Pharmacists Employ Strategies for the Management of Chronic Diseases

Three effective strategies that pharmacists can employ to deliver patient-focused care and manage chronic diseases are medication therapy management (MTM), collaborative practice agreements (CPAs), and community partnerships. Patient lifestyle changes, such as diet and exercise, can also have positive effects.

“With a background in pharmacy, I’ve seen how powerful the profession can be in helping to prevent chronic disease when the focus shifts from products to patients,” said Levi Sanderson, PharmD, senior director of clinical solutions at AdhereHealth, a health care technology and services company based in Nashville, Tennessee. “Dispensing medications safely and accurately is, of course, fundamental. But the real impact happens when pharmacists step into a more patient-centered role, using their accessibility and clinical expertise to guide people toward healthier outcomes.”

MTM

For example, MTM moves pharmacy practice beyond filling prescriptions to a more holistic evaluation of the patient’s medication regimen and health needs.¹ “MTM creates space for pharmacists to review every medication a person is taking, look for duplications or interactions, and assess whether treatment goals are being met,” Sanderson said. “For instance, someone with diabetes might be taking several prescriptions, but if their hemoglobin [HbA_1c] level remains high, the pharmacist can recommend adjustments, reinforce education, and collaborate with the provider on next steps.”

MTM is also valuable for arresting chronic illnesses. “Pharmacists can identify early warning signs of chronic disease—whether through missed refills, unmanaged blood pressure readings, or [adverse] effects that cause a patient to stop therapy,” Sanderson said. “Because patients interact with pharmacists so frequently, often more than with physicians, these touchpoints allow pharmacists to intervene sooner. That might mean counseling on adherence, recommending a screening, or pointing out when therapy isn’t optimized.”

Another advantage pharmacists bring is their ability to address barriers that often go unnoticed. “In many MTM sessions, issues like cost, transportation, or even understanding how to take medications correctly become apparent,” Sanderson said. “These are not minor details. They’re the very things that keep people from managing conditions like hypertension or asthma effectively. Pharmacists can help by identifying alternatives, enrolling patients in support programs, or coordinating services like medication synchronization or delivery.”

Sanderson noted in an AdhereHealth online blog article² last year that the percentage of older adults—classified as 50 years and older—in the US with 2 or more chronic conditions is expected to double by 2050: an increase from 7.8 million to 15 million, representing nearly 70% of the projected adult population.

A survey on the pharmacist’s role in chronic disease management published in Innovations in Pharmacy³ found that most physicians agreed or strongly agreed (n = 53) that they felt comfortable with pharmacists providing chronic disease management. The most desired clinical service for pharmacists to perform was reviewing patients' medications (n = 60), followed by provision of chronic disease state management (n = 54) and refill authorizations (n = 50).

In addition, nearly all physicians who were comfortable or very comfortable with pharmacists providing follow-up care for their patients had worked with a pharmacist at least once before.

Hannah Fish, PharmD, senior director of strategic initiatives at the National Community Pharmacists Association (NCPA), based in Alexandria, Virginia, said pharmacy “can have tremendous impact” on improving patient-focused care for chronic diseases, including reducing HbA_1c levels for diabetes and decreasing blood pressure for heart disease and hypertension. “By effectively managing chronic diseases and working with our patients to prevent further complications from some of those diseases, we have reduced both hospital readmissions and hospital admissions in the first place.”

Pharmacists are in a unique position to provide counseling to patients about their disease state and educate them about the importance of lifestyle, such as eating differently or the best exercise for them, Fish told Total Pharmacy. “Pharmacists are also able to help manage patient goals so they can live their life in a way that matters to them. . . . But everything is in concert with optimized medication use.”

CPA

CPAs are more of a regulatory tactic for letting a pharmacist practice under the authority of a physician more directly, according to Fish.

“There are some states in which a CPA is needed, while in other states it is not necessary,” she said. “CPAs are helpful in those states where regulation limits the pharmacist’s ability to optimally take care of patients.”

CPAs in some states allow pharmacists to modify medicine regimens without necessarily having to contact a physician first. CPAs may also allow pharmacists to perform screening or point-of-care testing for markers of disease. “These services are more convenient for patients,” Fish said. “Patients can be seen in off-hours or potentially make an appointment quicker with a pharmacist than with a physician.”

From a regulatory standpoint, the NCPA is seeking to change pharmacy legislation and models to adopt a standard of practice, “so we don’t need tools like CPAs to practice at the top of our education,” Fish said. “I believe that with the shortage of family physicians, pharmacists are going to start filling gaps in primary care. We also need to recognize broadly the value that pharmacists can provide, beyond just the products we dispense.”

An online article from publisher Wolters Kluwer on the evolving role of pharmacists⁴ noted that health care consumers increasingly rely on pharmacists for wellness information, drug consultation, and nonemergency services.

Furthermore, a Wolters Kluwer survey mentioned in the same article concluded that 79% of consumers believe their pharmacist is a trustworthy source of care. Overall, 56% of Gen Z and 54% of millennials entrusted their care to a pharmacist during the year prior to the survey vs 40% of Gen X and 35% of baby boomers.

