Traditionally, pharmacist reimbursement has largely been focused on obtaining payment for the provision of products, like prescription medications. Today, pharmacists have an expanded scope of practice and the pharmacy profession has incorporated more clinical aspects into routine patient care, like chronic disease management, care transitions interventions, and medication therapy management. For these clinical services to be sustainable, pharmacists must be able to receive payment for the resources and time dedicated to improving patient care and outcomes.

Currently, pharmacists are not recognized as providers under Medicare Part B and therefore cannot directly bill for most of the clinical services they have been trained to provide. However, through collaborations with other health professionals, state insurers, private insurers and health systems, pharmacists can implement more sustainable clinical programs into their practices.

Our payment resources are designed to help you understand existing and emerging opportunities to be compensated for providing certain patient care services. 

Payment News
March 19, 2018
APhA2018: The journey toward value-based payment models

Most organizations are going through the shift from traditional fee-for-service to value-based payment models. “Quality is here to stay,” said Amanda Brummel, PharmD, BCPS. Pharmacists “need to understand the culture change happening.” Brummel, of Fairview Health Services, based in Minneapolis,…

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March 17, 2018
Getting Started with Outpatient Fee-for-Service (FFS) Billing

Pharmacists have opportunities to be paid for patient care services but understanding those opportunities can be complicated. Billing Primer: A Pharmacist’s Guide to Outpatient Fee-for-Service Billing offers an introduction to common billing codes and provides a broad overview of factors to…

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February 5, 2018
Chronic Care Management

Beginning January 1, 2015, the Medicare Physician Fee Schedule (PFS) reimburses qualified providers for Chronic Care Management (CCM) services for Medicare beneficiaries with two or more chronic health conditions. Pharmacists can participate in CCM as clinical staff, with their services being…

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November 28, 2017
Investment in MTM services a win for Giant Eagle, patients, and payers

Giant Eagle is a medium-sized chain, but when it comes to providing MTM services, it’s a titan. Its clinical program has racked up awards from health plans, vendors, and pharmacy organizations—including APhA—and continues to expand. What’s the secret to its success? Corporate support, a dedicated…

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November 20, 2017
Big changes could be in store for 2019 Medicare drug plans

For the first time in 3 years, the CMS regulatory agenda released a Medicare Advantage and Part D proposed rule. The Part D proposed rule is a platform for presenting major policy changes for public comment. CMS will accept public comments through January 18, 2018. To view a CMS fact sheet on all…

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October 17, 2017
Medicare open enrollment begins on October 15, ends December 7

It’s that time of year again! In September, CMS announced that the average basic premium for a Medicare prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the average basic premium of $34.70 in 2017. The…

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