Projecting financial sustainability for clinical pharmacy services: An implementation science brief report

Background: The United States faces a projected shortage of 86,000 physicians by 2036, disproportionately affecting rural areas. Meanwhile, 90% of Americans live within 5 miles of a pharmacy, positioning pharmacists to help address care gaps. Despite demonstrated clinical value, pharmacist integration into primary care is hindered by unclear compensation pathways. Objectives: This study developed and piloted the Pharmacist Revenue and Integration Modeling Engine (PRIME), a novel tool to support financial decision-making for pharmacist integration. Objectives included (1) developing PRIME, (2) exploring implementation strategies, and (3) modeling financial viability. Methods: The University of Tennessee Health Science Center partnered with an academic family medicine clinic in Memphis, TN, to re-establish clinical pharmacy services. PRIME used the 2025 Medicare Physician Fee Schedule, adjusted for Medicaid, private insurance, and self-pay, to model revenue across 4 service delivery scenarios. A full-time pharmacist (40 h/wk, 46 wk/y) was assumed, and projected revenue was compared to personnel costs. Results: Financial viability varied by service type and volume. Preventive care and collaborative physician-pharmacist visits (e.g., annual wellness visits and 99,214 E/M codes) were key revenue drivers. The most successful model (approach 1.5) blended preventive and collaborative services, generating $286,700 in annual revenue and a net surplus of $105,500 (ROI 1.58:1). This led to a clinic-academic partnership placing 2 pharmacists (1 full-time equivalent) in the clinic. Conclusion: Strategic use of billing codes can make clinical pharmacy services financially self-sustaining in primary care. PRIME offers a customizable roadmap for clinics to evaluate and implement pharmacist integration. This model supports workforce expansion, training opportunities, and improved access to care.