Reimbursement Key to Implementing Social Needs Services in Community Pharmacies

Community pharmacies are nimble, efficient, and cost-effective at delivering health care services. During the COVID-19 pandemic, they administered a majority of vaccines across the United States, demonstrating their central role in public health. Beyond these immediate contributions, pharmacies have the potential to expand services, addressing both clinical care and health-related social needs.

Practice transformation in community pharmacies depends on two main factors: workflow adaptation and reimbursement. While pharmacies can implement innovative services and act as healthcare extenders, sustaining these programs requires a reliable fee-for-service model. Many pharmacies already operate at a loss in their day-to-day medication dispensing, so providing clinical or social care services without reimbursement is not financially feasible. Support through grants, Medicaid redesign, or other billing mechanisms, whether pharmacy-directed or integrated with medical services, is essential to ensure these programs can operate sustainably.

Evidence shows that pharmacies can successfully integrate new services when given proper resources, training, and leadership support. Programs involving cross-trained staff and embedded community health workers demonstrate feasibility, effectiveness, and positive outcomes for both patients and the community, according to a recent study.¹ Economic analyses further highlight that with reimbursement, these services can be scaled and sustained nationwide.

The next steps involve policy changes at the local, state, and federal levels to support reimbursement structures that recognize pharmacies as essential health care providers. By securing sustainable funding and expanding the ability of pharmacies to bill for clinical and social care services, community pharmacies can continue to strengthen population health, improve patient outcomes, and serve as central hubs for health care access in their communities.

Drug Topics® recently sat down with Christopher Daly, PharmD, MBA, BCACP, clinical associate professor at the University at Buffalo, and David Jacobs, PharmD, PhD, associate professor at the University at Buffalo, who were authors on the study, to discuss How important reimbursement is when considering the long-term sustainability of pharmacy-based HRSN programs.

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References

1. Daly CJ, Iqbal DN, Chen E, et al. Implementing a Community Health Worker Model to Address Health-Related Social Needs in a Community Pharmacy Network: A Pragmatic Evaluation. 2025. J Am Pharm Assoc. DOI:10.1016/j.japh.2025.102490