McKesson IdeaShare 2025: Independent Pharmacies Boost Revenue and Sustainability Through Clinical Services

As independent pharmacies face mounting pressures from declining reimbursement rates and rising operational costs, many are looking beyond traditional dispensing to secure their future. In this discussion, Nancy Lyons, BSPharm, MBA, CDCES, vice president and chief pharmacy officer of Health Mart by McKesson, shares her insights on why diversifying revenue streams is essential for long-term sustainability, the strategic value of services like point-of-care testing and chronic care management, and practical advice for overcoming the hurdles of implementing new clinical offerings. Her perspective highlights both the urgency and the opportunity for community pharmacies to evolve in order to meet changing patient needs and remain financially viable.

Q: The traditional dispensing model faces increasing pressures. From your perspective, what are the primary financial and operational reasons independent pharmacies must diversify their revenue streams beyond dispensing, and how critical is this for long-term sustainability?

Nancy Lyons, BSPharm, MBA, CDCES: I think the word "critical" doesn't even describe how critical it is for pharmacies to really get into diversification of revenue. Many pharmacies have been doing it for years, but we're at a state now—with reimbursement of medications and just other pressures within the market—that really makes this the place to potentially see some revenue, potentially see some light at the end of the tunnel for all the great work that the pharmacies are doing. Operational costs are rising—staffing, inventory, compliance, regulatory fees, and all of that. But it's really a time. I'm so proud of many of our Health Mart pharmacies who've already gone down the road and can act as role models for some of those that might be looking for it now.

Q: Services like point-of-care testing, immunizations, and chronic care management are often highlighted as key expansion areas. Can you walk us through the strategic advantages of offering these specific services from both a patient care and a business profitability standpoint?

Lyons: Definitely. I mean, we still have to figure out the reimbursement piece for many of the patient care services that are offered. But many pharmacies have had luck charging patients cash—especially patients with high-deductible plans who would rather have the convenience of walking to their community pharmacy in the heart of their community to do that. All of the services you just mentioned—whether it's point-of-care testing and immunizations—I consider table stakes for any community pharmacy, where the profitability is still there for the services that pharmacists can provide, in addition to the preventive care that keeps communities healthier.

Chronic care management—I think we should talk more about that. It's kind of what's old is new again. Pharmacies have been involved in chronic care management literally for decades, having really cost-effective care outcomes for those patients, saving dollars that are invested in preventive care and maintenance. It's about making sure patients not only take their medications—we hear about adherence a lot—but also making sure the medications are optimized, doing the right thing for them, side effects are minimized, and really, patients have a better chronic care life. Instead of a chronic condition, they're able to really work on the things that they like.

Lots of resources are available to help pharmacies with that. There’s a lot that was learned during the COVID-19 pandemic, with schedulers and tools that pharmacists can use to really optimize care and match consumer expectations at this time too.

Q: Implementing new clinical services requires significant investment in training, resources, and often, technology. What are some of the biggest hurdles pharmacists face when trying to introduce these services, and what advice would you offer to overcome them?

Lyons: I want to pressure test that one a little bit, because I think it is a perception that if a pharmacy is going to do a new clinical service, they have to spend so much money on training, or timing, and all of that. I will admit that some of the tools needed for documentation and billing can be costly.

I think my advice is to start small. Start with what you know. Start with what your patients need—really taking some time to think about the things your patients are going to be interested in—and then take a small bite of the elephant by doing a new clinical service and expanding from there. I think one of the worst things that we, as a profession—I've been in the profession for a while—can do is talk ourselves out of getting started today with something. And then too many todays go by, and nothing changes, except the reimbursement pressures that continue to get tougher.

Really, just keeping up with clinical guidelines, making sure your staff has access to tools and resources, investing in maybe some additional technology to help with scheduling and flow management is always advisable. But then do the service. Find the payment—whether that's from the patient directly, with those high-deductible plans, or getting into some of the increasing number of models that are available for pharmacists to receive payment for patient care services.