Payment for Clinical Pharmacy Services Revisited

Abstract

It has been over 30 years since the first articles describing payment models for clinical pharmacy services were published. The purpose of this editorial is not to simply revisit the problem that most pharmacists already understand all too well, but to provide a fresh perspective on the pharmacy profession’s continued challenges, to highlight the opportunities (or threats) presented in the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), and to offer a simple checklist for addressing the elements that must be in place to ensure payment for clinical pharmacy services. Our progress has been steady but slow. In 1977, the first, to our knowledge, documented instance of payment for clinical pharmacy services was published in the American Journal of Hospital Pharmacy. The authors described payment from Blue Cross Blue Shield of Central Ohio for a home therapy education program for antihemophilic factor. In the same issue of the journal, another article outlined a stepwise approach for obtaining third-party reimbursement for clinical pharmacy services separate from dispensing fees. Since the early reports, payment models for clinical pharmacy services have progressed slowly, despite evidence that such services provide a solid return on investment and improve patient outcomes. Still, there remains a public perception that these services are “free.” A recent article in the Chicago Tribune touted pharmacists as a “vital, if underused part of health care” and went on to say that pharmacists can help people understand how their drug therapy works—“for free.” Payment for clinical pharmacy services may continue to expand slowly as we train new generations of pharmacists who perform clinical rather than distributive services, and as the public perception of clinical pharmacy services continues to improve. However, a more rapid impetus to change may come with the passage of the Affordable Care Act in which pharmacists’ medication management services are included as a key element in health care reform.