Applying Recommendations for Health Plans and Pharmacists to Advance Coverage of Pharmacists’ Services in the Medical Benefit

Session Description: There is a need across the profession to expand payer programs covering patient care services provided by pharmacists which can be facilitated by continued collaboration between pharmacist practitioners (PPs) and health plans (HPs) to increase patient access to care and quality medication use. A group of thought leaders representing HPs and PPs were convened to provide insights into successes, challenges, and barriers in scaling pharmacists’ patient care services covered under the HP medical benefit culminating in 11 recommendations. The Recommendations, based upon learnings from these thought leaders at an original in-person Summit and subsequent virtual learning collaborative discussion sessions, are intended to foster collaboration and assist HP representatives and pharmacists in advancing coverage for pharmacists’ patient care services under the medical benefit. The Recommendations span a gamut from advocacy needs to various payment model types, including value-based payment models, to medical benefit considerations such contracting, enrollment, credentialing, and medical billing processes. During the session, experts representing pharmacist practitioners and health plans will review the Recommendations and discuss their experiences with implementing them, including barriers and successes. Join this session to learn about the Recommendations and how they support medication use quality and patient outcomes.