Beyond Dispensing: The Top Challenges Pharmacies Face in Clinical Services Expansion

Pharmacies have lots of reasons to focus on expanding clinical services. Whether striving to become a healthcare destination in their communities, aiming to diversify revenue streams, or leveraging legislative changes to allow pharmacists to operate at the top of their licenses, expanding their clinical services offerings is a mission many pharmacies have decided to embark on.

While the opportunities are robust and the rewards could be significant, pursuing clinical care is no easy task. Pharmacy teams interested in expanding their clinical services face three common challenges.

Payors and the Evolution of Pharmacy Care

It can be difficult for pharmacies to achieve in-network coverage with payors. Payor policies and behavior constantly change, creating a more complex environment for submitting claims that meet their policy and submission requirements.

To provide clinical services, pharmacists typically must be credentialed with the commercial payor as an ordering, referring, prescribing (ORP) provider. They must also request that the evaluation and management (E&M) codes be added to their fee schedule to bill for clinical services with commercial payors.

In addition, providing clinical services typically requires more documentation and prior authorization. For example, pharmacists must document test results accurately to bill a point-of-care test, and the diagnosis on the claim must match the test results.

A fundamental change to how payors typically collaborate with pharmacies is needed. Until that adjustment is realized, pharmacy teams must be diligent and well-informed when pursuing partnerships with payors.

Digital and Physical Infrastructure

In addition to the challenges and complexities of payor adoption, pharmacies must have certain digital and physical elements to offer a full menu of clinical services.

Think of it this way: a typical trip to a physician’s office is likely to include dedicated space for consultations and treatments, a team of people who handle the patient’s check-in, insurance eligibility check, and appointment scheduling, plus nursing staff who support the physician. Pharmacies, on the other hand, do not have the same advantages. However, technology could be the great equalizer pharmacies need to overcome these challenges.

Your digital infrastructure planning should include identifying resources that can help with your:

• Scheduling capabilities
• Eligibility verification
• Patient check-in
• Billing and revenue cycle management

It’s also essential to prepare to provide physical space for consultation with patients. While evaluating the floor space to determine how to operationalize it, pharmacy teams should consider the following:

• Is there an isolated area to receive patients?
• From a privacy perspective, does your pharmacy have room for a dedicated space that separates patients who need a clinical visit?
• Can your pharmacy utilize a drive-thru or offer curbside options?

Patient Education and Adoption

According to the JD Power 2023 US Pharmacy Study, 83% of pharmacy customers are strongly interested in receiving health and wellness services at the pharmacy. However, most consumers are accustomed to accessing preventative and other clinical healthcare services from a primary care physician.

Pharmacies that want to expand their clinical services must be ready to educate and engage with their patients.

The key messages you should communicate to your patients include the availability of clinical services, how to schedule a visit, and the advantages of visiting a pharmacy instead of a doctor’s office. Your education and engagement strategy should include communicating general pharmacy information and health-specific messages to your patients.

Consider employing patient engagement software to automate patient notifications and build relationships that can improve health outcomes.

Overcoming Clinical Services Expansion Challenges

Expanding clinical services represents an opportunity for pharmacies to cement their position as the front door of healthcare. US consumers demand more convenient and cost-effective access to healthcare, and pharmacies can play a vital role in delivering against that need.

Understanding how to approach the payor landscape, outlining your digital and physical infrastructure, and being prepared to educate your visitors are all necessary steps to pursue clinical services expansion. Lean into top-notch expertise and intuitive technology to remove the barriers that stand between your pharmacy and its clinical expansion goals.

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