Bridging Innovation and Access: The Next Chapter in Pharmacy’s Value Evolution

The pharmacy industry stands at a pivotal crossroads, where consumer expectations, value-based care, and financial sustainability converge, creating a greater need for real pharmacy solutions. The question is no longer whether pharmacies will evolve beyond dispensing medications, but how we’ll sustain and scale that evolution.

As a pharmacist by training, I’ve seen firsthand the power of collaboration, the challenges of fragmented systems, and the opportunities that lie in reimagining our role in healthcare delivery. Whether we’re talking about credentialing, quality measurement, or data interoperability, one principle remains consistent: solve the big problems first.

Reducing Friction to Unlock Innovation in Pharmacy Revenue Cycle Management

Too often, healthcare policy becomes a solution in search of a problem. We introduce new programs or systems without first identifying the barriers that stand in the way of success. For pharmacies, these barriers often stem from operational inefficiencies, such as credentialing delays, a lack of data integration, or payment models that fail to reward clinical value.

To truly innovate, we must adapt systems, such as revenue cycle management for medical billing, rather than build parallel ones. When we reduce friction between payors, providers, patients, and pharmacies, we create a foundation for financial sustainability and scalable care models.

Patient Access and the Geography of Care

Access is about more than proximity; it hinges on trust and convenience. Pharmacies are the most accessible healthcare touchpoint for most Americans; however, access without adequate infrastructure doesn’t solve the problem. Leveraging telehealth and diagnostic partnerships can help bridge these gaps. Pharmacies must be empowered not only to dispense medications but to provide point-of-care testing, chronic disease support, and preventative care, especially in communities where clinical access is limited.

Collaborating Across the Care Continuum

Pharmacies and diagnostic providers share a common mission: improving health outcomes through timely, data-driven care. Nearly 90% of Americans live within five miles of a pharmacy, and 70% of medical decisions rely on diagnostic results—a compelling case for closer collaboration.

Payors, too, recognize the need for integration. Many are forming relationships with major retail pharmacies to close gaps in care, linking medication adherence, testing, and clinical interventions to achieve measurable outcomes. These partnerships create a win-win: pharmacies expand their clinical role, diagnostics gain reach, and payors reduce avoidable costs tied to unaddressed care gaps.

There’s a huge desire from payors to establish gap-in-care relationships with pharmacies. However, those pharmacies require lab relationships to operationalize those programs.

Defining and Measuring Value That Matters

The concept of “value” in healthcare is evolving. Traditional metrics, such as the overly simplistic cost-to-quality ratio, don’t capture the nuances of patient experience, access, or social determinants of health (SDoH). The Centers for Medicare and Medicaid Services (CMS) is already moving toward a universal foundation of measures centered on wellness, care coordination, and patient satisfaction. However, there’s still room for pharmacies to lead.

Pharmacists interact with patients more frequently than any other provider type. That gives us an unmatched opportunity to collect patient-reported outcomes, including how patients feel about their health, rather than just what their lab values indicate. As value-based models mature, these insights will become just as critical as clinical measures in defining success.

Leveraging Pharmacy Billing Systems and Interoperability

Data connectivity is the backbone of value-based care. Yet the technology interoperability gap in pharmacy is real. For too long, pharmacies have operated as a claim-based system, with much of their clinical work undocumented and therefore unreimbursed. That must change.

Regulations such as the Trusted Exchange Framework and Common Agreement (TEFCA) and the information-blocking rule are paving the way for greater interoperability among pharmacies, laboratories, and healthcare systems. As these data flows open, pharmacies will be able to demonstrate outcomes more effectively, justify reimbursement, and build deeper trust with patients and partners alike.

AI and Automation: The Next Catalyst

Artificial intelligence isn’t just a buzzword; it’s the next competitive differentiator. Payors are already leveraging AI to streamline claim processing, detect policy violations and documentation gaps, and resolve process inefficiencies. Pharmacies that don’t adopt similar technologies risk falling behind.

AI can help automate repetitive administrative tasks, improve accuracy in clinical documentation, and reduce prior authorization friction. When implemented responsibly, it enhances—not replaces—human judgment, enabling pharmacists to focus on patient care rather than paperwork.

The Road Ahead

The pharmacy of the future is not a storefront; it’s a connected node in a larger ecosystem of value-based healthcare. Our challenge is to align incentives, close care gaps, and document outcomes in a manner that payors and policymakers recognize. The opportunity lies in collaboration—between pharmacies and labs, between technology and policy, between innovation and access. When we reduce friction, embrace data-driven care, and put patients at the center, we unlock not just new revenue streams but a more resilient and impactful healthcare system. And that’s what strategic market access is about.

Discover how the right technology can help your pharmacy reduce prior authorization friction, improve data flow and interoperability, and enhance medical billing reimbursement. Explore our pharmacy solutions now and get ready for the road ahead.