Pharmacy has spent years making a familiar argument: pharmacists can improve medication use, prevent medication-related problems, and reduce downstream healthcare costs.
A newly published study gives that argument something increasingly important in a value-based healthcare system.
A number.
Researchers evaluated a pharmacist-led medication therapy optimization program among Medicare patients participating in an accountable care organization. The analysis included 1,003 patients who received the program and 14,031 matched controls, using more than 334,000 member-months of claims data from 2022 through 2025. The intervention combined pharmacogenomic testing, medication-risk analytics, comprehensive pharmacist review, and structured recommendations back to prescribers.
The result that immediately stands out is the money.
Participation in the program was associated with 19.4% lower total medical costs, equal to $246 per member per month, compared with the matched control group. The researchers also found lower healthcare utilization across multiple settings, including 43.1% fewer inpatient admissions, 41.3% fewer emergency department visits, and 28.3% fewer outpatient visits.
Those are meaningful numbers.
But I think the most important finding may be what happened over time.
For patients with more than nine months of program exposure, the estimated association grew to 31.9% lower medical costs, or $462 per member per month. During the first three months, the estimated cost difference was only 4.7%.
That changes the way we should think about the economic value of pharmacist care.
The value may not be in the medication review. It may be in what happens after it.
A traditional pharmacy service model can be very transactional.
Complete the medication review.
Make the recommendation.
Document the intervention.
Get paid for the encounter.
Move on.
But medication optimization does not necessarily work on that timeline.
A pharmacist might identify a medication interaction today. A prescriber may change therapy next week. The patient’s risk of an adverse event may decline over the following months. A hospitalization that might have happened six months later may never occur.
The downstream financial effect does not necessarily show up on the day the pharmacist completes the review.
That is what makes the duration finding in this study so interesting.
The longer patients remained exposed to the medication-optimization program, the larger the observed difference in healthcare spending became. The authors concluded that short evaluation periods may substantially underestimate the economic value of the intervention.
That points toward a much bigger idea for pharmacy:
The future may be less about one medication review producing one payment and more about ongoing medication optimization producing measurable longitudinal outcomes.
That distinction matters because healthcare payment is increasingly interested in outcomes over time.
Medicare Accountable Care Organizations, for example, are held accountable for the quality and cost of care delivered to an assigned population. Under the Medicare Shared Savings Program, ACOs that meet quality requirements while spending healthcare dollars more efficiently can potentially share in the savings they generate.
In that environment, the economic question surrounding pharmacist services becomes much more specific.
Not simply:
Did the pharmacist perform a medication review?
But:
What happened to healthcare utilization and spending after the medication review?
That is a completely different conversation.
Pharmacy needs to move from proving activity to proving value
This is where I think the study becomes useful far beyond pharmacogenomics.
It would be easy to read the paper and make the headline:
Pharmacogenomic testing saves money.
That would oversimplify the intervention.
The program included pharmacogenomic testing, but it also included medication-risk analytics, pharmacist review, and recommendations to prescribers. The study evaluated the combined medication therapy optimization model, not PGx in isolation.
DecisionRx, the company whose program was studied, reported that roughly one-third of pharmacist recommendations were informed by pharmacogenomic risk, while the remaining recommendations addressed other medication-related risks such as drug interactions, contraindications, therapeutic duplication, and adverse-effect risk. Because that information comes from the company providing the program, it is worth treating it as additional context rather than independent evidence.
The bigger lesson is about measurement.
Pharmacy has traditionally been very good at measuring activity.
How many prescriptions did we fill?
How many vaccines did we administer?
How many medication reviews did we complete?
How many interventions did pharmacists make?
How many patients did we call?
Those numbers matter operationally.
But they do not necessarily answer the question that determines whether someone wants to pay for the service.
What changed because the pharmacist was involved?
That is the measurement pharmacy increasingly needs to get better at.
A health plan does not ultimately benefit because a pharmacist completed 420 medication reviews.
