I’ve spent a large part of my career working in and around pharmacy interoperability (though we haven’t always called it that), from early on with a PBM to over two decades of NCPDP standards work for various clients. It’s an area I keep coming back to, not out of habit, but because I see the gap between what pharmacists can do and what we enable them to do remains significant.
That gap is especially relevant right now.
States are preparing to deploy funding from the Rural Health Transformation Program (RHTP), a substantial investment aimed at improving access, strengthening the workforce, and supporting more sustainable models of care in rural communities.
Much of the early conversation has focused on workforce challenges—how to recruit, retain, and support clinicians in underserved areas. That makes sense. Staffing shortages are one of the most visible and pressing issues in rural health, as I’m well aware, being from a four-stoplight town of 3,500 in rural Iowa.
There is also an important discussion around technology and infrastructure. In general, rural communities need modern systems, better connectivity, and improved data exchange. Those investments are necessary.
But they are not sufficient on their own.
There is also an opportunity to better utilize the clinical resources already present in these communities. One of the most overlooked is the pharmacist.
We recently explored many of these themes through our contribution to an NCPDP Foundation-funded whitepaper, “A Business Model Framework to Scale Pharmacy-Delivered Clinical Services”, authored by Summit Health Advisors, on scaling pharmacist-delivered clinical services
Community pharmacists are often the most consistently available healthcare professionals in rural areas. Patients interact with them more frequently than with most other providers. They are trusted, accessible, and increasingly equipped — through expanded scope of practice — to deliver a range of clinical services.
These services are not theoretical. Pharmacists are already contributing to chronic disease management, preventive care, medication optimization, and transitions of care. They help patients understand drug interactions, manage complex medication regimens, and close care gaps.
In some community pharmacy models, engagement has been shown to meaningfully improve adherence and reduce avoidable utilization.
What’s often missing from this conversation is that we already have evidence that pharmacy engagement works at scale when the right structures are in place.
For example, community pharmacy networks like CPESN have demonstrated:
These are substantial, system-level impacts.
And they are being driven by clinicians who are already embedded in the community.
The map illustrates the states in which pharmacists have provider status and/or prescriptive authority.
If the outcomes are this compelling, the obvious question is: why haven’t these models scaled more broadly?
The limitations are not about clinical capability. They are structural.
Reimbursement models are inconsistent and often insufficient. Payer policies vary widely, creating friction for pharmacies as they attempt to operationalize services. Patient volume in rural areas, while critically important, may not be concentrated enough to justify upfront investment without some level of coordination.
Technology and workflow also play a role. Pharmacists are not always able to access the full clinical picture, nor are they consistently able to contribute data back into the patient record to support continuity of care.
These factors create a “cold start” problem. Payers hesitate to invest without clear evidence of scale. Pharmacies hesitate to invest without predictable reimbursement. Progress stalls.
The Pharmacy Health Alliances for Reimbursable Medical Services (PHARMS) framework, discussed in the whitepaper I mentioned in the intro, was developed to address these exact challenges.
Rather than waiting for national alignment, PHARMS takes a regional, action-oriented approach. It brings together health plans, pharmacies, and other stakeholders to align on a defined set of priorities:
The model intentionally starts small, focusing on achievable early wins. It typically begins with fee-for-service reimbursement to build volume and operational experience, with a pathway toward more advanced models over time.
This approach is designed to overcome the fragmentation and uncertainty that have limited previous efforts.
RHTP funding creates a unique moment for states to rethink how care is delivered in rural communities.
Workforce investments are critical. Technology investments are necessary. But neither will fully deliver on their promise without care models that make better use of the resources already available.
Pharmacists represent one of the most immediate and scalable opportunities to expand access.
Integrating pharmacy into broader interoperability and care delivery strategies can help states:
This requires intentional design. Pharmacists need access to relevant clinical and administrative data. They need to be able to contribute information back into the patient record. And the workflows supporting this work must reduce burden rather than shift it.
Without that, there is a risk that new investments will result in disconnected pilots rather than sustainable, scalable solutions.
This work is actively evolving.
Seth Joseph, managing director of Summit Health Advisors, and I will be presenting on this topic at the upcoming NCPDP Annual Conference, where the PHARMS framework and underlying research will be discussed in more detail, along with a peer discussion portion of the session.
For those planning to attend the NCPDP Annual Conference, it is worth prioritizing this session as part of your agenda:
https://ncpdp.org/ac/track-sessions.aspx
Each state approaches rural health differently. The mix of stakeholders, existing infrastructure, and community needs varies.
What remains consistent is the opportunity to better integrate pharmacy into care delivery.
We’ve been working with states and other stakeholders to connect pharmacy into broader interoperability strategies, modernize prior authorization workflows, and align stakeholders around practical, standards-based approaches.
We’re also actively reaching out at the state level to better understand where support is needed most. Every state has its own mix of communities, challenges, and opportunities, and a one-size-fits-all approach won’t work here.
If you’d like to discuss the challenges in your state, explore PHARMS, or start bringing stakeholders together to collaborate, reach out to me to set up a discussion.
These are solvable challenges. The opportunity now is to approach them with the level of coordination and practicality required to make them stick.