Unlocking Pharmacy Value Through Payer Program Engagement

In an era of rapid health care evolution, community pharmacies face unprecedented challenges. At a recent Total Pharmacy Solutions Summit, Emily Endres, BSPS, and Todd Sega, PharmD, MBA, explored the critical change facing pharmacies, exploring how they can successfully navigate value-based care models, and generate new revenue streams.

“I think it’s accurate to say that change is truly the only constant that we have in the pharmacy business, as these rapid shifts in the industry and world around us have created immense challenges for our profession and for your businesses now,” Endres said. “From the largest pharmacy chains in the country down to independent pharmacies and single store owners, these pressures are sometimes significantly similar.”

Presenters offered insights into revenue diversification and the opportunities community pharmacies can take advantage of. | image credit: Tyler Olson / stock.adobe.com

Key Takeaways

Endres and Sega offered the following points during the summit:

• Pharmacies are experiencing pressures from multiple fronts. Reimbursement challenges, and drug pricing complexities are creating substantial operational and financial strain. Competition has intensified with the rise of mail order services, and telehealth models. Provider shortages have further complicated the health care ecosystem, positioning community pharmacists as critical access points.
• Despite challenges, pharmacies possess strategic advantages. With 90% of the population living within 10 miles of a pharmacy, pharmacies represent an unparalleled health care access point. Consumers are increasingly open to expanded services, with over half of surveyed individuals willing to consider pharmacies as comprehensive health care destinations. This positioning allows pharmacies to serve as crucial care coordination hubs.
• The health care system is rapidly transitioning from traditional fee-for-service models to value-based care approaches. This transformation requires pharmacies to evolve their business models. Payers are increasingly interested in performance-based contracts that tie reimbursement to specific outcomes rather than individual services. Pharmacies can now participate in programs that offer shared savings and rewards for closing care gaps, improving patient adherence, and supporting population health initiatives.

READ MORE: Navigating Legal, Billing Challenges in Pharmacists’ Clinical Services

Revenue Diversification Opportunities

The presenters also highlighted 4 key program types for pharmacies to generate nondispensing revenue, as follows:

• Quality network programs: Bonus-based improvement programs focusing on population performance
• Adherence monitoring: Longitudinal interventions, including quarterly check-ins and medication-adherence tracking
• Healthcare Effectiveness Data and Information Set–related programs: Opportunities for collecting blood pressure readings and hemoglobin A1c measurements
• Care gap closure services: Interventions that help health plans achieve quality metrics and improve patient outcomes

To address implementation challenges, they introduced Equipp Copilot, a technological solution that integrates seamlessly with existing pharmacy management systems. This tool helps pharmacies do the following:

• Identify nondispensing revenue opportunities within their current workflow
• Reduce administrative burdens
• Enable staff-wide participation in value-based care programs
• Provide real-time notifications and intervention opportunities
• Offer benchmarking and performance tracking capabilities
• Address data and coordination challenges

Data fragmentation and complex documentation requirements are significant barriers to pharmacy participation in value-based programs. The Equipp Copilot addresses these challenges by:

• Normalizing data across different systems
• Enabling single-point documentation
• Providing a unified platform for care coordination
• Reducing the need for multiple portal logins
• Implementation and sta engagement

To read these stories and more, download the PDF of the Total Pharmacy August issue here.