Table 1. Pharmacist services available in the community pharmacy setting.
| Service/Activity | Availability status (date) | Regulation level | Reimbursement |
|---|---|---|---|
| Immunizations | • All 50 states and the District of Columbia
(Jun. 2020) • 1 state (Alabama) only by prescription (Jun. 2020) • 6 states allow pharmacy technicians with required training to administer vaccines under the supervision of a certified pharmacist (Jun. 2020) |
State | • Via contract with the appropriate payers
(i.e., pharmacy benefits managers, Medicare, Medicaid,
third-party medical plans) • Bill payers for both the vaccine and administration service (varies between USD 15 - 40) or paid by patients out-of-pocket |
| Medication Therapy Management (MTM) program | • All 649 Medicare Part D contracts use pharmacists to provide MTM (2019) | Federal | • Reimbursement provided by CMS
• Billing in 15-minute increments using current procedural technology codes |
| Medication packaging | • Implementation status unknown | N/A | • Paid by customers out-of-pocket or offered as part of a medication synchronization program |
| Medication synchronization | • 22,000 community pharmacies (2015) | N/A | • No reimbursement. MTM billing codes apply if offered as part of the service |
| Hormonal contraception prescribing | • 9 states and the District of Columbia (Dec. 2019) | State | • Reimbursement varies by state |
| Point-of-care (POC) testing | • All 50 states and the District of Columbia - for approved tests with pharmacy CLIA waiver from CMS (1988) | Federal | • Paid by customers out-of-pocket |
| Naloxone prescribing or dispensing | • All 50 states and the District of Columbia
(Jan. 2019) ○ 17 states and the District of Columbia - statewide protocol/pharmacist prescribing (Jan. 2019) ○ 12 states - statewide standing order (Jan. 2019) ○ 4 states - dispense without a prescription (Jan. 2019) ○ 17 states - standing order (Jan. 2019) |
State | • Variable out-of-pocket costs depending on
the patient’s health insurance • Pharmacist counseling not reimbursable |
| Tobacco cessation aid prescribing | • 37 states (Nov. 2019)
○12 states - statutes or regulations allowing pharmacists to prescribe (Nov. 2019) ○ 17 states - prescribe under population-based CPAs (Nov. 2019) ○ 7 states - prescribe via autonomous prescribing (Nov. 2019) ○ 1 state - independent prescribing (Nov. 2019) |
State | • Reimbursement varies by state |