Community Partnerships

The positive impact of pharmacist-provided, patient-focused care is substantial and has been proven through a multitude of studies, according to Hannah Smith, PharmD, clinical pharmacy manager at Topeka Pharmacy in Topeka, Indiana. Studies like the Asheville Project⁵ in 2003 and multiple meta-analyses on pharmacist-driven hypertension management “show that clinical pharmacists improve patient outcomes through chronic disease state management and adverse drug event prevention, leading to significant cost savings for the health care system.”

Additional proven benefits include reduced hospital readmissions, improved patient adherence, and greater overall productivity.

“Pharmacists are trained to provide patient-focused care,” Smith said. “In addition to dispensing medications, we can perform point-of-care testing, take vital signs, administer immunizations and other injectable medications, conduct patient interviews, and much more. We are a greatly underused resource in the medical community.”

Community partnerships can be successfully utilized for managing chronic illnesses, particularly in situations where physicians are overwhelmed by increasing patient loads and documentation requirements. “Shared access to electronic medical records [EMRs] and CPAs between health care institutions and primary provider groups with community pharmacists would provide the communication and medical information necessary for pharmacists to provide patient-focused care in their community and take some of the strain off of our providers,” Smith said.⁶

Providing adequately reimbursed, patient-focused care in community pharmacies would also help keep trusted pharmacies open in their communities, in addition to improving patient outcomes and saving health care dollars, according to Smith.

“If there [were] a payment strategy established to hold insurers responsible for adequate reimbursement to pharmacists, the opportunity to provide health and wellness classes, such as Diabetes Self-Management, Education, and Support [DSMES], would be outstanding in the community pharmacy setting,” said Smith, who has been a resource for the Indiana Department of Health in providing education on expansion of DSMES services, as well as immunization access in communities.

Moreover, accessibility of pharmacists and the trusting relationships they forge with patients “makes them especially adept at helping patients overcome social determinants of health and other drivers of health inequities, thereby ensuring all community members have access to care,” Smith said.

However, Smith emphasized the importance of establishing means for insurer responsibility in reimbursing pharmacists for the clinical services they provide. “Community pharmacists have always provided patient-focused care in their pharmacies,” she said. “All the counseling, advice, checking of vital signs, etc, has been provided at no cost to insurers or patients. But at this time, we are at an impasse where pharmacies can no longer afford this.”

Smith pointed out that because of low reimbursement, many community pharmacists have been forced to transition to “alternate positions outside their trusted community pharmacy that do not afford the same opportunities for patient-focused care."

Conclusion

Pharmacists are willing and able to step up to provide patient-focused care and help bridge the gap in America’s overwhelmed health care system, according to Smith, but are prevented from doing so due to the system’s restrictions in access to medical information and reimbursement.

Ultimately, the pharmacist’s role in preventing chronic disease is about shifting from a transaction to a relationship, according to Sanderson of AdhereHealth. “It’s about seeing the patient, not just the prescription,” he said. “When pharmacists are empowered to engage in MTM, provide preventive screenings, and address social and behavioral barriers, they contribute far more than medication access. They support long-term health and reduce the burden of chronic illness on individuals and communities.”

The future of pharmacy “is less about the product in the bottle and more about the value of the pharmacist as a trusted health care partner,” Sanderson said.

References

1. Butler L, Zona S, Patel AA, Brittle C, Shea L. How can pharmacists better support patients with chronic diseases? the patient perspective. J Am Pharm Assoc (2003). 2023;63(6):1776-1784.e3. doi:10.1016/j.japh.2023.08.023

2. Sanderson L. Strategies to help Medicare Advantage SNPs improve care for older adults (COA), increase star ratings and reduce medical costs. AdhereHealth blog. September 3, 2024. Accessed October 16, 2025. https://adherehealth.com/blog-strategies-to-help-medicare-advantage-snps-improve-care-for-older-adults-coa-increase-star-ratings-and-reduce-medical-costs

3. Shah A, Jay A, Pfund T, Akers J. Pharmacists' role in chronic disease management from physicians' perspective. Innov Pharm. 2019;10(2):10.24926/iip.v10i2.1449. doi:10.24926/iip.v10i2.1449

4. The evolving role of pharmacists: bridging the gap in healthcare access and patient care. Wolters Kluwer. October 20, 2023. Accessed October 16, 2025. https://www.wolterskluwer.com/en/expert-insights/evolving-role-pharmacists-bridging-gap-healthcare-access-patient-care

5. Strand MA, DiPietro Mager NA, Hall L, Levin Martin S, Sarpong DF. Pharmacy contributions to improved population health: expanding the public health roundtable. Prev Chronic Dis. 2020;17:200350. doi:10.5888/pcd17.200350

6. McCarthy C, Bateman MT Jr. Impact of pharmacist-led chronic disease management in a Federally Qualified Health Center. J Am Coll Clin Pharm. 2022;5(12):1263-1277. doi:10.1002/jac5.1720