Facing Reimbursement Pressure, Pharmacy Answers With Clinical Value

This July/August issue lands at a moment when the financial ground beneath pharmacy is shifting fast enough that clinical excellence alone is no longer enough. Reimbursement pressure that once seemed confined to a single sector is now surfacing across long-term care, independent community pharmacy, and even individual OTC recommendations pharmacists make at the counter. What ties this issue together is not the size of the pharmacy involved but the resourcefulness required to keep serving patients when the numbers stop cooperating.

Our cover story examines the mounting crisis in long-term care (LTC) pharmacy, where reimbursement changes tied to the Inflation Reduction Act of 2022 are threatening decades-old infrastructure just as the population it serves keeps growing. According to survey data cited in the piece, more than 80% of responding LTC pharmacies expect to cut services in 2026, a shift that could touch more than 1.6 million vulnerable seniors, disproportionately in rural communities. The story asks a pointed question for community and independent pharmacists watching from the outside: As closed-door LTC operators retreat, what role can pharmacy practice outside that model play in closing the gap?

That question about roles under financial strain echoes through the rest of the issue. In our Total Pharmacy section, we look at how independent pharmacy owners are being forced to think like CFOs: building real budgets, managing the widening gap between wholesaler payment terms and pharmacy benefit manager reimbursement timelines, and diversifying revenue beyond the prescription counter to survive margins that keep shrinking.

Elsewhere, Amy Ricupero, PharmD, MEd, and Jennifer D. Goldman, PharmD, CDCES, BC-ADM, FCCP, offer a practical guide to optimizing medication therapy management services for cardiometabolic patients, a reminder that the clinical services pharmacists are being asked to prove out financially are also some of the most effective tools available for improving outcomes in chronic disease.

In our pain column, Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, revisits aspirin’s fading role in chronic pain management for older adults, a useful case study in how even the most familiar recommendations deserve regular reassessment as evidence evolves.

Together, these stories describe a profession being asked to do more with less and, in many cases, rising to meet that demand. Whether the setting is a nursing home medication cart, an independent pharmacy’s balance sheet, or a conversation about a decades-old OTC staple, pharmacists remain the ones patients and the health care system count on to make sense of complexity. Thank you for reading.