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Updated: Jul 12, 2026

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Published on: December 11, 2016
Clinical value optimization versus transactional price navigation: Rethinking pharmacist roles in medication
Abstract:
The growing number of prescription drug discount programs has intensified calls for pharmacists to help patients identify the lowest available price. However, the profession has yet to distinguish between 2 distinct types of affordability work. In this commentary, I propose a 2-tier framework that separates clinical value optimization (tier 1)-pharmacist-led assessment of cost-effectiveness for high-cost or specialty therapies, including biosimilar substitution, therapeutic interchange, and deprescribing-from transactional price navigation (tier 2), the point-of-dispensing comparison of drug prices across discount programs and insurance options for commodity medications. Conflating them has produced a misallocation of doctoral-level expertise and an unrecognized labor burden on the dispensing workforce. I argue that tier 1 work should be formalized, trained, and reimbursed as a clinical service, whereas tier 2 work should be systematically delegated to pharmacy technicians or digital tools. Redesigning pharmacist involvement around this distinction offers a more rational and sustainable path forward.
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