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

The United States faces a projected shortage of 86,000 physicians by 2036, disproportionately affecting rural areas. Meanwhile, 90% of Americans live within 5 miles of a pharmacy, positioning pharmacists to help address care gaps. Despite demonstrated clinical value, pharmacist integration into primary care is hindered by unclear compensation pathways.

This study developed and piloted the Pharmacist Revenue and Integration Modeling Engine (PRIME), a novel tool to support financial decision-making for pharmacist integration. Objectives included (1) developing PRIME, (2) exploring implementation strategies, and (3) modeling financial viability.

The University of Tennessee Health Science Center partnered with an academic family medicine clinic in Memphis, TN, to re-establish clinical pharmacy services. PRIME used the 2025 Medicare Physician Fee Schedule, adjusted for Medicaid, private insurance, and self-pay, to model revenue across 4 service delivery scenarios. A full-time pharmacist (40 h/wk, 46 wk/y) was assumed, and projected revenue was compared to personnel costs.

Financial viability varied by service type and volume. Preventive care and collaborative physician-pharmacist visits (e.g., annual wellness visits and 99,214 E/M codes) were key revenue drivers. The most successful model (approach 1.5) blended preventive and collaborative services, generating $286,700 in annual revenue and a net surplus of $105,500 (ROI 1.58:1). This led to a clinic-academic partnership placing 2 pharmacists (1 full-time equivalent) in the clinic.

Strategic use of billing codes can make clinical pharmacy services financially self-sustaining in primary care. PRIME offers a customizable roadmap for clinics to evaluate and implement pharmacist integration. This model supports workforce expansion, training opportunities, and improved access to care.