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
July 31, 2018
Soaring insulin prices have patients terrified and pharmacists scrambling

The numbers are staggering. According to the American Diabetes Association (ADA), 7.5 million Americans rely on insulin—including 1.5 million with type 1 diabetes—but the average cost of insulin tripled between 2002 and 2013 and continues to surge. A June 2018 study by UpWell Health found that 45%…

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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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December 20, 2017
Walgreens uses intelligent automation in HR

IBM announced Walgreens has implemented robotic processing automation (RPA) software from automation specialist Blue Prism to support its human resources (HR) function. The RPA solution delivers digital workforce capabilities that meet Walgreens' security and governance standards and enable…

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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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