More than 12,000 Medicaid members supported
Community Pharmacy Total Care: Care Beyond Prescriptions
Contributing experts: Amy Mulderry and Lisa Morris
Community pharmacies, like retail chains or those found in grocery stores, play an essential role in healthcare today, bridging the gap between individuals, care providers, and health plans. Trusted and accessible, they often see patients more frequently than primary care providers, especially in underserved communities. A community pharmacist’s unique position enables them to identify risks early, support medication adherence, and drive equitable, person-centered care. CarelonRx's Community Pharmacy Total Care program harnesses the power of a community pharmacy to elevate medication management, improve patient experience, and promote whole health.
Connecting Members to Better Health
Through a partnership with the Community Pharmacy Enhanced Services Network (CPESN), CarelonRx’s Community Pharmacy Total Care program connects individuals with chronic conditions that may benefit from additional support with high-performing independent community pharmacies. The program empowers these pharmacies to deliver personalized, ongoing medication management at no cost to members.
How It Works
Local pharmacists meet patients where they are — literally and clinically — building trust through consistent, personalized care.
Comprehensive Onboarding:
Individuals start with a 60-minute medication review and health goal-setting session.
Ongoing Support:
Pharmacists follow up monthly, adjusting care plans and collaborating with physicians as needed.
Consumer-Centered Experience:
Members benefit from custom packaging, home delivery, and medication synchronization for easier refills.
A Value-Based Approach
Operating under a value-based care model, participating Community Pharmacy Enhanced Services Network pharmacies are recognized for proactive, results-driven care. They receive additional compensation for closing care gaps, supporting adherence, and improving quality metrics for high-risk conditions including:
- Behavioral health diagnoses
- Cardiovascular disease
- Asthma and chronic obstructive pulmonary disease (COPD)
- Diabetes
Current Footprint
Over 500 pharmacies engaged in care delivery
11 active markets across the U.S.
Delivering Measurable Results*
17.9% reduction in emergency department visits
30.1% decline in inpatient admissions
8.1% decline in reliever inhaler use
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The CarelonRx Clinical Pharmacist support has been crucial in identifying improvement opportunities for medication adherence measures. Her weekly pharmacy reports, detailed reviews, and attention to detail have enhanced our provider panel's compliance. Her support with integrating Commercial members and providing educational flyers has been invaluable. I appreciate the CarelonRx Clinical Pharmacist’s proactive engagement in strategy development and workflow changes, demonstrating a clear commitment to improving patient outcomes.
Chinese American IPA, New York City, New York
Seamless Coordination with Physicians
CarelonRx and participating pharmacies coordinate through our proprietary platform, which provides shared visibility into medication histories and claims data. This seamless integration reduces administrative friction and enhances care continuity — leading to improved medication adherence through regular pharmacist engagement, less administrative burden through shared medication management, and stronger care coordination supported by real-time updates and collaboration.
Scaling the Power of Local Relationships
Community Pharmacy Total Care represents a scalable model for value-based pharmacy engagement. By combining CarelonRx’s clinical oversight with the local expertise of independent pharmacists, Elevance Health helps care providers extend their reach beyond the clinic, supporting whole health, improving the patient experience.
Together, we’re advancing pharmacy’s role in total health—one community at a time.
* Elevance Health Public Policy Institute: PBM and Community Pharmacy Partnerships Can Improve Medicaid Outcomes (2023): https://www.elevancehealth.com/content/dam/elevance-health/articles/ppi_assets/65/EHPPI_PBM_and_Independent_Pharmacy.pdf
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