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
January 23, 2020
Evidence Based Practice: Podcast and Literature Series

APhA has partnered with iForumRx, an interactive web-based community for Ambulatory Care pharmacy specialists, to produce a line of innovative and interactive recertification products. This series will feature succinct commentaries about practice-changing evidence through a series of podcasts,…

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January 13, 2020
Big-time PBM scrutiny on the way as U.S. Supreme Court agrees to hear Arkansas case

“A handful of PBMs that rival the most profitable corporations in the world somehow operate with very little oversight because of confusion over whether federal law preempts the states from regulating them,” said Mustafa Hersi, NCPA's vice president and general counsel. “They have failed entirely…

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December 24, 2019
Trump administration pushes drug importation despite safety concerns

Pharmacy organizations and advocates have long asserted that importation poses an unacceptable threat to public safety. Other importation skeptics question whether the process of shipping and redistributing drugs under the proper conditions would result in net savings. It would require ensuring…

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December 23, 2019
Only one drug pricing policy in federal appropriations bills

The CREATES Act (S. 340/H.R. 965) is aimed at bringing generics and biosimilars to market more quickly. Under the law, drug manufacturers are prohibited from refusing to sell samples of their products to other manufacturers who want to develop generic alternatives. Generic drugmakers can sue if the…

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December 13, 2019
DIR reform in updated Senate bill welcome news to pharmacists and advocates

APhA signed onto a letter praising the legislation, which “addresses backdoor clawback fees charged by large pharmacy benefit managers (PBMs) that are shuttering pharmacies and costing patients more at the pharmacy counter.” The National Community Pharmacists Association—which has led the coalition…

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October 22, 2019
Ohio moves to expand pharmacist services after gaining provider status

Several states across the nation have granted provider status to pharmacists, but implementation has often stalled, leaving many to wonder what comes next. OPA’s new initiative addresses these concerns by partnering with Ohio’s colleges of pharmacy, adding resources, and hiring new staff members…

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