Implementing Payer Partnerships for Patient Care Programs within Clinically Integrated Networks of Community Pharmacies: A Qualitative Study

Christopher Daly; Durdana N Iqbal; Jessica B Finke; Kim C Coley; William R Doucette; Stefanie P Ferreri; Sophia M C Herbert; David M Jacobs; Randy McDonough; Melissa A Somma McGivney; Wesley Nuffer; Megan G Smith; Jennifer L Bacci

doi:10.1016/j.japh.2025.102951

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Implementing Payer Partnerships for Patient Care Programs within Clinically Integrated Networks of Community Pharmacies: A Qualitative Study

Journal article

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Implementing Payer Partnerships for Patient Care Programs within Clinically Integrated Networks of Community Pharmacies: A Qualitative Study

Christopher Daly, Durdana N Iqbal, Jessica B Finke, Kim C Coley, William R Doucette, Stefanie P Ferreri, Sophia M C Herbert, David M Jacobs, Randy McDonough, Melissa A Somma McGivney, …

Journal of the American Pharmacists Association, Vol.66(1), 102951

01/2026

DOI: 10.1016/j.japh.2025.102951

PMID: 41135727

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Abstract

Community pharmacy partnerships expanding patient care opportunities are growing through clinical integration. Practice transformation efforts through the Community Pharmacy Enhanced Services Networks (CPESN USA) has supported over 100 state and national payer programs. While previous work identified themes for sustained program success, program facilitators indicated a need for additional insight into program design, execution, and evaluation. To identify successful practices for implementing patient care programs in collaboration with health payers across community pharmacy networks nationwide. This qualitative study consisted of an online demographic survey and semi-structured interviews conducted in 2023 with CPESN USA program facilitators. The Practical, Robust, Implementation, and Sustainability Model (PRISM) framework was used for developing study materials. Descriptive statistics were utilized to analyze the survey. A rapid analysis approach was used to evaluate and summarize major themes from the interviews. Of 43 eligible program facilitators across 40 networks, 14 completed the survey and interview. Participants varied in years of experience, with 6 (43%) having 1-3 years and 8 (57%) having 4-6 years. Pharmacy networks averaged 119 pharmacies and a cumulative average of 7 payer programs. Twenty-three total themes for developing and implementing patient care programs within community pharmacies were categorized in the following sections: 1) Engagement, 2) Program Intervention and Design, 3) Contract Set-up, 4) Communication Across Program Collaborators, 5) Training (Preparing for Service Implementation), 6) Outcomes Assessment, 7) Data Collection, and 8) Payment Mechanisms. Keys to successful community pharmacy-payer programs include collaborative program design, ongoing dialogue, effective evaluations, technology utilization, and evolving payment models. Findings can be utilized to implement successful partnerships with payers, supporting the integration of community pharmacies into value-based care models.

community pharmacy services

insurance

practice transformation

qualitative research

reimbursement mechanisms

implementation science

Details

Title: Subtitle: Implementing Payer Partnerships for Patient Care Programs within Clinically Integrated Networks of Community Pharmacies: A Qualitative Study
Creators: Christopher Daly - University at Buffalo, State University of New York
Durdana N Iqbal - University at Buffalo, State University of New York
Jessica B Finke - Palm Beach Atlantic University
Kim C Coley - University of Pittsburgh
William R Doucette - University of Iowa
Stefanie P Ferreri - University of North Carolina at Chapel Hill
Sophia M C Herbert - University of Pittsburgh
David M Jacobs - University at Buffalo, State University of New York
Randy McDonough - Loma Linda University
Melissa A Somma McGivney - University of Pittsburgh
Wesley Nuffer - University of Montana
Megan G Smith - University of Arkansas for Medical Sciences
Jennifer L Bacci - University of Washington
Resource Type: Journal article
Publication Details: Journal of the American Pharmacists Association, Vol.66(1), 102951
DOI: 10.1016/j.japh.2025.102951
PMID: 41135727
NLM abbreviation: J Am Pharm Assoc (2003)
ISSN: 1544-3191
eISSN: 1544-3450
Publisher: Elsevier
Grant note: Community Pharmacy Foundation: 72152-236 Pharmacy Quality AllianceNational Community Pharmacists Association
This work was supported by a Community Pharmacy Foundation grant (number 72152-236) and fulfilled by members of the Academia-Community Transformation (ACT) Pharmacy Collaborative in partnership with CPESN USA, the Pharmacy Quality Alliance, and the National Community Pharmacists Association.
Language: English
Electronic publication date: 10/22/2025
Date published: 01/2026
Academic Unit: Pharmacy Practice and Science
Record Identifier: 9985019146602771

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