Reimbursement Advancement of Clinical Pharmacy Services

Community pharmacy has strived to expand its practice from a product-based model to a patient-centered model to optimize medication treatment and overall patient outcomes. The International Journal of Clinical Pharmacy has published a review of a noteworthy achievement in Germany related to our goals.

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Following 2 decades of difficult negotiations, 5 clinical pharmacy services became eligible for reimbursement by all health insurance in Germany. Despite this progress, challenges persist in upscaling and sustaining these services.

Unlike the United States, Germany mandates statutory or private health insurance coverage for its population of 83.3 million, the highest population in the European Union. Only pharmacists can own a pharmacy and pharmacists may supervise up to 3 subsidiaries near their main pharmacy. Thus, no chain pharmacy exists in Germany. In 2021, a significant portion of pharmacists (77%; 53,300 of 68,800) worked in community pharmacy.

In summary, the 5 newly reimbursed community clinical pharmacy services include the following:

1. Medication review for patients who are taking at least 5 systemic or inhaled medications long-term.

Only pharmacists are authorized to provide this service and they must complete an advanced training course. Patients are entitled to receive 1 medication review per year, with the possibility of a second service if significant changes occur in medication regimen before year-end. On average, a medication review session lasts approximately 80 minutes.

2. Blood pressure (BP) control in hypertension.

All pharmacy dispensing staff, including pharmacists and pharmacy technicians in training, are authorized to measure patients’ BP. Pharmacists can make appropriate referrals in case of elevated or abnormal readings. This service is offered to individuals with hypertension diagnoses and who are taking at least 1 antihypertensive medication. Patients are eligible to receive this service once annually unless changes in their medications necessitate additional services.

3. Assuring proper inhalation techniques for patients receiving a new device or device change.

All pharmacy dispensing staff, excluding pharmacists and pharmacy technicians in training, are authorized to provide this service. Invoicing for the service is permitted when a patient is prescribed a new device or device change, or when the patient has not received practical training with their device in a doctor's office or pharmacy within the past 12 months. However, patients, who are enrolled in a disease management program for asthma or COPD are not eligible for this service.

4 and 5. Medication review with follow-up for patients taking oral anticancer medications or post-transplantation immunosuppressants.

These services fall under the category of polymedication review and are tailored to specific and smaller patient populations. Only pharmacists who completed advanced training courses are authorized to provide these services. The initial medication review can be conducted within the initial 6 months following transplantation or the initiation of oral anticancer therapy, or during a switch in these drug categories. The subsequent medication review can be scheduled 2 to 6 months after the initial consultation.

By examining other Western countries' reimbursement policies and practices, health care professionals and stakeholders can gain valuable insights to improve and expand clinical pharmacy care reimbursement practices in the United States.

About the Author

Mirina (Yangzhou) Li, PharmD,is a regulatory medical writing scientist at the Janssen Pharmaceutical Companies of Johnson & Johnson based in Boston, MA.

Reference

Schulz M, Griese-Mammen N, Müller U. Clinical pharmacy services are reimbursed in Germany: challenges of real world implementation remain. Int J Clin Pharm. 2023;45(1):245-249.