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
September 24, 2019
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…

Read More
July 18, 2019
Texas pharmacists now providers in private health plans

On May 29, Texas Governor Greg Abbott signed HB 1757 into law, which amends Texas’ insurance code for commercial health plans and will allow a beneficiary of a commercial health plan to select a pharmacist to provide services in the health insurance policy.   According to a statement from the…

Read More
February 4, 2019
Bipartisan bill to end retroactive fees on Part D prescriptions reintroduced

Retroactive DIR fees are among pharmacists’ biggest headaches. Pharmacists don’t know until months after a transaction whether they’ve even recouped their costs, complicating decisions about keeping their pharmacies open, expanding their business, and addressing staffing needs. In addition,…

Read More
October 10, 2018
President’s signature frees pharmacists to help patients identify ways to decrease their medication costs

President Trump has signed into law two popular bills striking down so-called “gag clauses” in PBM contracts. Gag clauses barred pharmacists from telling patients the cash price of their medications, even when the out-of-pocket cost was lower than their copay. With the new laws, PBMs can no longer…

Read More
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%…

Read More
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,…

Read More