Preparing Pharmacy for Performance-Based Reimbursement

The current pharmacy payment model is based on payment for dispensing services without accounting for clinical services designed to improve patient care and outcomes. Pharmacists routinely counsel patients on proper use of medications and other health issues, but new payment structures are needed to support pharmacists’ role as healthcare providers, allowing them to receive consistent reimbursement for disease state management, medication optimization and other preventive services. In 2019, pharmacies felt increased downward pressure on reimbursement rates as narrow networks continued to form and grow in relevance. However, now in 2020, Eyad Farah, vice president and general manager of Health Mart Atlas, expects the industry to continue moving towards value-based care and performance-based payment models that will benefit pharmacies—and most importantly, their patients.

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