Best Practices for Pharmacy Billing, Payment, and Reimbursement

Change must start in the practice before payment can be delivered.

How can pharmacists best navigate billing and be compensated for the patient care they provide?

At her presentation at the APhA 2022 Annual Meeting & Exposition in San Antonio, Texas, Melissa Somma McGivney, PharmD, FCCP, FAPhA, professor and associate dean for community partnerships at the University of Pittsburgh School of Pharmacy, set out to explain just that.

“I’m going to take you on a bit of a journey when it comes to answering this question about how pharmacists can be billing and be compensated for patient care services,” she said, explaining that the 3 parts of the session would cover 4 key practice enhancements that are necessary to be able to support pharmacists patient care services and being able to bill for those services.

During the pandemic, McGivney explained, there was an incredible light shone on community pharmacies in ways that often the public didn’t recognize before.

“We have 65,000 community pharmacy doors in the United States, much more than hospitals, and we didn’t shut the doors or move entirely to technology during the point in time where everyone had to stay home,” she said. “So, we’ve started to get the attention of health payers, we’ve got the attention of physician groups, and we’ve also gotten the attention of the public. Access is what it’s all about."

Still, from the pharmacy side—because drug reimbursement as an all-time low—pharmacists need to be doing something different.

McGivney noted that although her tips are aimed at community pharmacy practices, but these principles can apply to any other pharmacist practice.

“We can’t talk about payment or change without acknowledging that there are challenges,” she said, pointing to current pharmacy workflows and volume. “The first point is really that practice change must start before payment. We can’t do anything before workflow changes.”

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