Diabetes Care in Clinical, Community Pharmacy Practices | APhA 2025
Heather Johnson, PharmD, BCACP, CTTS, and Heather Roth, BSPharm, RPh, compare patients’ diabetes outcomes in clinical and community pharmacy settings.
Despite evidence of improved diabetes outcomes in clinical and community pharmacies, all pharmacy settings are capable of having a significant impact on diabetes care, according to a presentation at the American Pharmacists Association 2025 Annual Meeting and Exposition.1
“These 2 particular areas are where a lot of our pharmacists practice and provide diabetes education and medication management for patients with diabetes,” said Heather Roth, BSPharm, RPh, in a session titled Moonshine vs Tennessee Wine: Debate on Controversies in Diabetes.1
Roth was joined by her colleague Heather Johnson, PharmD, BCACP, CTTS, to conduct a mock debate on the advantages of receiving diabetes care from either a clinical or community pharmacy setting. With Johnson presenting support for clinics and Roth supporting community pharmacies, they each touched on how these settings benefit patients, save them money, and help pharmacists make more money utilizing their diabetes expertise.
Roth and Johnson debated at APhA 2025 on which pharmacy setting yields the most optimal diabetes outcomes. | image credit: jokekung / stock.adobe.com
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Before diving into community pharmacy’s place in diabetes care, Roth mentioned the obvious advantages community practices possess and how they are portrayed in health care. Among several other reasons, community pharmacists are beneficial because of their access to patients, cost-effectiveness, ability to garner personal relationships, and administration of crucial services such as immunizations.
“Just because we are able to see our patients often and they come through the door, does that matter?” Roth said.1 “Well, there have been studies that show that, in community settings, pharmacist intervention in diabetes has direct outcomes that are shown, [like] significant reductions in A1c, total cholesterol, [low-density lipoproteins], and also reduction[s] in medical and health care costs.”
Roth explained that it’s the pharmacists in these community settings that are the facilitators in improving diabetes outcomes. However, the same could be said about clinical pharmacists, the evidence that supports their role in diabetes care, and the recommendations to conduct diabetes care services in clinical settings.
“The [American Diabetes Association (ADA)] standards of care in 2025 include specific settings where patients get optimal diabetes care,” Johnson said.1 “They mentioned patient-centered medical homes and accountable care organizations.”
Moreover, she explained how thousands of pharmacists are currently working in settings specifically noted for their improved diabetes outcomes. Johnson’s argument is that the focus within diabetes clinics can potentially outweigh benefits experienced in community pharmacies.
To further bolster her support for clinical diabetes care, Johnson explored 3 separate studies that assessed the impact of pharmacists on diabetes outcomes in clinics. Simply having a pharmacist on a clinical care team improved patients’ A1c and decreased emergency department visits, which translated to improved cost-effectiveness for patients and clinics.
“Now, we have a different type of intervention: pharmacist-led group medical visits,” continued Johnson.1 “We see the same thing: A1c improvement as well as systolic blood pressure improvement. When we're looking at blood pressure, that's another remote patient-monitoring metric that we can bill for.”
By highlighting the improved outcomes in diabetes clinics, Johnson also presented significant overlap on how clinics can improve outcomes, cost patients less, and improve reimbursements for pharmacists all at the same time. With their concentrated expertise in clinical settings, these pharmacists are able to bill for a variety of services, including remote patient monitoring, transitions of care management, education and training, placement and interpretation of continuous glucose monitoring, point-of-care testing, and more.
However, many of these services can also be conducted in a community setting.
“Diabetes self-management education and support can be used and are being used in community pharmacy today,” Roth said.1 “Medication therapy management has been kind of the bread and butter of community pharmacy practice. I think that's a really important part that we need to continue and get reimbursed for. There's direct contracts with employers and health plans [as well].”
In community settings, there is evidence that supports pharmacists providing specific services as well as their ability to bill for them. “We can be creative. The evidence is strong,” Roth continued. “We just need to tell our story to those that are going to pay for it.”
At the conclusion of their presentation, Roth and Johnson stated that neither a clinical nor community pharmacy setting is preferred over the other for optimal diabetes care. While each has specific advantages for both the patient and pharmacist, utilizing the proper education, evidence, and recommendations will be crucial in improving diabetes outcomes. According to Roth, Johnson, and several other experts, the best way to conduct diabetes services is through collaboration and constant communication.
“People with diabetes can benefit from a coordinated interprofessional team that may include and is not limited to diabetes care and education specialists, primary care and subspecialty clinicians, nurses, registered dietitian nutritionists, exercise specialists, pharmacists, dentists, podiatrists, and behavioral health professionals,” wrote the ADA.2
Ultimately, Roth and Johnson do not recommend diabetes care be conducted in one setting over another. With the importance of collaboration in diabetes care and health care in general, they stressed how simple communication between health care professionals and seeking to increase education on diabetes care will be of the utmost importance for improving outcomes.
“Pharmacists in all settings have a significant impact on diabetes care,” Johnson said.1 “We know the clinic, community, hospital, industry, managed care, any setting that [they’re] in, [pharmacists] are having the impact on patients with diabetes and with every disease state.”
