Community Health Care Hubs Benefit From Clinical Care With Pharmacists

Pharmacists are in a unique position to improve the well-being of their communities by augmenting basic services with other vital health care needs, such as vaccination,¹ senior care, and optimizing patient medication regimens. However, reimbursement continues to be a challenge,² as do provider recognition and lack of coordination with primary care providers.

“Access to vaccination and other preventive services, especially in rural or underserved areas, can be addressed by pharmacists,” Jackie Straughn, PharmD, co-owner of Doctors Park Pharmacy in Norman, Oklahoma, said. “Pharmacies and pharmacists can improve vaccine coverage due to our extended hours and availability, building relationships with the community and using patient profiles to identify and educate eligible patients.”

Chronic disease management³ and medication therapy management (MTM) optimization are 2 other ways pharmacists can improve patient outcomes. “We can help monitor medication therapy, adjust medications under collaborative practice agreements [CPAs], provide hypertension/diabetes coaching, and reduce medication-related problems, all while improving clinical outcomes and lowering downstream costs,” Straughn, president of the Oklahoma Pharmacists Association, said.

Pharmacies are also well positioned to offer hemoglobin A_1C blood tests, blood pressure and cholesterol screenings, health education, and referral to primary care. “This helps catch undiagnosed disease and reduces barriers to care,” Straughn said.

However, for pharmacists to attain provider status and determine how to bill for these services, it can be daunting, according to Straughn. “There are not a lot of ways for standardized billing,” she said.

Likewise, services may be impeded by busy pharmacies, insufficient staffing, and space constraints. “Pharmacists also have limited access to electronic health records [EHRs] and poor data exchange with primary care providers, so that can make outcomes measurement harder to recognize and document,” Straughn said.

Another potential hindrance to expanding clinical care is the cost of devices and the materials associated with these devices; for example, an entire box of test strips may not be used due to an expiration date.

“Advocating for pharmacists to be billable providers will be key in advancing our role,” Straughn said. Other solutions are pursuing payer contracts and value-based pilots, employing CPAs, redesigning workflows with trained technicians, and integrating documentation with local EHRs.

According to Kari Trapskin, PharmD, senior vice president of practice transformation at the Pharmacy Society of Wisconsin, pharmacists can improve access to care by offering vaccinations, blood pressure checks, home blood pressure monitor education, and comprehensive medication review services, “filling gaps for both insured and underinsured patients.”

In states that allow medical billing, pharmacists can also deliver reimbursable services such as point-of-care testing and chronic disease monitoring, “thus making care more sustainable,” Trapskin said. “Similarly, by working closely with other providers and community-based organizations, pharmacists strengthen continuity of care, ensuring patients receive follow-up, medication support, and social needs referrals that reduce barriers and prevent avoidable hospital visits.”

Despite pharmacists being ideally suited to provide such clinical services in a community setting, “many states still limit pharmacists’ ability to bill medically, and community pharmacies often lack the infrastructure or training to initially manage the multiple facets of medical billing, making reimbursement initially inconsistent and unsustainable,” Trapskin said.

Medication product reimbursement struggles, such as low or unpredictable payment for dispensing, “further strain margins, making it difficult to add new clinical services into already pressured workflows,” Trapskin said. Furthermore, obtaining CPAs with physicians for specific services that require CPAs “is a barrier for pharmacies unaffiliated with health systems. Additionally, limited health record access and incomplete provider recognition hinder collaboration, while patients often remain unaware of pharmacists’ extensive capabilities to provide services outside of dispensing medications.”

Expanding pharmacists’ clinical roles requires coordinated efforts between policy, people, and systems, according to Trapskin. “Collaboration with state associations, Community Pharmacy Enhanced Services Network [CPESN],⁴ and schools of pharmacy can provide pharmacists the training and peer support needed to adopt new clinical workflows and navigate medical billing,” she said. “Building medical billing capacity—through medical billing software support, technician support, and standardized processes—will help to create sustainable care models.”

But policy advocacy remains essential because pharmacies need clearer provider status and consistent scope-of-practice rules to deliver and bill for care. “Pharmacists must be recognized by both public and private payers to successfully implement sustainable models over time,” Trapskin said. “Long-term practice transformation also depends on initial investment and patience with the process of phased implementation, workforce development, ongoing training, and identifying new bidirectional referral relationships with community-based organizations and community health workers.”

Trapskin said stronger connections with health care systems and clear patient education can help integrate pharmacists into care teams and increase community understanding, trust, and engagement.

Kat Marie Alvarez, MBA, RN, is CEO and founder of Katalyst & Co, a Palm Beach, Florida–based health care transformation platform that partners with pharmacies and pharmaceutical consultants to develop and implement pharmacy programs, both community-based and larger-scale initiatives. Alvarez collaborated with a rural pharmacy to manage hard-to-reach members during an influenza campaign and led a medication reconciliation program with a chain pharmacy to support diabetes management.

Polypharmacy management, particularly in senior-focused health care, is a critical community need that pharmacists can address by expanding clinical care, according to Alvarez. “Seniors often see multiple specialists and receive care from various physicians, resulting in duplicate medications or contraindicated combinations,” she said. “This can lead to adverse drug interactions, cognitive impairment, and even death. Medication complications are one of the primary causes of hospital readmissions in the United States.”

Communities also need screening and early detection of medication-induced cognitive concerns. “These problems are rampant in [older patients],” Alvarez said. “Pharmacists need to be more involved in identifying polypharmacy issues that may mask or worsen dementia symptoms [and] also provide MTM to reduce the anticholinergic burden.”

