Q&A: Pharmacy Success Lies in Service, Payment Reform | PQA 2025

Pharmacy is evolving rapidly, with pharmacists taking on more patient-centered services beyond dispensing medications. Patients increasingly rely on their local pharmacies for accessible health care, including vaccines, screenings, and chronic disease management. This shift presents both opportunities and challenges—particularly in expanding scope of practice and updating outdated reimbursement models.

Q&A: Pharmacy Success Lies in Service, Payment Reform | PQA 2025 / REDPIXEL - stock.adobe.com

At the Pharmacy Quality Alliance (PQA) 2025 Annual Meeting, held May 19 to 21 in Tampa, Florida, Drug Topics® sat down with Micah Cost, PharmD, MS, CAE, CEO of PQA, to discuss the biggest issues currently impacting pharmacy, key things community pharmacies can do to keep their doors open, and what he sees as critical for pharmacies to advance care, services and partnerships with payers for the benefit of patients.

READ MORE: Access, Innovation, and the Changing Face of Pharmacy | PQA 2025

Drug Topics: What do you see as the biggest issues currently impacting pharmacy?

Micah Cost, PharmD, MS, CAE: There's a lot of change happening in pharmacy right now, certainly a lot of challenges and opportunities, as well. I think one of the things the focus is on is the changing scope of practice for pharmacy. We see a lot of increased access to care, and pharmacies really focusing on growing the services they provide. Increasingly, we see patients seeing the pharmacy as a valuable access point. We have an opportunity to leverage that through the increased scope of practice, but also creating those opportunities where if patients want care at pharmacies, we can deliver that to them. State by state solutions are certainly happening, and we see some variability, but it's really exciting to see pharmacy take a hold of the patient care services that they're providing. That's a great issue that we have. How do we have an all boats rise mentality whenever you talk about scope of practice?

The other thing that we see is a changing reimbursement model. We see a lot of different policy solutions around payment for services, but also payment for drugs. That's a huge issue, one that we can't ignore. We've seen recent administrative actions around that. In payment for drugs and the whole payment model, we see a lot of focus on reforming that payment model. There's a lot of different solutions in that space, and PQA members are certainly weighing in on different ways around the payment model. We see that there's an opportunity to optimize that payment model, both to improve outcomes but also reduce cost of care.

Drug Topics: Community pharmacies across the country are struggling to stay afloat. What do you think are some of the key things they can do to keep their doors open?

Cost: Taking hold of those opportunities is really important. Rethinking the pharmacy business model is obviously something that a lot of our members are focused on. The most important thing that we focus on at PQA is what that access issue creates for patients. Making sure you're accounting for all of the variables that affect quality medication use like social determinants of health, some of the challenges around food insecurity, the challenges around housing insecurity, and all of those upstream factors that affect downstream medication use. That's an area where we're really focused.

The other question that we're seeking to answer this year is we want to understand what happens when a patient loses access to a pharmacy. That's really important. Not only does the patient lose access to the medication, they lose access to that trusted healthcare professional, and they may actually forgo the medications because it's too far. They don't have transportation to get there. We really want to understand, from the patient's perspective, what those barriers are, and how do we make sure that we protect that patient access to their trusted healthcare provider that's in their community, that lives as a part of their community, and serves that community. What does that really mean? How do we make sure that we protect that patient relationship with the pharmacy? That pharmacy access is so important.

Drug Topics: What do you see as critical for pharmacies to advance care, services and partnerships with payers for the benefit of patients?

Cost: One of the biggest things that pharmacy can do is to work toward those shared incentives and the aligned incentives with the larger healthcare system. Payers certainly play a huge role in that. We've run a couple of pilots around A1c and blood pressure improvement and control. We actively have a pilot focused on immunization assessment and gap closure, and those are built based on pharmacy and health plan partnerships, where they have value based agreements. It creates that opportunity for that synergy. We need more of that. We need to make sure that pharmacy and the rest of the healthcare system align themselves together. We are focusing on things that the entire system sees as valuable. The opportunity for pharmacy to come in and say, “What are your biggest pain points, and how do we reduce those?” That's a great opportunity to solve a health plans issue, but also to solve a patient's issue.

For the good of the patients, focusing on the shared incentives is one of the most important things that I think pharmacy can do. A lot of that comes through conversation. Pharmacies can start actively engaging with health plans. It's also important for pharmacists to talk to other providers, because other providers have incentives and they have priorities as well, and if you can help a provider, there are upstream implications for a health plan. One of the beautiful parts about PQA is we have this consensus based group that comes together, and it actually brings the pharmacies and the health plans together, literally at a lunch table, where they can sit down and talk about the kind of the shared pain points, but also the opportunities where they can both add value in that conversation. We like to think of ourselves as that stakeholder, that consensus based, big tent collaborative, where health plans and pharmacies can come together and talk about solutions.

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