Practice of billable pharmacy service programs and billing in the United States
- VernacularTitle:美国可收费药学服务项目及收费实践
- Author:
Lirong YANG
1
;
Siyu LIU
2
;
Shushan WU
3
Author Information
1. Dept. of Pharmacy，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China
2. University of Vermont Medical Center，Vermont 05401，USA
3. Dept. of Pharmacy Administration and Clinical Pharmacy，School of Pharmaceutical Sciences，Peking University，Beijing 100191，China
- Publication Type:Journal Article
- Keywords:
clinical pharmacy;
pharmacy service;
pharmacist;
billing;
United States
- From:
China Pharmacy
2025;36(10):1161-1165
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To introduce the characteristics and practice of billable pharmacy service programs in the United States， aiming to provide reference for the development of clinical pharmacy service and the establishment of corresponding billing criteria in China. METHODS By searching the official websites of American Pharmacists Association， American Society of Health- System Pharmacists， Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention， and the PubMed database， the contents of American billable pharmacy service programs， corresponding service billing criteria， the approaches to being paid as pharmacists and the clinical practice evidence were summarized. RESULTS Current major billable pharmacy service programs implemented in the United States included medication therapy management， outpatient pharmacy service， transition of care management， chronic disease management， annual wellness visits， as well as diabetes self-management training/education. Except for diabetes self-management training/education， which lacked robust data on practice outcomes， all other programs mentioned above were demonstrated to have positive impact on patient outcomes， reducing health care cost and/or generating revenues. The most common approaches for pharmacists to obtain reimbursement were “incident to” billing and using procedure codes. CONCLUSIONS Billable pharmacy practice programs in the United States are achieving progress in service specialization and billing standardization. China can learn from successful cases in the United States while considering its own national context， with the ultimate goal of improving the overall health outcomes of patients， so that pharmacy services can become an important part of the medical service system.