It benefits if those medication reviews lead to fewer preventable hospitalizations, better adherence, safer medication regimens, reduced unnecessary therapy, improved quality measures, lower total cost of care, or some other measurable outcome.
A health system does not necessarily care that a pharmacist made 100 recommendations.
It cares how many were accepted, what changed for patients, and whether those changes affected outcomes that matter to the organization.
A physician practice participating in value-based care does not only need more clinical activity.
It needs activity that translates into better performance.
That is the shift.
Activity tells people what pharmacists did. Outcomes tell people why it was valuable.
The $246 number is powerful because it speaks the language of the payer
Imagine two ways of describing the same pharmacy program.
The first says:
Our pharmacists provide comprehensive medication reviews and personalized recommendations to optimize therapy.
That sounds useful.
Now consider:
Participation in our medication-optimization program was associated with $246 lower total medical spending per patient per month in a matched Medicare population.
That starts a different conversation.
One describes a service.
The other describes a potential economic outcome.
This is where pharmacy’s evolution into value-based care gets interesting.
If pharmacist involvement can be connected reliably to measurable changes in total cost of care, hospitalization, emergency department utilization, adherence, medication safety, or other important outcomes, the discussion begins moving away from:
How much should we pay a pharmacist for completing this task?
and toward:
How much value does this intervention create for the healthcare system?
Those are very different pricing conversations.
And pharmacists should want to move toward the second one.
There is an important reason to be careful with the results
The findings are encouraging, but they should not be overstated.
This was not a randomized controlled trial.
Researchers used an observational design with propensity score matching and a regression-adjusted difference-in-differences analysis. Those methods are intended to make the intervention and comparison groups more comparable and account for changes over time, but observational studies can still be affected by unmeasured differences between groups.
That is why the most accurate language is:
Participation was associated with lower medical costs and healthcare utilization.
Not:
The pharmacists definitively caused a 19.4% reduction in costs.
The authors themselves argue that their parallel-trends testing and the larger effects seen with longer program exposure support a causal interpretation, but additional research, including studies using other populations and designs, would strengthen the evidence base.
There is another disclosure worth knowing.
Three of the five authors are affiliated with DecisionRx, the company whose medication therapy optimization program was evaluated. Two authors are affiliated with the Johns Hopkins Bloomberg School of Public Health.
That does not mean the findings should be dismissed. The study was published as an accepted research manuscript in Health Affairs Scholar, and the analytical methods and results are available for scrutiny. But affiliations matter when evaluating evidence, especially when the intervention being studied is commercially provided by an authors’ organization.
That is exactly how pharmacists should approach evidence.
Be excited by a promising finding.
Then understand the design, the limitations, and the context.
The time effect may be the most important clue for pharmacy
The headline number is $246.
I keep coming back to the $462 figure.
Not because it is necessarily the number every pharmacy program should expect. It absolutely is not.
It is interesting because it highlights the difference between episodic pharmacy services and longitudinal medication management.
If the observed benefits of medication optimization accumulate over time, then pharmacy may need business models that allow pharmacists to remain involved long enough for those outcomes to develop.
Think about a patient taking eight, ten, or twelve medications.
The pharmacist reviews the regimen.
A therapeutic duplication is addressed.
Another medication is changed because of an interaction.
A dose is adjusted.
An adherence barrier is identified.
A medication with unfavorable genetic risk is reconsidered.
Several months later, the medication list changes again.
The patient’s kidney function changes.
Another specialist adds therapy.
A hospitalization occurs and the medication list is rewritten.
Medication optimization is not really a single event.
It is an ongoing process.
That is why longitudinal models are so interesting.
The future opportunity may look more like:
identify medication risk → intervene → monitor → reassess → measure outcomes → continue optimizing
rather than:
complete review → submit claim → done
That fits much more naturally into value-based care.
Pharmacists need to learn the language of economic value
This is not only relevant to pharmacy owners or pharmacists negotiating payer contracts.
It is a career skill.
A pharmacist working in managed care should understand total cost of care.
