Projecting financial sustainability for clinical pharmacy services: An implementation science brief report

Area of Science:

• Health Services Research
• Pharmacy Practice
• Health Economics

Background:

• The US faces a physician shortage by 2036, particularly in rural areas.
• Pharmacists are accessible, with 90% of Americans living near a pharmacy.
• Integrating pharmacists into primary care is limited by unclear financial compensation.

Purpose of the Study:

• Develop and pilot the Pharmacist Revenue and Integration Modeling Engine (PRIME).
• Explore strategies for implementing pharmacist integration.
• Model the financial viability of integrating clinical pharmacy services.

Main Methods:

• Partnered with an academic family medicine clinic to reestablish pharmacy services.
• Utilized the 2025 Medicare Physician Fee Schedule, adjusted for other payers.
• Modeled revenue across four service delivery scenarios for a full-time pharmacist.

Main Results:

• Financial viability depended on service type and volume; preventive and collaborative visits were key revenue drivers.
• The optimal model blended preventive and collaborative services, yielding $286,700 in annual revenue.
• This resulted in a net surplus of $105,500 and a clinic-academic partnership.

Conclusions:

• Clinical pharmacy services can be financially self-sustaining in primary care through strategic billing.
• PRIME provides a customizable framework for clinics to assess and implement pharmacist integration.
• This model supports workforce growth, training, and enhanced patient access to care.