An NCPA® Program, Powered by CPESN®
In Partnership with GamePlan Medical, a CMS ACCESS Participant
ACCESS to Pharmacy Care brings trusted pharmacist services and Medicare Part B billing support into one program. Built by pharmacy, for pharmacy to support your pharmacy across patients, practice models, and technology platforms.
BACKGROUND
CMS ACCESS
ACCESS (Advanced Chronic Care with Effective Scalable Solutions) is a 10-year voluntary CMS model that pays providers to deliver technology-supported, outcomes-based chronic care management.
Co-Management
Co-management compensates pharmacies for reviewing ACCESS care updates and performing related care coordination activities for people enrolled in an ACCESS track.
Targeted Intervention
Pharmacies can also help patients manage qualifying chronic conditions through targeted interventions. Full payment depends on achieving measurable health outcomes. Pharmacies are compensated for each service and for getting patients to goal.
CARE TRACKS
Outcome metrics and payment model
CMS ACCESS is the largest service-based program ever available to pharmacists. Payment under the new model will be driven by improved health outcomes for original Medicare patients with chronic conditions as described in the four tracks below. It will also test whether technology can improve patient outcomes and lower costs.
01
eCKM
Early Cardio-Kidney Metabolic:
HTN, Obesity, Prediabetes, Dyslipidemia
Outcomes Measured:
Blood pressure, Weight, HbA1c, LDL-C
02
CKM
Cardio-Kidney Metabolic:
ASCVD, Diabetes, CKD
Outcomes Measured:
Blood pressure, Weight, HbA1c, LDL-C
If CKD or DM also need baseline, eGFR & uACR
03
MSK
Musculoskeletal:
Chronic Pain
Outcomes Measured:
Patient Reported Outcome Measures (PROM): Pain Intensity and Improvement Surveys
04
BH
Behavioral Health:
Depression, Anxiety
Outcomes Measured:
Patient Reported Outcome Measures (PROM): PHQ-9, GAD-7
OPERATIONAL CONTEXT
Medical direction for ACCESS to Pharmacy Care
Pharmacy services are coordinated by GamePlan Medical, serving as physician clinical director for pharmacies enrolled in ACCESS to Pharmacy Care.
Payment under the new model will be driven by improved health outcomes for Medicare patients with chronic conditions, including high blood pressure, diabetes, and depression.
NCPA and CPESN together will provide training and resources to support individual pharmacy success in this outcomes-based CMS program.
BENEFITS
Why ACCESS to Pharmacy Care?
Simple
Clear steps and practical tools
Supported
Help with credentialing, billing, and implementation
Scalable
Readiness for current and future opportunities
Sustainable
A foundation for financially viable pharmacist services
Pharmacy-driven
Designed around independent pharmacy practice
For NCPA members and CPESN participants
FAQ
Your questions, answered