Transforming Pharmacy Practice: Sustainable Billing Solutions in Kentucky and Beyond (TransPharm-KY)

“Transforming Pharmacy Practice: Sustainable Billing Solutions in Kentucky and Beyond (TransPharm-KY)” Background/objectives The proposed project aims to improve vaccine safety counseling services across community pharmacies in Kentucky by establishing a network of pharmacist coaches who will collaborate with pharmacies to implement comprehensive vaccine safety counseling and assist them in billing Medicaid for these services. This initiative seeks to address gaps in vaccine education, reduce vaccine hesitancy, and optimize billing processes to ensure financial sustainability for pharmacies providing these vital public health services. Historically, community pharmacies have utilized a product-based reimbursement model with the primary revenue stream based on the number of prescriptions filled. This leaves little time, and often no payment, for advanced patient care services, resulting in an incentive for pharmacies to sell more product rather than ensure best patient outcomes.1 As evidenced by the alarming rate at which community pharmacies are closing, these reimbursement models are not sustainable. In Kentucky, 100 independent community pharmacies have closed since July 1, 2021 and this is a trend that is being seen nationally. 2 Pharmacy payment reform is clearly needed, but the path is complex. In recent years, there have been pharmacy practice act expansions as well as emerging payor opportunities for pharmacies.3 In 2021, House Bill 48 enacted payment parity for pharmacist services by commercial payers in Kentucky.4 To allow expanded access to care and improved outcomes for the most vulnerable patient populations, similar progress is needed within Kentucky Medicaid. We have seen some positive movement through pharmacists’ ability to bill Medicaid for vaccine safety counseling. However, expanded implementation efforts are needed to realize the full benefit of this opportunity. Transformation of the community pharmacy model is necessary for patients to continue to have access to care provided by these practices. Flip The Pharmacy (FtP) aims to “flip” community-based pharmacies away from point-in-time prescription-level care processes to more longitudinal, patient-care processes.5 The initiative focuses on identifying and adopting the best practices and workflows that promote the delivery of enhanced clinical services. In Kentucky, a practice transformation team has participated in this initiative over the last four years, working with over 30 pharmacies, 10 practice transformation coaches, and multiple partners to provide nearly 70,000 interventions to patients through pharmacist-delivered care.