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 7, 2020
We know it, they know it, let’s get it done! Pharmacists must be formally included in public health efforts

The pharmacy community has fought for payment for pharmacists’ services under Medicare Part B—otherwise known as provider status—for years. Getting that message through to Congress has been painfully slow. Even though a huge and bipartisan number of federal legislators signed onto the Pharmacy and…

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May 29, 2020
APhA coronavirus watch: New York, Ohio, and Maryland make moves toward allowing pharmacists to bill Medicaid for COVID-19 testing

Big steps in the Empire State New York Gov. Andrew Cuomo issued an executive order on May 22 that authorized licensed pharmacists to order COVID-19 tests approved by FDA through emergency use authorizations detect SARS-CoV-2 or its antibodies; administer COVID-19 tests subject to CLIA certificate…

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March 17, 2020
New Mexico and West Virginia make progress on provider status

HB 42, introduced by Rep. Deborah A. Armstrong (D-Albuquerque), mandates that health plans reimburse pharmacist clinicians for clinical and prescriptive services they are already authorized to provide within New Mexico’s scope of pharmacy practice. Pharmacist clinicians would be compensated at the…

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February 18, 2020
Grassroots effort is aimed at pharmacist action on drug importation

U.S. Health and Human Services Secretary Alex Azar at one time dismissed the idea of importing drugs from Canada as a way to secure lower prices as a “gimmick.” But with the release of a December 23, 2019, FDA draft guidance and proposed rule, importation from Canada has a pathway toward reality. …

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February 11, 2020
Pharmacists are trapped in a system that threatens patient safety

If you ask me what keeps me up at night, I’d say it’s the kinds of mistakes that Ellen Gabler described in her January 31 New York Times story, “How Chaos at Chain Pharmacies Is Putting Patients at Risk.” During my time as a community pharmacist, I cherished the relationships I established with…

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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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