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Advancing Coverage of and Payment for Pharmacists’ Services in the Medical Benefit

Pharmacists’ patient care services improve health outcomes for patients, increase access to clinical services, and support team-based care models. Increasingly, health plans are seeking to cover pharmacists’ services that align with state scopes of practice or standard of care models under the medical benefit. Once a covered benefit for patients has been authorized, pharmacists may enroll and be credentialed as plan network providers and submit claims for payment for the patient care services delivered. APhA is working with pharmacist members and leaders and health plan partners to navigate these paths for you. Check out the information to support advancing coverage of and payment for pharmacists’ services.

Optimizing Patient Outcomes


APhA previously hosted a convening of pharmacists and health plans to define the value of pharmacists to health plans, barriers to covering pharmacists’ services, and scalable solutions for coverage of pharmacists’ services under the medical benefit.

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Recommendations for Pharmacists and Health Plans


As health plan representatives and pharmacist practitioners start dialogue or continue conversations to advance coverage of pharmacists’ patient care services under the medical benefit, reference these Recommendations from thought leaders for components to include and lessons learned to apply.

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Advocacy Action Center


There continues to be strong momentum in state and federal legislatures to expand programs that recognize and pay for pharmacists’ patient care services. Take action today through APhA’s Advocacy Action Center to urge your elected officials to support increased access to pharmacist-provided care.

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