to put more full-time equivalents into both this work and our centralized team and in our clinic teams. We're also going to learn how to work smarter. There is evolving technology to help with this work. We need to learn how to harness this to improve our workflows,” Hanson said.

Community Pharmacy Business Model Challenges

Shifting to challenges in community pharmacy business models, Troy Trygstad, PharmD, PhD, MBA, executive director of CPESN USA, emphasized the need for a different approach to marketing pharmacy services, focusing on local networks and specific practice models. He highlights the need for a different approach to marketing pharmacy services, specifically around reducing friction and transaction costs in community pharmacy.

“You can access a pharmacist without an appointment, pretty much if you jump up and down and pound on the window enough, right? Imagine going to a physician's clinic and jumping up and down and pounding on the window. We're accessible out there in the community, but workflow, friction, and dispensing workflow—how do you put those two things together?”

Looking ahead, Trygstad shared the potential for value-based contracts and the role of technology in improving workflows and efficacy.

The panelists all ultimately conveyed a similar message: Pharmacists are crucial health care providers who need supportive financial models, legislative recognition, and innovative approaches to fully realize their potential in patient care.

REFERENCE

Kliethermes M., Brummel A., Zook A., Hanson L., Trygstad T., Exploring Financially Supported Roles for Pharmacists Through Model Programs. Academics of Science: Innovations in Pharmacy Training and Practice to Advance Patient Care: A Workshop. Washington, DC. May 29, 2025 – May 30, 2025.