Success Stories

Kevin Day, owner of Day's Pharmacies and CPESN Ohio Managing Network Facilitator, describes the statewide Medicaid program exclusive to CPESN Ohio network pharmacists that allows billing for provider-status initiatives without a collaboration agreement. The program for Humana's Medicaid enrollees has a January 1, 2024 start date.

Tough times, turbulent times, and unimaginable industry change - familiar words for community pharmacy. How to make it through the coming months, positioned for opportunity? Randy McDonough, CPESN Iowa and USA Luminary, and a member of the CPESN USA Board of Managers shares his insights.

John Croce, CPESN USA Program Lead for Drug Clinical Trials, describes a growing non-dispensing revenue stream for participating pharmacies through three key partnerships, with interest from additional potential partners. "In the trials that we have performed, we have far outperformed other avenues that drug trial sponsors have used in the past."

CPESN® Virginia is preparing to launch the network's first value-based payer program to provide services to Medicaid patients enrolled in an Elevance/CarelonRx plan. Lura Thompson, CPESN VA Managing Network Facilitator, shares details in this video.

CPESN® Minnesota pharmacies will support prescribed use of medications for identified members enrolled in one of UCare’s Medicare plans. Lindsay Christensen, CPESN Minnesota's Executive Director, describes how network will provide direct support and education to promote medication adherence for hypertension, cholesterol, and diabetes medication, and will address gaps in statin therapy for cardiovascular health.

Medicaid patients of 18 CPESN® Iowa pharmacies showed improved outcomes for their mental health, asthma, and chronic obstructive pulmonary disease (COPD) with fewer ED visits and hospital admissions. Elevance Health reported the outcomes last week, concluding that value-based partnerships with CPESN community pharmacies can be an effective strategy to improve quality and lower costs for plan members with the most complex needs. Lindsey Ludwig, CPESN Iowa Managing Network Facilitator shares the details.

Here's a preview of the 150+ Payer video stories in this showcase. It features CPESN local pharmacies from coast to coast, in small towns and in the Bronx, from the Midwest to the Deep South delivering improved patient outcomes and lowering costs through over 250 local Payer contracts. It's a story about scaling - learning from one success to build another for 41 national Payer contracts, and growing. Local. Quality. Scale.

A strong partnership between the Holston Medical Group and CPESN® Northeast Tennessee persuaded a national health plan to restore preferred provider status to CPESN pharmacies. Samantha Sizemore, COO of HMG and its Emergent ACO made a strong case to the payer, demonstrating value to both patients and the health plan.

Johnathan Hamrick, CPESN Georgia Managing Network Facilitator, describes the network's fee-for-service contract with a national Medicaid MCO to close car gaps for high-risk patients.

CPESN® pharmacies working with Mobility Health under a national payer program now have access to two additional lab services - the COVID-19 / Flu A&B / RSV Multiplex (four results) and the new COVID-19 Antibody saliva test. Sarah Priestle, owner of Hart Pharmacy in Cincinnati, talks about the new patient offerings.

CPESN® Michigan luminary Austin Brown reminds network leaders to look in their backyards for unexpected payer opportunities with local and regional agencies.

Rebecca Wagers, CPESN® Northeast Tennessee Managing Network Facilitator details how four CPESN networks in three states helped Emergent ACO boost flu and fall risk scores in a 2022 year-end crunch. Now is the time for networks to approach local ACOs to offer similar support earlier.

CPESN® Pennsylvania pharmacists will provide onsite vaccine clinic services at community outreach events held by a payer partner under an expansion of a regional Medicaid MCO program.

CPESN® North Carolina Luminary Jessi Stout says involving a pharmacy student helped make recruitment for an asthma medication study fast and easy for her Table Rock Pharmacy in Morganton, NC. The 10 participating network pharmacies met the RxE2 program goal of qualifying 32 patients for referral to the study sponsor.

Through a national payer program with Genemarkers, CPESN® pharmacies are paid a flat fee to collect patient DNA samples for testing and review results with patients. The personalized medicine approach can indicate how a patient might respond to a particular treatment or which medication may work best for an individual.

