Community Pharmacies Embrace Clinical Services to Sustain Operations

Independent community pharmacies are fighting to survive in a system that rarely pays for the care they quietly provide. For years, pharmacists have counseled patients, troubleshot medication regimens, and answered urgent clinical questions—work that has largely gone unpaid and unrecognized. Now, as shrinking dispensing margins make it harder for pharmacies to keep their doors open on prescriptions alone, many are turning to formally defined clinical services as a lifeline and a logical next step in patient care.

Across the country, pharmacists are beginning to prescribe contraception, supply naloxone, administer vaccines, and manage chronic conditions under expanding scopes of practice that vary dramatically by state. These services not only reflect pharmacists’ training and expertise, but they also meet patients where they are: in familiar neighborhood settings that are often far more convenient—and less intimidating—than traditional clinics. The COVID-19 pandemic accelerated this shift, as pharmacies became front-line access points for testing, vaccination, and basic health services, especially in communities with limited primary care.

But the transition from informal counseling to structured, billable clinical services is far from simple. Pharmacies must rethink staffing, workflow, and scheduling to carve out time for 10- or 15-minute encounters in environments built for rapid prescription dispensing. They face mindset challenges as well, with many pharmacists questioning whether they have enough experience or confidence to fully step into a more clinical role, even when the knowledge is there. Meanwhile, patients who are uninsured, between insurance plans, or hesitant to engage with the traditional health system are increasingly looking to pharmacies for accessible options such as birth control or naloxone—services that can be delivered without invasive exams, lab work, or multiple follow-up visits.

In this interview, Salley Rafie, PharmD, BCPS, APh, FCCP, FCPhA, founder of the Birth Control Pharmacist, discusses how clinical services are reshaping community pharmacy, the barriers to scaling them, and why pharmacists may be key to closing critical gaps in care.

“Our pharmacies are struggling with just keeping the doors open based on prescription drug dispensing alone,” Rafie said. “They’re going to continue to do that because it's so essential to provide the actual medications to their communities, but they also need to diversify, and clinical services are definitely the future.”