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As accessible healthcare providers, community pharmacies are key to the shift towards value-based care, which focuses on quality and cost-effectiveness in our U.S. healthcare system. Pharmacies and health plans need to adapt and work together to improve patient outcomes and reduce costs. Todd Sega, Managing Director of Pharmacy at PQS by Innovaccer, predicts five key changes that will drive pharmacy’s value-based care evolution in 2025.
1. Increased Non-Dispensing Revenue Opportunities
2025 is expected to deliver one of the largest increases in non-dispensing revenue opportunities for pharmacies. This shift is driven by several factors:
- A significant decrease in star ratings has prompted health plans to seek additional channels for improvement initiatives
- Health plans are exploring creative quality and clinical programs beyond traditional MTM services
- Unprecedented bonus pools are being created for pharmacies that can deliver value-based services, where some of the first true shared savings programs will be launched around managing drug formularies.
“We have seen a pretty big decrease in the star ratings for payers for the 2025 plan year,” notes Sega. “The percent of membership that’s in a four star or above contract is down 12% from the prior year… the impact on bonus payments to plans from the decrease can have a pretty big impact.”