Pharmacy Practice

Pharmacy practice is moving further into the VBC infrastructure: Humana’s oncology pharmacy care coordination model reported lower costs and fewer hospitalizations for cancer patients, reinforcing pharmacy as a longitudinal care-management asset for Medicare Advantage and ACO-aligned specialty populations rather than a dispensing function alone (Humana study). At the same time, adherence and access remain unstable operating assumptions for population health models—digital refill outreach, scrutiny of adherence metrics, patient out-of-pocket cost barriers, pharmacy closures, and 340B rebate timing all point to growing tension between pharmacy economics and VBC quality performance. Enforcement risk is also rising, with HHS OIG’s $5.3M long-term care pharmacy settlement underscoring that medication-management strategies in Medicare and Medicaid populations must pair expanded pharmacy roles with tighter prescription, billing, and documentation controls (OIG settlement).