When we covered CMS’s new ACCESS Model earlier this year, the story was largely about where healthcare payment might be headed.
CMS was testing something important: instead of paying only for individual activities, it would test recurring payments tied to measurable improvements in chronic disease outcomes.
That was worth watching.
Now the story has changed.
Community pharmacies have a more concrete pathway to participate.
On September 15, NCPA told members that enrollment is open for ACCESS to Pharmacy Care, following a September 14 formal announcement. The program is administered by CPESN in partnership with GamePlan Medical, one of the organizations participating directly in CMS’s ACCESS Model. It is open to qualifying community and long-term care pharmacies that are NCPA members and/or participating CPESN pharmacies.
NCPA describes the program as creating new pharmacy revenue opportunities tied to chronic-condition care and measurable patient outcomes.
That makes this a very different story than it was in July.
Before, ACCESS was a signal.
Now, for some pharmacy owners, it is becoming a business model they can actually evaluate.
The opportunity is not simply “more clinical services”
The more interesting change is how the model is structured.
A pharmacy does not necessarily need to become a CMS ACCESS participant, build a national technology platform, hire a medical director, create its own billing infrastructure, and independently manage every piece of chronic care.
In ACCESS to Pharmacy Care, GamePlan Medical serves as the CMS ACCESS participant and clinical coordinating entity, including medical director oversight. NCPA and CPESN provide pharmacy onboarding, training, tools, and implementation support. The participating pharmacy becomes the community-based care delivery piece inside that larger structure. Pharmacies receive payment for their services through the GamePlan Medical collaboration.
That is the entrepreneurial lesson.
For years, pharmacy entrepreneurship has often meant adding another business line.
Compounding.
Vaccinations.
DME.
Delivery.
Medication packaging.
Front-end products.
Testing.
Those models are still relevant.
But a different model is emerging:
Pharmacy + technology platform + care organization + payer + measurable outcomes
The pharmacy does not necessarily own every part of the infrastructure.
It plugs into a larger care-delivery system and contributes the capabilities it already has.
That is an important mindset shift.
What the pharmacy actually brings to the table
Technology-supported chronic care sounds like a technology business.
But technology still needs a connection to patients.
Community pharmacies already have something incredibly valuable: repeated patient contact.
A patient with hypertension, diabetes, kidney disease, or dyslipidemia may visit a physician periodically. The pharmacy may interact with that patient every month.
That creates opportunities for follow-up, adherence support, medication management, measurement collection, patient engagement, and care coordination.
ACCESS to Pharmacy Care is designed specifically around those existing pharmacy touchpoints. Its public program materials say participating pharmacies may build on medication synchronization, appointment-based workflows, adherence support, care coordination, and follow-up. Pharmacies are expected to identify potentially eligible Original Medicare patients, support enrollment and consent, collect required baseline measures, and document ongoing care.
That means the value of the pharmacy is not that it suddenly becomes something completely different.
The opportunity is to organize capabilities that may already exist inside the pharmacy into a more structured, measurable care model.
The payment model is what makes this especially interesting
CMS’s ACCESS Model is a 10-year voluntary Innovation Center model that began in July 2026.
At its core is a different way of paying for chronic care.
Traditional Medicare fee-for-service generally pays for specific services or activities. ACCESS instead introduces Outcome-Aligned Payments, recurring payments for managing qualifying chronic conditions where the amount earned is tied to measurable patient outcomes.
Think about the difference.
A traditional model might ask:
Did someone perform the service?
An outcomes model increasingly asks:
Did the patient’s health improve?
For participating ACCESS organizations, those outcomes can include measures related to conditions such as hypertension, diabetes, kidney disease, chronic musculoskeletal pain, anxiety, and depression. CMS bases payment partly on the share of an organization’s patients who meet specified outcome targets.
For pharmacy, that is a very important transition.
The business opportunity is no longer simply:
Perform another billable task.
It is increasingly:
Become part of a system capable of producing and documenting a measurable health outcome.
That aligns closely with where pharmacy needs to go if the profession wants sustainable payment for patient care.
And this is no longer a small CMS experiment
CMS reported on September 15 that more than 160 healthcare organizations are participating in ACCESS. The agency says many of these organizations had not previously served Medicare beneficiaries and will bring new technology-supported care options into chronic disease management.
There is also a potentially much larger signal outside Original Medicare.
Private payers representing 165 million members across Medicare Advantage, Medicaid, and commercial insurance have pledged to align with core elements of the ACCESS payment approach. CMS says many are beginning that alignment this year, while an earlier CMS announcement said pledge participants are committed to offering aligned arrangements by January 1, 2028.
That does not mean 165 million people are currently receiving ACCESS services.
They are not.
ACCESS itself is being tested in Original Medicare.
The significance is that major payers are signaling interest in a similar concept: paying for technology-supported chronic care based more heavily on outcomes.
If that approach spreads, pharmacies capable of consistently delivering and documenting measurable care could become useful partners across a much larger market.
But this is where owners need to slow down
When a new pharmacy opportunity appears, the first question is often:
How much money can I make?
