Unlocking Pharmacy Value: A Guide to Payer Program Engagement
Emily Endres, BSPS, and Todd Sega, PharmD, MBA, discuss pressures that pharmacies are currently facing, including reimbursements, competition, and patient needs.
The Total Pharmacy Solutions Summit session focused on the critical challenges facing community pharmacies and the opportunities for success in payer-sponsored programs. Emily Endres, BSPS, vice president of pharmacy at PQS by Innovaccer, and Todd Sega, PharmD, MBA, managing director of pharmacy at PQS by Innovaccer, highlighted the significant pressures pharmacies currently face, including reimbursement challenges, increasing competition, and evolving patient needs. With provider shortages and changing health care dynamics, pharmacies are uniquely positioned to become essential care coordination hubs, serving patients more frequently than any other health care provider.
Endres emphasized the shift towards value-based care and the importance of diversifying revenue streams beyond traditional dispensing. Pharmacies have unique advantages, with approximately 90% of the population living within 10 miles of a pharmacy and consumers increasingly open to receiving expanded health care services from pharmacists. However, implementing these new care models comes with significant challenges, including resource constraints, complex documentation requirements, and the need to maintain core dispensing operations.
To address these challenges, Endres introduced Equip Copilot, a technological solution designed to seamlessly integrate with existing pharmacy management systems. This innovative tool aims to help pharmacies identify and capitalize on non-dispensing revenue opportunities, reduce administrative burdens, and streamline participation in payer programs. The Copilot enables pharmacies to access targeted intervention opportunities, document care coordination efforts, and track financial impacts without disrupting existing workflows.
Key opportunities for pharmacies include quality network programs, adherence monitoring, and Healthcare Effectiveness Data and Information Set-related services like blood pressure and A1c gap closures. These programs allow pharmacies to generate additional revenue by closing care gaps, improving patient outcomes, and providing valuable data to health plans. Endres stressed that success in these emerging models requires flexible technology, team-based approaches, and a willingness to evolve beyond traditional dispensing roles.
Endres concluded by encouraging pharmacies to explore these new opportunities, join the Equip Copilot waitlist, and prepare for a more integrated, value-driven health care ecosystem.
Explore more of our coverage from the Total Pharmacy Solutions Summit Summer 2025: Revenue Stream Diversification
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