Pharmacists' facilitators and barriers to implementing and billing for patient care services: Interviews from the Ohio Medicaid Project

Background: In the past several decades, a growing body of literature is recognizing the benefits of pharmacist-led health care services in improving clinical and economic outcomes. Despite this evidence, pharmacists are not recognized on a federal level as health care pro-viders in the United States. Ohio Medicaid managed care plans began partnering with local pharmacies in 2020 to launch initial programs for implementing pharmacist-provided clinical services.Objectives: This study aimed to identify barriers and facilitators to implementing and billing for pharmacist-provided services in Ohio Medicaid managed care plan programs.Methods: This qualitative study interviewed pharmacists involved in the initial programs using a semistructured interview based on the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded for thematic analysis. Identified themes were mapped to the CFIR domains.Results: Four Medicaid payors partnered with 12 pharmacy organizations, representing 16 unique sites of care. Interviews were conducted with 11 participants. The thematic analysis found data fit within the 5 domains with 32 total themes. Pharmacists described the imple-mentation process of their services. The primary themes for improvement of implementation process were system integration, payor rule clarity, and patient eligibility and access. The 3 themes that emerged as key facilitators were communication between payors and pharma-cists, communication between pharmacist and care teams, and the perceived value of the service.Conclusions: Payors and pharmacists can work collaboratively to improve patient care op-portunities by increasing access with sustainable reimbursement, clear guidelines, and open communication. Continued improvement is needed in system integration, payor rule clarity, and patient eligibility and access.& COPY; 2023 American Pharmacists Association & REG;. Published by Elsevier Inc. All rights reserved.