The Outcome-Based Program That Could Reshape Pharmacists’ Roles

The ACCESS to Pharmacy Care Program is a 10-year approach tying together patient outcomes and provider reimbursement, while giving community pharmacies their first large-scale route to Medicare payment beyond dispensing.

“Officially, ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions,” said Douglas Hoey, RPh, CEO of the National Community Pharmacists Association (NCPA), according to a column about the program.¹ “The program is about ensuring that tens of millions of Medicare patients have access to chronic care services. But it also recognizes that health care providers, including pharmacists, need to have access to compensation to provide those services.”

In part 2 of our interview with Mark Ey, RPh, senior vice president and chief operating officer with NCPA, he dove deep into the clinical parameters that are set to advance the new CMS-led initiative and just how pharmacists can be rewarded for services they are already conducting on a daily basis.

READ MORE: ACCESS to Pharmacy Care Model Lets Pharmacists Bill for Chronic Care

Translating Clinical Metrics into Direct Financial Returns

Ey emphasizes that the core objective of the ACCESS program centers on improving patient health through target metrics such as controlled blood pressure and lowered blood sugar levels. Achieving these clinical goals directly reduces total health care expenditures by lowering emergency room visits and hospital admissions.

The structure of the program aligns with the broader CMS framework, which establishes 10-year voluntary tracks focused on early cardio-kidney-metabolic conditions, chronic pain management, and behavioral health. Under the model, participating practices receive predictable monthly management payments alongside additional bonus dollars when patients reach defined therapeutic targets.^1,2

NCPA data indicates that an average independent pharmacy serves over 200 eligible Medicare patients. Enrolling just 50 patients can add approximately $10,000 to a pharmacy’s bottom line, creating a substantial financial opportunity for independent practices.

According to the 2026 NCPA Digest, government programs account for nearly half of all prescription sales across 18,988 independent community pharmacies nationwide, underscoring the critical necessity of establishing direct government reimbursement mechanisms.³

Overcoming Operational Obstacles and Preparing for Expansion

In previous years, community pharmacists frequently engaged in clinical management without receiving shared performance data or compensation for the value of their services. Because Medicare does not currently recognize pharmacists as Part B billing providers, NCPA partnered with CPESN and GamePlan Medical to provide necessary oversight and billing administration.¹

Participating pharmacies must also maintain a 30% medication synchronization rate to preserve group outcome metrics, an operational benchmark supported through dedicated fellowship training programs.

Although the initiative initially focuses on original Medicare beneficiaries, Ey notes that Medicare Advantage and Medicaid programs may join the model by 2028. Given that government programs account for more than half of independent pharmacy dispensing revenue, this expansion could allow up to 50% of a pharmacy’s patient population to qualify for outcome-based care.

Strengthening Patient Relationships and Recognized Care Roles

Beyond immediate financial returns, Ey highlights that direct face-to-face pharmacist engagement builds stronger patient bonds and delivers superior clinical results compared with remote technology tools or automated bots. This personalized approach addresses major health care challenges, including the fact that roughly 50% of patients struggle with medication adherence and over 1.3 million emergency room visits occur annually due to adverse drug events.⁴

Public trust in community pharmacists remains high, with survey data showing that 79% of health consumers view pharmacists as a trusted source of care and over 54% of younger generations regularly consult them for health care needs. Independent community pharmacies already deliver extensive clinical support, with 81% offering medication therapy management and 62% providing blood pressure checks.^3,4

By securing structured compensation tied with patient progress, pharmacists can finally transition from commodity dispensers to fully recognized clinical care participants within the health care system.

READ MORE: Law and Advocacy Resource Center

REFERENCES

1. Finally — payment for services you’re already providing. NCPA. News Release. July 24, 2026. Accessed November 4, 2026. https://ncpa.org/newsroom/executive-update/2026/07/24/finally-payment-services-youre-already-providing

2. Sutton A, Shiff J. Improving ACCESS to technology-supported care with outcome-aligned payments. CMS. December 19, 2025. Accessed November 4, 2026. https://www.cms.gov/newsroom/blog/improving-access-technology-supported-care-outcome-aligned-payments

3. NCPA releases 2026 Digest Report. NCPA. News Release. October 4, 2026. Accessed November 4, 2026. https://ncpa.org/newsroom/news-releases/2026/10/04/ncpa-releases-2026-digest-report

4. The evolving role of pharmacists: bridging the gap in healthcare access and patient care. Wolters Kluwer. October 20, 2023. Accessed November 4, 2026. https://www.wolterskluwer.com/en/expert-insights/evolving-role-pharmacists-bridging-gap-healthcare-access-patient-care