Are you Ready to Shift Test-to-Treat into Hyperdrive?


From the Desk of David Pope, PharmD, CDE; Chief Pharmacy Officer

Chief Pharmacy Officer

As a fellow pharmacist, I’m thrilled to see how the profession has embraced clinical services in the retail space. Going beyond immunizations into areas such as Test-to-Treat for infectious disease and prescribing hormonal contraceptives is reaching a scale never seen in our industry. This rapid growth has caused other stakeholders, such as payers, to ask how pharmacists should be reimbursed for clinical services.

Ultimately, the “pharmacist-as-provider” movement has always been simple: treat pharmacists like other providers. The practical application of this movement means that pharmacists may be subject to credentialling and payer enrollment. Additionally, the process of determining patient benefit coverage and clinical eligibility, and performing medical billing using pharmacist-level NPIs poses new challenges within the typical pharmacy workflow.

Pharmacists should be able to provide patient care without focusing heavily on clinical documentation or medical billing. That means the claims process—whether medical or pharmacy—should have similar “clean claim rates” and require the same or less operational time as pharmacy benefit claims. For pharmacists to adopt clinical services at scale, key capabilities must be addressed and made available within the pharmacy workflow including 1) patient financial and clinical clearance integrated into patient scheduling and pharmacy workflow; 2) provider credentialing and eligibility; 3) simplified clinical documentation that informs the claim; and 4) compliant and timely billing.

As the payer and regulatory landscapes evolve to encompass pharmacy-based clinical services, pharmacy organizations that choose to offer clinical services will be better able to respond quickly if they have revenue cycle functionality fully integrated into their clinical care delivery solution and have access to both pharmacy and medical billing pathways embedded within the pharmacist’s workflow…

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