That is understandable.
But it should not be the first question here.
The first question should be:
What exactly would my pharmacy be agreeing to do?
That distinction matters because value-based care is different from adding another product to the shelf.
You are taking responsibility for a workflow.
You are committing staff time.
You are collecting and documenting data.
You are coordinating with another healthcare organization.
And ultimately, the economics depend on whether the model works inside your pharmacy.
There are several things owners should understand before treating this as another revenue stream.
Who actually qualifies?
The September enrollment announcement says the program is open to community and long-term care pharmacies that are NCPA members and/or participating CPESN pharmacies.
But membership alone is not the entire readiness test.
The program currently expects pharmacies to have either at least 30% medication synchronization penetration or complete a qualifying transformation pathway. A pharmacy must also designate a clinical lead, complete required training, and demonstrate the capacity to perform program documentation and follow-up.
That requirement tells you something about the model.
CMS is not simply looking for another dispensing location.
The pharmacy needs an organized patient-care workflow.
Medication synchronization becomes useful because it creates predictable touchpoints where chronic care can be layered into the pharmacy’s operations.
What work will the pharmacy actually perform?
This is where owners should look beyond the headline.
The public program overview lists responsibilities that can include identifying appropriate Original Medicare patients, confirming fit, helping with consent and eligibility steps, collecting baseline measures, and documenting follow-up care.
NCPA has also described implementation work around patient identification, clinical interventions, documentation, care plan development, patient engagement, and care coordination.
Before participating, an owner should map those activities against current staffing.
Who identifies the patients?
Who speaks with them?
Who collects measurements?
Who documents?
Who follows up?
What happens when something is outside the pharmacy’s responsibility?
How much pharmacist time is involved?
How much can technicians or other trained team members support?
A program can create revenue and still be a bad business if the workflow consumes more labor than the economics support.
That has to be evaluated.
Who carries clinical responsibility?
This is another important question.
Under this specific pathway, GamePlan Medical is the CMS ACCESS participant and provides medical director oversight while coordinating pharmacy services.
That structure matters.
CMS requires direct ACCESS participant organizations to be enrolled in Medicare Part B and designate a Medicare-enrolled medical director responsible for care quality and compliance.
The pharmacy owner should understand exactly where their role begins and ends.
What decisions does the pharmacy make?
What requires escalation?
Who is responsible for medical management?
Who communicates with the patient’s existing physician?
Who owns the care plan?
Who handles a concerning result?
If a patient’s blood pressure is far outside target, what happens next?
These are operational questions, but they are also clinical-risk questions.
They need clear answers before implementation.
What actually determines whether the pharmacy gets paid?
This may be the most important shift.
Do not assume that showing up and completing a checklist automatically creates a successful value-based business.
ACCESS is explicitly designed around measurable outcomes.
That means pharmacy owners need to understand which outcomes matter for the patients they are supporting and what role their pharmacy plays in achieving them.
The ACCESS to Pharmacy Care program currently highlights four broad tracks.
Cardio-kidney-metabolic tracks include measures such as blood pressure, weight, HbA1c, LDL cholesterol, and, where applicable, kidney markers including eGFR and urine albumin-to-creatinine ratio.
Musculoskeletal care uses patient-reported measures around pain.
Behavioral-health tracks use validated measures including PHQ-9 and GAD-7.
That is very different from counting prescriptions.
The pharmacy of the future may increasingly need to know not only:
How many patients did we serve?
but:
What happened to those patients?
This is exactly why data capability is becoming a pharmacy business skill
Imagine two pharmacies.
Both provide excellent patient care.
The first says:
We regularly help our patients with their hypertension.
The second can say:
Here are the patients enrolled in our hypertension workflow. Here are their baseline readings. Here are the interventions we performed. Here is the follow-up. Here is the proportion who achieved the target outcome.
The second pharmacy is much easier to incorporate into an outcomes-based contract.
This is where pharmacy entrepreneurship is changing.
Clinical capability matters.
But so do:
Documentation.
Workflow.
Data capture.
Patient identification.
Follow-up.
Reporting.
Technology.
Staff training.
Care coordination.
Those capabilities may become just as important to the business as prescription volume.
The owner does not have to build all of this alone
That may be the biggest lesson from ACCESS to Pharmacy Care.
When we first wrote about the CMS ACCESS Model, it was easy to imagine the opportunity belonging mainly to digital health companies with sophisticated technology platforms.
Now the pharmacy pathway demonstrates another possibility.
A pharmacy can become the local care-delivery node inside infrastructure built by larger organizations.
That is similar to what we are beginning to see elsewhere in pharmacy.
One organization builds the platform.
Another provides clinical infrastructure.
Another manages contracts.
Another manages data.
The pharmacy contributes trusted local relationships, medication expertise, repeated touchpoints, and execution.
No single organization has to build everything.
That could make participation in new healthcare models much more realistic for independent pharmacies.
This also changes how owners should think about partnerships
For a long time, the instinct in entrepreneurship has been:
What can I build?
