Pharmacies Successfully Scale Paid SDOH Services Through Medicaid

Pharmacies demonstrated the ability to bill for social determinants of health (SDOH) screening and referral services under Medicaid payer programs, according to a study in the Journal of the American Pharmacists Association (JAPhA).¹ With these pharmacies’ ability to scale payment programs across locations in Pennsylvania, study results underscore the ability to enhance pharmacy-led SDOH services on a significantly greater scale.

“The SDOH, defined as ‘the conditions in the environments in which people are born, grow, live, work, and age,’ are the nonmedical factors that impact patients' health, health outcomes, and health equity,” according to a separate study published in JAPhA.² “SDOH can act as barriers that prevent patients from receiving the care they need, creating gaps in health equity.”

The analysis of the Pennsylvania Pharmacists Care Network (PPCN) revealed that between August 2022 and April 2024, 108 pharmacies successfully provided 15,441 reimbursed SDOH services to more than 5400 unique patients. This milestone was achieved through 4 distinct contracts with regional Medicaid Managed Care Organizations (MCOs) that recognized pharmacists as vital partners in addressing nonmedical health barriers.¹

READ MORE: Payers, Health Systems, and Pharmacies Partner to Fill SDOH-Related Gaps

By utilizing the Pharmacist Electronic Care Plan (PeCP) and standardized SNOMED-CT codes, pharmacy teams were able to document screenings and referrals for 9 priority needs, including food insecurity, financial strain, and transportation. This systematic approach allowed for a fee-for-service reimbursement model for screenings, while referrals were often paid through a value-based model that incentivized pharmacies to connect patients with multiple resources.

Pharmacist-Led SDOH Services in Practice

The necessity of these services is underscored by research suggesting that social determinants can drive as much as 80% of a person’s health outcomes. Medicaid enrollees are particularly vulnerable to these factors, often struggling with the basic needs required to manage chronic conditions effectively.^1,3,4

For example, the CDC notes that patients with chronic diseases visit pharmacies far more frequently than they see primary care clinicians, making the community pharmacy a natural hub for early identification of social risks. Despite only 24% of hospitals and 16% of physician practices currently screening for these determinants due to time and infrastructure constraints, pharmacies offer geographic proximity and extended hours that increase the feasibility of these interventions.^3,5

Real-world applications of this model, such as the Connect AF program in North Carolina, further illustrate the clinical value of pharmacy-led social care. In that initiative, a vertically integrated partnership between community pharmacies and health systems addressed care gaps for patients with atrial fibrillation.⁶

Their findings mirrored the Pennsylvania data, identifying mental health, housing instability, and transportation as the most prevalent barriers to medication adherence. Such collaborations demonstrate that when pharmacies are equipped with the right tools and payer support, they can provide a more complete picture of a patient's circumstances than a clinic.^3,6

Scaling these programs requires significant network-level support and a shift in how state policymakers view Medicaid benefits. Currently, 24 states require MCOs to screen beneficiaries for unmet social needs, often mandating referrals to food, housing, and domestic violence resources.^1,4

How These Programs Increase the Role of Community Pharmacies

To meet these requirements, states are increasingly using value-based payments to reimburse providers for achieving specified health outcomes rather than just the volume of services.⁴

In Pennsylvania, the PPCN provided essential infrastructure, including educational materials, technical assistance, and monthly webinars, to ensure pharmacy teams could navigate the complexities of these new payer programs.¹

Despite this progress, pharmacists face ongoing challenges, including staffing constraints, workflow integration, and the need for culturally competent care to overcome medical mistrust in minority populations. To address these hurdles, some experts suggest training pharmacy technicians as community health workers to serve as liaisons between the pharmacy and local social services.^1,5

Leveraging state scope-of-practice laws and collaborative practice agreements can also expand the range of services pharmacists are authorized to provide, from chronic disease management to transitions of care.⁵

The success in Pennsylvania proves that with appropriate reimbursement and structured network support, community pharmacies can move beyond traditional dispensing to become sustainable pillars of public health.¹

As more payers recognize the link between social interventions and reduced medical spending, the role of the pharmacist in addressing the whole person is poised for national expansion. Adopting these services is not only a matter of professional evolution but also a critical step toward achieving health equity for the millions of Americans whose well-being is dictated by the environments in which they live.^1,3-5

“SDOH services were scaled across the network, and PPCN pharmacies demonstrated their ability to provide referrals intended to close gaps,” concluded the authors of the current study.¹ “Payment from the MCOs and PPCN-level support promoted adoption and implementation of SDOH services across Pennsylvania community pharmacies.”

READ MORE: Higher Education, Income Does Not Shrink Disparities for Black Americans

REFERENCES

1. Hake KL, Schneider SN, Coley KC, et al. Social determinants of health screening and referral services in community pharmacies: a payor program analysis. JAPhA. 2026;66(4):103109. doi:10.1016/j.japh.2026.103109

2. Lakada I, Stutsky M, Huynh C, et al. Implementation and outcomes of a pharmacist-led social determinants of health screening and intervention program in an integrated health system specialty pharmacy model. JAPhA. 2025;66(2):103008. doi:10.1016/j.japh.2025.103008

3. Enhancing health outcomes with SDOH through pharmacist collaboration. AnewHealth. September 10, 2025. Accessed July 23, 2026. https://anewhealthrx.com/insights/enabling-outcomes-with-social-determinants-of-health-through-pharmacist-collaboration/

4. Medicaid’s role in addressing social determinants of health. Robert Wood Johnson Foundation. February 1, 2019. Accessed July 23, 2026. https://www.rwjf.org/en/insights/our-research/2019/02/medicaid-s-role-in-addressing-social-determinants-of-health.html

5. Public health strategies for pharmacists to improve health for people with chronic disease. CDC. May 27, 2026. Accessed July 23, 2026. https://www.cdc.gov/cardiovascular-resources/php/public-health-strategy/index.html

6. Liang D, Witkowski M, Abolins N, et al. Pharmacist-led community network approach addressing social needs and adherence. JAPhA. 2026;66(4):103123. doi:10.1016/j.japh.2026.103123