Tapping Into Clinical Service Enablement to Transform Pharmacy Growth

As the healthcare market continues its shift toward more patient-driven models, pharmacies are uniquely positioned to expand their role in patient care. No longer defined solely by medication dispensing, pharmacies are evolving into community health hubs, delivering clinical services, and taking on a more collaborative role in the patient’s healthcare journey.

The Expanding Role of Pharmacists

Legislative changes across the country are fueling this evolution. States are increasingly recognizing pharmacists as providers, creating opportunities for expanded service offerings. Pharmacies are already reimbursed for test-to-treat consultations, chronic disease management, and immunizations.

In addition to legislative change, patient demand supports this drive toward pharmacies offering a broader range of clinical services. Consumer interest in accessible, local care means pharmacies are positioned to deliver more clinical services—especially when equipped with credentialed providers and the right medical billing pathways.

However, this transformation requires vision, preparation, and the right combination of people, processes, and technology to enable growth.

Clinical Services as a Growth Engine

According to XiFin’s 2025 Pharmacy Transformation Outlook Study, pharmacies are prioritizing clinical service expansion as part of their long-term growth strategy. Services like wellness and disease prevention programs and specialty pharmacy offerings are advancing.

The benefits are clear:

• New revenue streams from reimbursable clinical services consultations
• Closer patient relationships through expanded services
• Competitive advantage in a crowded retail and specialty pharmacy market

However, expansion also brings challenges, including credentialing complexity, staffing limitations, hurdles in payor contracting, and reimbursement variability.

Digitizing the Patient and Financial Journey

To succeed, pharmacies must deliver care that is seamless, transparent, and patient-friendly. That means digitizing every touchpoint of the patient journey:

1. Pre-Visit Scheduling and Check-In – Patients expect to be able to use apps to schedule visits, capture insurance information via photo, and receive accurate, upfront out-of-pocket estimates.
2. Pharmacy Arrival – Clinical and financial eligibility and medical necessity documentation are verified in real time.
3. Clinical Encounter – Pharmacists perform assessments, testing, and prescribing while capturing compliant documentation aligned with payor requirements to facilitate reimbursement.
4. Post-Visit Engagement – Patients receive results, summaries, and even bill notifications via text with simple payment options.

By combining technology with workflow enablement tools, pharmacies can scale services while improving efficiency and patient satisfaction.

Credentialing and Contracting: Keys to Success

Credentialing is a critical piece of the puzzle. Pharmacies can be credentialed individually, collectively as an organization, or through delegated models offered by payors. The process can take up to 120 days and must be managed carefully to avoid reimbursement delays.

Equally important is contracting. Pharmacies must proactively evaluate their contracts to ensure pharmacist-performed services are included, particularly for Evaluation and Management (E/M) codes. Collaborating with payors to establish medical benefit billing pathways is essential for sustainability.

Medical Billing Complexities

Medical coding must align with documentation, requirements vary by state, and payors are constantly adding layers of complexity. Billing for clinical services is more complex than traditional prescription claims – but that shouldn’t be a deterrent.

This is where a purpose-built revenue cycle management (RCM) solution becomes essential. By integrating clinical documentation capture, billing, denial support, and analytics, pharmacies can support compliance and accelerate reimbursement.

Future-Ready Strategies for Pharmacy Leaders

Pharmacies looking to future-proof their business should focus on six core strategies:

1. Expand Clinical Services – Add reimbursable offerings such as office visits, consultations, immunizations, chronic disease management, and specialty pharmacy offerings.
2. Adopt Workflow Enablement Tools – Leverage scheduling, credentialing-linked availability, and integrated documentation.
3. Build a Community Health Hub Model – Transition from a dispensing-first business model to one that emphasizes comprehensive patient care.
4. Strengthen Payor Relationships – Pursue in-network coverage and use technology and services that help you stay ahead of payor policy changes.
5. Embrace Financial Transparency – Offer patient cost estimates and digital payment options as a standard part of the care experience.
6. Invest in Advocacy and Education – Work at the state and community levels to ensure reimbursement models keep pace with evolving pharmacy capabilities.

Pharmacies are at a turning point. With legislation, consumer demand, and technology converging, the opportunity to transform from a dispensing model into a community health hub has never been greater. But success requires more than intent; it demands the right strategies, tools, and partners to manage complexity and unlock sustainable growth.

By embracing clinical service enablement, pharmacies can expand their scope of care and secure their future as critical players in a patient-centered healthcare ecosystem.

Learn how XiFin empowers pharmacies to expand services, strengthen financial performance, and deliver better patient care. Explore how we serve pharmacies.