State of the union: A review of state-based laws and regulations supporting pharmacist payment for clinical services

Abstract

Integrating pharmacists into interdisciplinary care models is essential for achieving the Quintuple Aim in health care, which emphasizes improving patient outcomes, enhancing patient and provider experiences, reducing costs, and advancing health equity. Despite expanded scopes of practice that facilitate collaborative models, pharmacists often face significant barriers due to inconsistent and insufficient reimbursement for their clinical services. This review seeks to address these challenges by focusing on state-based legislation and regulations that establish payment parity or create pathways for reimbursing pharmacist clinical services. Through a narrative review, this article systematically compares different states' approaches to pharmacist reimbursement by examining affected payers, billable services, and other pertinent details. The ultimate goal is to propose model characteristics for states considering the enhancement or development of legislation and regulations to ensure equitable payment mechanisms for pharmacist services. By providing a comprehensive overview of existing models and identifying effective legislative characteristics, this review aims to inform and empower pharmacists and their advocates with a better understanding of reimbursement regulations and to inspire community-driven advocacy for equitable compensation, thus supporting the integration of pharmacists as essential health care providers.