Medicaid MCO coverage of adherence packaging and delivery through CPESN® Nebraska has allowed Elmwood Pharmacy to expand the service. Pharmacist Crystal Pfeifer says that's a plus for patients and for the pharmacy.

Clinical Screening for Major Depression Disorder treatment study proved a good opportunity for pharmacies in the St. Louis, MO metro area to boost patient engagement and pharmacy revenue. Tyler Taylor CPESN Missouri regional facilitator, said the RxE2 program paid pharmacies for all steps regardless of outcome, saying that's "... very helpful in a world where we don't get paid for our work very often."

Expansion of a Medicaid MCO program allows CPESN® Pennsylvania pharmacist to add diabetes disease management to services they provide to Medicaid patients. Additionally, they will now be paid for Social Determinants of Health screenings and referrals.

Laura Rhodes, CPESN USA Regional PPP Lead, describes how quality performance by CPESN® Florida pharmacies in a 2022 Medicaid adherence program has led to renewal in that state with opportunities for nearly three times as many pharmacies, and expansion to Texas where almost 90 CPESN pharmacies will be able to participate. The two networks trained together last week, preparing for the renewal and rollout in Texas.

Helping Medicaid patients diagnosed with diabetes or hypertension control their blood pressure or lower their HbA1c is the focus goal of a broad statewide managed Medicaid program available to the nearly 200 CPESN® Pennsylvania pharmacies across the state. Early patient outcomes include significantly lowered HbA1C levels and impactful referrals to other community providers based on social determinants of health surveys.

Brianna Chesser, a pharmacist with Best Value Ridglea Pharmacy in Fort Worth, shares examples of how CPESN® Texas pharmacies are helping to improve the health of diabetes and CVD patients enrolled in a managed Medicaid program.

Sarah Covert, a pharmacist with McCoy-Tygart Drug in Sheridan, AR describes how her team works with rural patients enrolled in a Medicaid MCO plan. Understanding and addressing health inequities is part of her efforts to improve medication adherence.

CPESN® Hawaii pharmacies reached out to Medicare programs with medication adherence gaps for treating diabetes, hypertension, and other chronic illnesses. In addition to meeting year-end goals for the health plan, the pharmacies coached patients to support their longer term health outcomes.

Rebecca Wagers, CPESN® NET Managing Network Facilitator, says the Emergent ACO Special Purpose Partnership has expanded to seven states and that CPESN pharmacies have submiitted more than 50,000 eCare plans. And that's just the start.

Eric Hughes, CPESN® Arkansas Managing Network Facilitator, describes one of three new RxE2 clinical trial recruitment recruitment opportunities for 2023. In this multi-state recruitment, pharamcies in several networks review prescribing records to identify patients with treatment-resistent depression. Some patients with a specific gene marker may participate in an investigational drug study. It's a payable opportunity for patients, and creates network revenue as well.

Community pharmacies educating patients - especially in underserved communities - about health conditions and access to clinical trials is the focus of a partnership between CPESN® USA and Inside Edge Consulting Group.

Cold calls to the South Dakota Department of Health five years ago opened the way for a successful hypertension management program. The small network in a rural state has tripled in size and delivered cardiovascular risk reduction programs to more than 150 patients.

CPESN® Hawaii credits a unified marketing front, persistence, and leveraging COVID-19 opportunities for that network's steady growth and payer contracts.

CPESN® USA PPP Regional Lead Laura Rhodes describes how pharmacies in CPESN® Virginia and CPESN® Florida collectively engaged dually eligible patients in a quick turn program to obtain blood pressure readings and help the MCO close care gaps. Looking forward, Rhodes says with an earlier start in the year, CPESN community pharmacy efforts can deliver greater impact for MCO payers.

Grant-funded Nicotene Replacement Therapy program helped CPESN® California pharmacies refine workflows and create patient awareness of health services under expanded Medi-Cal coverage. Pharmacy Support Staff were critical to program success.