A pharmacist working in population health should understand utilization.
A pharmacist working in a health system should understand readmissions and avoidable admissions.
A pharmacist working in digital health should understand how product metrics connect to clinical outcomes.
A pharmacist working in a startup should understand return on investment.
A pharmacist working in medical affairs or outcomes research should understand how evidence is generated and communicated.
And a pharmacist trying to expand a clinical service should understand which outcomes matter to the organization paying for it.
Clinical expertise remains essential.
But the pharmacist who can connect clinical expertise to measurable organizational value becomes much harder to ignore.
Your Pharmacy Unlocked challenge this week
Pick one service you provide.
Medication reviews.
Adherence outreach.
Transitions of care.
Diabetes management.
Prior authorization support.
Vaccinations.
Medication reconciliation.
Specialty pharmacy services.
Whatever applies to your work.
Now look at how you currently describe its success.
If the answer is primarily an activity metric such as:
“We completed 420 medication reviews.”
go one step further.
Ask:
What should happen downstream if those reviews are actually valuable?
Maybe prescribers accept medication changes.
Maybe potentially inappropriate medications are discontinued.
Maybe adherence improves.
Maybe care gaps close.
Maybe high-risk medication combinations decline.
Maybe emergency department visits fall.
Maybe hospitalizations decrease.
Maybe total cost of care changes.
Then ask an even harder question:
Can we actually measure it?
You may not have access to every outcome today.
That is fine.
The first step is understanding what evidence would make your service more valuable to the person deciding whether to fund it.
Because healthcare does not only need pharmacists to do valuable work.
It increasingly needs pharmacists who can demonstrate the value of the work they are doing.
That may be one of the biggest opportunities in pharmacy.
For years, we have said pharmacists can save the healthcare system money.
Studies like this move the conversation forward.
How much?
For which patients?
Through which interventions?
Over what period?
What happens to utilization?
What happens to total cost?
Those are harder questions.
They are also much more powerful ones.
And if pharmacists can consistently answer them, the conversation around payment changes.
The goal is no longer simply to convince healthcare that pharmacists deserve a seat in the payment model.
It is to bring the data showing why leaving them out may cost more.
Resources & Citations
1. Elewa HF, Levy JF, Pandya C, Goldberg SE, Morgan TA. “Cost and Utilization Outcomes of Pharmacist-Led Medication Therapy Optimization in a Medicare ACO Population.” Health Affairs Scholar. Published August 26, 2026. DOI: 10.1093/haschl/qxag223.
Primary peer-reviewed research source for the study design, 1,003 intervention patients, 14,031 matched controls, 334,531 member-months of claims data, medication-optimization intervention, 19.4% and $246 PMPM total medical cost findings, duration-dependent results, and healthcare-utilization findings. The article is currently published as an accepted manuscript prior to final copyediting and typesetting.
Health Affairs Scholar study
2. Johns Hopkins ACG System. “Cost and Utilization Outcomes of Pharmacist-Led Medication Therapy Optimization in a Medicare ACO Population.” August 26, 2026.
Johns Hopkins bibliography entry reproducing the study abstract and documenting the difference-in-differences methodology, propensity score matching, cost results, duration effect, and utilization findings.
Johns Hopkins ACG study overview
3. DecisionRx. “Pharmacist-Led Medication Optimization Associated With 19.4% Lower Medical Costs in a Medicare ACO Population.” September 2026.
Company-issued summary of the study providing additional detail on the intervention and pharmacist recommendations. Because DecisionRx provided the program being evaluated and several study authors are affiliated with the company, this source is used only for supplementary program context rather than independent validation of the primary outcome.
4. Centers for Medicare & Medicaid Services. “About the Medicare Shared Savings Program.”
Official CMS source describing Accountable Care Organizations, accountability for quality and total cost of care, and the ability of qualifying ACOs to participate in savings when they deliver high-quality care while spending Medicare dollars more efficiently.
CMS Medicare Shared Savings Program
