Traditionally, pharmacist reimbursement has largely been focused on obtaining payment for the provision of products, like prescription medications. Today, pharmacists have an expanded scope of practice and the pharmacy profession has incorporated more clinical aspects into routine patient care, like chronic disease management, care transitions interventions, and medication therapy management. For these clinical services to be sustainable, pharmacists must be able to receive payment for the resources and time dedicated to improving patient care and outcomes.

Currently, pharmacists are not recognized as providers under Medicare Part B and therefore cannot directly bill for most of the clinical services they have been trained to provide. However, through collaborations with other health professionals, state insurers, private insurers and health systems, pharmacists can implement more sustainable clinical programs into their practices.

Our payment resources are designed to help you understand existing and emerging opportunities to be compensated for providing certain patient care services. 

Payment News
March 24, 2021
Medicaid programs in five states make moves to pay pharmacists for COVID-19 services

The news was hailed by APhA CEO and Executive Vice President Scott J. Knoer, PharmD, MS, FASHP. "This is one more example of how states are leading the way for positive change in the pharmacy profession. State pharmacy associations are out there getting the job done," he said. He saluted the work…

Read More
February 8, 2021
New Massachusetts law recognizes pharmacist as providers

The new law, S.2984: An Act Promoting a Resilient Health Care System That Puts Patients First, not only expands scope of practice for certain health care providers, but also increases insurance coverage for telehealth services, recognizes the continuing impact of COVID-19, and more. “This is a…

Read More
November 24, 2020
HHS releases drug pricing announcements, fails to address harmful DIR fees

Rebate reform  July’s Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen called on CMS to carry out rulemaking and publicly confirm that “[i]t is the policy of the United States that discounts offered on prescription drugs should be passed on to patients,” so…

Read More
July 7, 2020
We know it, they know it, let’s get it done! Pharmacists must be formally included in public health efforts

The pharmacy community has fought for payment for pharmacists’ services under Medicare Part B—otherwise known as provider status—for years. Getting that message through to Congress has been painfully slow. Even though a huge and bipartisan number of federal legislators signed onto the Pharmacy and…

Read More
May 29, 2020
APhA coronavirus watch: New York, Ohio, and Maryland make moves toward allowing pharmacists to bill Medicaid for COVID-19 testing

Big steps in the Empire State New York Gov. Andrew Cuomo issued an executive order on May 22 that authorized licensed pharmacists to order COVID-19 tests approved by FDA through emergency use authorizations detect SARS-CoV-2 or its antibodies; administer COVID-19 tests subject to CLIA certificate…

Read More
March 17, 2020
New Mexico and West Virginia make progress on provider status

HB 42, introduced by Rep. Deborah A. Armstrong (D-Albuquerque), mandates that health plans reimburse pharmacist clinicians for clinical and prescriptive services they are already authorized to provide within New Mexico’s scope of pharmacy practice. Pharmacist clinicians would be compensated at the…

Read More