• Randy McDonough

The Path the Community Pharmacy Transformation

I can remember back in the early nineties when pharmaceutical care became the “new” way of community pharmacy practice. Twelve community pharmacies in Iowa met with both Colleges of Pharmacy (Iowa and Drake) and the Iowa Pharmacy Association at the famous Bob O porch meeting. Both colleges offered up two faculty with IPA providing an individual for administrative support. These five individuals began a practice transformation process with these twelve pharmacies that eventually expanded throughout the whole state, then nationally.


Although there was some urgency in pharmacists wanting to transform their practices, the financial incentives still supported a fee-for-service model whereby—more prescriptions filled meant more profit so that still remained the dominant business model for community pharmacy practice. Also, the lack of acceptance of the pharmacist’s new role from third party payers, other providers, and patients slowed the pharmaceutical care progress. Eventually, with the growth of pharmacy benefit managers, reimbursement for product dispensing was significantly reduced so that a viable business model for dispensing was no longer possible.

And so here we are today with community pharmacy being threatened due to a business model that is no longer viable, new competitors entering the pharmacy space (e.g. Amazon), and reductions in the pharmacist workforce by major employers.


It is time for a revolutionary change in community pharmacy practice and now we have the opportunity to do it on a much large scale with a partnership from the Community Pharmacy Foundation (CPF) and the Community Pharmacy Enhanced Services Network-USA (CPESN-USA) through a national transformation program called Flip the Pharmacy. This new funding program aims to usher more than 1,000 pharmacies through a two-year transformation process with the objective of reinventing the community pharmacy. The goal is to turn community pharmacies into economically viable, scalable, and sustainable care and business processes among clinically integrated networks. The program will be modeled after similar CMS innovation efforts in primary care practices across the country.

Flip the Pharmacy will deploy a 24-month transformation process that emphasizes local supports (practice transformation teams including practice coaches) and data driven milestones using SMART (specific-measurable-attainable-relevant-timely) methodologies across six different domains.


1. Domain 1: Leveraging the Appointment-based model

2. Domain 2: Improving patient follow-up and monitoring

3. Domain 3: Developing new roles for non-pharmacist support staff

4. Domain 4: Optimizing the utilization of technology and electronic care plans

5. Domain 5: Establishing working relationships with other care team members

6. Domain 6: Developing the business model and expressing value.


This is an exciting time for community pharmacy. More and more opportunities are being realized by community pharmacies to participate in value-based payment models, collaborate with physicians and health systems, and partnering with public health departments and social services to provide support for social determinants of health issues affecting patients including the utilization of community health workers. But it is important the community pharmacies are ready to provide enhanced services and participate in value-based contracts by transforming their practices to have the capacity to support these efforts and implement the six domains. Flip the Pharmacy supports the funding of CPESN networks and qualified practice transformation teams to successfully transform pharmacies.

I encourage CPESN networks, qualified practice transformation teams, and their practice partners to submit an application to Flip the Pharmacy. The application is found at flipthepharmacy.com.

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