Personalized Care From Community Pharmacies: A Prescription for Better Health

A standout teen soccer player struggles to make it through practice without using a rescue inhaler to tame his asthma. A busy mother of three with newly diagnosed diabetes needs help learning how to give herself insulin injections. A 62-year-old farmer with a heart condition drives a long way into town for his prescription refills.

Each of these people would benefit from care tailored to their specific health needs. That care doesn’t have to be limited to a doctor’s office, thanks to a partnership between Elevance Health’s pharmacy benefit manager, CarelonRx, and a network of local pharmacies already on the front lines of community health. 
 

How CarelonRx Partners With Community Pharmacies for Better Health

The Community Pharmacy Total Care (CPTC) program connects members of Elevance Health-affiliated Medicaid plans who have complex health conditions with independent community pharmacies able to offer a range of services that make managing their conditions just a little easier.

“That’s where the personal touch really begins,” said Stacey Decembrele, staff vice president of pharmacy network management and strategy for CarelonRx. “The pharmacist conducts a thorough review of the patient’s prescriptions, making sure the member understands what medications they’re taking. They assist in simplifying the process and smoothing out any barriers with services the pharmacy can offer.”

Smoothing out barriers may include the pharmacist synchronizing prescription refills to occur on the same day and arranging for the medication to be delivered to a location the member chooses (such as their home or workplace) at no extra cost. The pharmacist can also arrange for customized packaging of the medication with doses organized by day and time they should be taken, and set up a care plan that includes follow-up visits and further information.

This integrated, consumer-centered approach incentivizes community pharmacists to work closely with people to help them get and stay healthy, which builds on the role the pharmacist already plays as a trusted health resource.
 

What Is an Independent Community Pharmacy?

Nearly 90% of people in the United States live within five miles of a community pharmacy, which can be part of a chain or franchise, or an independently owned retail location. Housed in spaces like grocery stores or their own brick-and-mortar buildings, community pharmacies can provide guidance to people on medication use and offer health assessments or other services like immunizations.

That may be particularly important in under-resourced areas where there’s a shortage of healthcare providers, and where local independent pharmacies can serve an outsized role in individual and community well-being. While travel distance and transportation might be barriers to regular medical visits for residents living in rural areas, for example, pharmacists ingrained in their communities can be a valuable source of medication advice and baseline preventive care.

“Independent community pharmacies are more than just places to pick up prescriptions,” said Nirali Parikh, a registered pharmacist and pharmacy account director with CarelonRx. “They have familiar faces and trusted health partners who build lasting relationships with customers and their families.”

According to the National Community Pharmacists Association, there were nearly 19,000 independent community pharmacies operating in the U.S. in 2024. These types of pharmacies account for 35% of all retail pharmacies in the country, and 65% of them served communities with fewer than 50,000 residents in 2023.

The CPTC program provides a pathway for people to better manage their health. It also allows local pharmacists to engage more with the people they serve and can give pharmacists the opportunity to serve new people.  Among its success stories:

• In Maquoketa, Iowa, a program pharmacist advised a health plan member about taking behavioral health medications during pregnancy and continued to engage with her after she delivered her baby.
  
• In Stafford, Texas, a member with diabetes and unable to drive due to cataract surgery was able to have her medication home-delivered in customized packaging.
  
• In Little Rock, Arkansas, a program pharmacist referred two people without a primary care physician to a doctor and helped them set up appointments.

The CPTC program has “significantly reduced the time patients spend on managing their medications, allowing them the ability to focus on their lives,” said a participating pharmacist in Shenandoah, Texas. “As a result, we've seen improved medication adherence and health outcomes within the community." 
 

The CarelonRx Approach: Embracing Collaborative, Customized Care

The CPTC program demonstrates the direct impact an innovative and collaborative pharmacy benefit manager can have on people’s health.

A recent analysis by the Elevance Health Public Policy Institute across eight Elevance Health-affiliated Medicaid plans with a CPTC program in place showed benefits among participating plan members including:

• Improved adherence across nearly all medication categories, including among those with prescriptions for conditions like high blood pressure and depression.
• Improvements across all identified quality measures, including blood sugar control among people with diabetes, optimal use of asthma medication, and adherence to statin therapy for patients with cardiovascular disorders.

“To provide people with more personalized care, this program converts data into insights that can close key treatment gaps,” Decembrele said. “It’s a prime example of how local pharmacists and PBMs can work together for better health outcomes and improved efficiency in healthcare, helping to strengthen core community businesses in the process.”