Another essential service pharmacists can assist with is medication adherence, especially for underserved or more isolated populations. “Pharmacists can identify patients who are socially isolated, as these individuals tend to have more medication mismanagement,” Alvarez said. “Creating touchpoints for homebound or socially isolated individuals and connecting patients with community resources and social services are areas where community-based pharmacy can make a significant impact.”

These 3 services are hindered by limited infrastructure and poor integration between pharmacies and providers. “Beyond simply sending prescriptions, there is limited interaction or information exchange that occurs between critical stakeholders,” Alvarez said.

Alvarez said pharmacists need to be formally acknowledged in the health care system for the clinical services they are currently providing. “Without formal recognition, pharmacists are unable to consistently bill for the clinical work they’re already doing, even when it improves adherence, reduces avoidable ED [emergency department] visits, or closes care gaps,” she said. “The major area requiring attention is the technical use of pharmacists within the clinical network, ensuring that technology coupled with clinical workflows brings pharmacists fully into the health care ecosystem.”

An article published in 2024 in the Journal of the American Pharmacists Association⁵ evaluated 2 models of community pharmacy and community-based organization (CBO) collaboration to address health-related social needs (HRSNs) facing patients taking medications. “Both pharmacy CBO models effectively identified clients in need of medication management services or patients with HRSNs impacting medication optimization,” coauthor Trapskin said. “Developing relationships with CBOs is of utmost importance when trying to address HRSNs in the community pharmacy. CBO partners serve as the trusted partner or cultural broker, helping patients feel safer with the pharmacist.”

Trapskin is also a corresponding author of a 2025 feature story in The Journal of the Pharmacy Society of Wisconsin⁶ on Wisconsin’s pathway to pharmacist provider status. “The article describes the process used by our organization to support the initial implementation of Wisconsin Medicaid provider status for pharmacists so they can medically bill for services provided to Wisconsin Medicaid program recipients,” she said.

Trapskin is optimistic about the future of community pharmacy, especially as more states permit medical billing opportunities. “Establishing the regulatory opportunities is not enough, though,” she said. “Transforming practice in a challenging environment requires investment in new care models, infrastructure, and technician-supported workflows.” Collaboration with state associations, CPESN pharmacies, and schools of pharmacy will also be essential for training, coaching, and navigating medical billing.

“Pharmacies that commit to this shift will be better positioned to deliver sustainable clinical services,” Trapskin said. “With time, training, and the right support systems, community pharmacies can successfully transform into fully integrated health care access points.”

Real-world examples demonstrate the potential of an ever-increasing role for pharmacists. For example, as part of a pharmacy intervention model that Alvarez of Katalyst & Co helped construct, a community pharmacy was integrated into an ecosystem through a pharmacist-led transition-of-care program for older patients. “We discovered that nearly 20% of readmissions were due to medication errors, either nonadherence or adverse drug events from polypharmacy,” she said.

Katalyst & Co also created an interventional model where pharmacists became part of the care coordination team, conducting comprehensive medication reconciliation upon hospital discharge. “The pharmacists identified discrepancies, duplications, and inappropriate medications for elderly patients, preventing drug-to-drug interactions among seniors, some of whom were taking 10 or more medications,” Alvarez said. “This model proves that with proper integration, pharmacists can significantly reduce preventable hospitalizations and improve patient outcomes.”

Straughn is hopeful that the future of pharmacy will advance into a more integral part of the health care team. “We showed how impactful we could be during the COVID-19 pandemic,” she said. “Pharmacists just need to keep up that momentum and keep advocating to advance the role of pharmacy.”

Straughn believes that having more pilot programs and value-based contracting will pressure provider recognition “so pharmacists can be sustainably reimbursed for clinical services,” she said. In addition, better EHR/health information exchange connections, point-of-care testing, and expanded roles for technicians “should enable higher volumes of clinical services without sacrificing safety.”

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REFERENCES

1. Elghanam Y, Kim EY. Impact of pharmacist intervention on enhancing vaccination coverage: a systematic review and meta-analysis. Res Social Adm Pharm. 2025;21(7):495-504. doi:10.1016/j.sapharm.2025.03.004

2. Alyaseen L. Challenges in reimbursement for pharmacy services, DIR fees, and the evolving PBM model. Pharmacy Times. May 19, 2023. https://www.pharmacytimes.com/view/challenges-in-reimbursement-for-pharmacy-services-dir-fees-and-the-evolving-pbm-model

3. Rendrayani F, Utami AM, Insani WN, et al. Interventions to improve pharmacists’ competency in chronic disease management: a systematic review of randomized controlled trials. BMC Med Educ. 2024;24(1):1441. doi:10.1186/s12909-024-06393-z

4. Starr K. CPESN: building networks for enhanced pharmacy services. Pharmacy Quality Alliance. www.pqaalliance.org/index.php?option=com_dailyplanetblog&view=entry&year=2020&month=12&day=11&id=31:cpesn

5. Doucette WR, Wolff K, Trapskin K, McDowell H, Mott DA, McDonough RP. Pharmacist-community-based organization collaboration to address health-related social needs. J Am Pharm Assoc (2003). 2024;64(5):102144. doi:10.1016/j.japh.2024.102144

6. Johnson A, Trapskin K. Wisconsin’s pathway to pharmacist provider status: 2024 update. Journal of the Pharmacy Society of Wisconsin. January-February 2025. www.jpswi.org/uploads/1/1/7/1/117140068/jpswjf25_providerstatus.pdf