Pharmacy reimbursement models

Pharmacy reimbursement models describe how pharmacies get paid for medications they dispense. Common models include fee-for-service, where pharmacies receive a set amount for each prescription; or value-based models, which reward better health outcomes. Sometimes, pharmacies negotiate prices with insurers, who then reimburse a portion based on terms of the insurance policy. Additionally, there are formularies—lists of covered drugs—that influence reimbursement rates. Overall, these models aim to balance fair compensation to pharmacies, affordability for patients, and cost control for payers, ensuring effective medication access and quality care.