Conversation Guide: Working With Your Carrier To Cover Pharmacy-Based Health Services

Conversation Guide:
Working With Your Carrier To Cover Pharmacy-Based Health Services

How to talk to your health plan partner about adding or expanding pharmacy-based services, including what to prepare, what to ask, and how to align on metrics and payment.

If you’re a self-funded or level-funded employer, working with your health plan may be the easiest way to add pharmacy-based services to your benefits.

This guide walks you through how to start the conversation with your carrier, broker, or health plan partner, what to discuss at each stage, and what to keep in mind as you roll out your program.

This tool was designed to be used in conjunction with our free playbook, Beyond the Script: An Employer's Guide to Unlocking the Value of Pharmacy-Based Services, as well as the other resources listed below.

We'd love to hear how you're using these free resources! Contact us at hello@healthaction.org to let us know how they're working for you and your team, request more information, or explore partnership opportunities.

Free Resource

Related Resources

Beyond the Script: An Employer's Guide to Unlocking the Value of Pharmacy-Based Services

Beyond the Script: An Employer's Guide to Unlocking the Value of Pharmacy-Based Services

A step-by-step guide for HR and benefits leaders to implement pharmacy-based healthcare services that lower costs, expand access to care, and improve employee health.

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Sample Scope of Work: Building Your Employer-Pharmacy Partnership Agreement

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Playbook:
Beyond the Script: An Employer's Guide to Unlocking the Value of Pharmacy-Based Services
A step-by-step guide for HR and benefits leaders to implement pharmacy-based healthcare services that lower costs, expand access to care, and improve employee health.

Sample Scope of Work:
Building Your Employer-Pharmacy Partnership Agreement
Key considerations and sample contract language to help you structure a pharmacy partnership agreement.

Research Report:
Closing the Care Gap: Community Pharmacies as Key Partners in Employer Health Strategies
A national study showing how employer-pharmacy partnerships can reduce healthcare costs while expanding access to quality care.

For Employers:
The Business Case for Employer-Pharmacy Partnerships
Practical steps for integrating pharmacy-based care into benefits strategies, and how to get started.

For Payers:
Pharmacy-Based Care: A Scalable Strategy for Payers To Cut Costs and Improve Access
Considerations for integrating pharmacists into provider networks and payment models to lower costs, expand access, and improve outcomes.

For Policymakers:
Pharmacy-Based Care: An Untapped Asset in America's Health Care Strategy
Policy solutions to expand pharmacist scope, modernize reimbursement, and advance pharmacy-based care as a national health asset.

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The Health Action Alliance is the nation's largest employer network advancing public health. We help companies navigate evolving health challenges, strengthen workforce well-being, and partner with public health organizations to build stronger, healthier communities. HAA's network includes more than 11,000 employers nationwide, collectively reaching over 50 million workers and their families. We believe good health is good business, and we equip employers with the tools, partnerships, and strategies to deliver on that promise.