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PBM and Community Pharmacy Partnerships Can Improve Medicaid Outcomes

October 2023
Full report

Value-based partnerships between pharmacy benefit managers (PBMs) and independent community pharmacies can improve outcomes for health plan members with complex or chronic conditions. Early results from Elevance Health’s partnership with a performance-based network of community pharmacies showed improvements in use of medications and healthcare services among one state's Medicaid members.

Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management and other counseling services, and are increasingly being rewarded for their expanded role as clinical providers in value-based contract arrangements with health plan-integrated PBMs. Further, individuals may visit community pharmacies twice as often as other healthcare providers, offering more frequent opportunities for engagement.  

This paper presents findings from a high-touch program available to help Medicaid members manage asthma, chronic obstructive pulmonary disease, mental health conditions, and opioid use disorders. Participating members had reductions in inpatient hospital and emergency department visits, among other healthcare services, and improved adherence to medications prescribed for their conditions.


  • PBM and Community Pharmacy Partnerships
  • Value-Based Care in Pharmacy
  • Methods
  • Program Outcomes
  • Considerations

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