A better question may increasingly be:
What valuable system can my pharmacy plug into?
Maybe that is ACCESS.
Maybe it is specialty medication access.
Maybe it is clinical research.
Maybe it is employer health.
Maybe it is transitions of care.
Maybe it is remote monitoring.
Maybe it is adherence infrastructure.
Maybe it is something that does not exist yet.
The entrepreneurial skill is not always invention.
Sometimes it is recognizing that your pharmacy already possesses one valuable piece of a larger healthcare system and finding the right partners for the pieces you do not have.
Before joining any new model, build the business case
If I owned a pharmacy evaluating ACCESS to Pharmacy Care, I would want clear answers to seven questions before treating it as a real opportunity:
Who qualifies?
How many eligible patients are realistically inside my pharmacy today?
What exactly does my pharmacy do?
Map every recurring task.
What data must we document?
Know the baseline measurements, follow-up requirements, and technology workflow.
Who carries clinical responsibility?
Understand the role of GamePlan Medical, the pharmacy team, and the patient’s existing providers.
How is performance measured?
Know which outcomes determine success.
How are payments distributed?
Understand exactly how and when the pharmacy is compensated and what conditions affect payment.
What staffing does this require?
Estimate pharmacist time, technician time, training, onboarding, documentation, and follow-up.
Then calculate the economics.
Not before.
That is how you turn a promising pharmacy headline into a business decision.
This is what value-based pharmacy starts to look like
For years, pharmacists have talked about being paid for patient care.
ACCESS gives us a useful glimpse of what that future may actually require.
It probably will not look like simply adding another billing code every time a pharmacist completes a task.
It may look more like:
Pharmacy identifies patient → ongoing care occurs → data are collected → outcomes are measured → payment follows performance
That is a much bigger transformation.
It shifts attention from volume to outcomes.
From isolated interventions to ongoing care.
From pharmacy operating alone to pharmacy operating as part of a larger clinical network.
And from asking:
What can my pharmacy sell?
to:
What measurable healthcare outcome can my pharmacy help produce?
That is the entrepreneurial opportunity worth watching.
When we covered ACCESS in July, the lesson was to understand where healthcare payment was going.
Now there is another lesson.
Some pharmacy owners can begin asking whether their business is ready to go there too.
Resources & Citations
1. National Community Pharmacists Association. “Enrollment now open for ACCESS to Pharmacy Care.” September 15, 2026.
NCPA member update confirming open enrollment for community and long-term care pharmacies that are NCPA members and/or participating CPESN pharmacies and describing the program as creating revenue opportunities tied to chronic-condition care and measurable patient outcomes.
NCPA September 15 enrollment announcement
2. National Community Pharmacists Association. “Enrollment Now Open for ACCESS to Pharmacy Care Program.” September 14, 2026.
Formal NCPA announcement detailing the structure of ACCESS to Pharmacy Care, the roles of NCPA, CPESN, and GamePlan Medical, participating pharmacy responsibilities, medical director oversight, payment through the GamePlan collaboration, pilot workflow development, and pharmacy readiness support.
NCPA formal ACCESS to Pharmacy Care announcement
3. ACCESS to Pharmacy Care. “Program Overview.” 2026.
Official program information describing pharmacy readiness requirements, the current 30% medication-synchronization threshold or qualifying transformation pathways, clinical-lead and training requirements, patient identification, baseline measurements, consent, documentation, and ongoing implementation support.
ACCESS to Pharmacy Care program overview
4. ACCESS to Pharmacy Care. Program website. 2026.
Official program information describing the four current chronic-condition tracks, outcome measures, role of GamePlan Medical, and the intended pharmacy-care model.
ACCESS to Pharmacy Care
5. Centers for Medicare & Medicaid Services. “ACCESS Model Participants.” Updated September 15, 2026.
Official CMS source reporting more than 160 participating healthcare organizations, participant guardrails, and private-payer commitments covering approximately 165 million Medicare Advantage, Medicaid, and commercial members.
CMS ACCESS Model participants
6. Centers for Medicare & Medicaid Services Innovation Center. “ACCESS Model.” 2026.
Official CMS model overview describing the 10-year ACCESS Model, its July 2026 launch, Outcome-Aligned Payments, participating-organization requirements, chronic-condition focus, patient enrollment structure, and payment based on measurable health outcomes rather than individual activities.
CMS ACCESS Model overview
7. Centers for Medicare & Medicaid Services Innovation Center. “Major Health Plans Join ACCESS Payer Pledge.” February 12, 2026.
Official CMS announcement reporting that health plans representing more than 165 million Americans pledged to offer outcome-based payment approaches aligned with ACCESS principles across Medicare Advantage, Medicaid, and commercial coverage.
CMS ACCESS Payer Pledge
8. National Community Pharmacists Association. “Today: Webinar on implementing the ACCESS to Pharmacy Care program.” July 21, 2026.
NCPA resource describing pharmacy implementation topics including patient identification, clinical interventions, documentation, care-plan development, and real-world workflow strategies.
NCPA ACCESS implementation resource