On July 5, 2026, the Centers for Medicare and Medicaid Services quietly launched one of the most consequential innovation models in recent memory, and the pharmacy world has barely noticed. That is a mistake. Because buried inside the ACCESS Model is a blueprint for a future of pharmacy practice that looks nothing like what most pharmacists experience today.
What the ACCESS Model Actually Is
ACCESS, Advancing Chronic Care with Effective, Scalable Solutions, is a voluntary CMS Innovation Center payment model that launched July 5, 2026 and runs for 10 years through June 30, 2036. Applications are accepted on a rolling basis through 2033, with the next cohort entry dates of August 17, 2026 and October 1, 2026. Nearly 200 organizations are already participating.
The model focuses on conditions affecting more than two-thirds of people with Medicare: high blood pressure, diabetes, chronic musculoskeletal pain, depression and anxiety, chronic kidney disease, and atherosclerotic cardiovascular disease. These are the conditions your patients are already managing at your counter every day.
What makes ACCESS genuinely different from every other CMS payment model is the payment logic itself.
Traditional Medicare fee-for-service pays for things that happen: minutes logged, devices issued, encounters recorded. ACCESS tests Outcome-Aligned Payments, a fundamentally different approach. Participating organizations receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes at the population level. In year one, earning the full payment means at least half of enrolled patients must hit guideline-informed improvement or control targets. That threshold increases with each participation year.
The financial incentive points directly at outcomes, not activity. That is not an incremental reform. It is a different theory of how healthcare payment should work.
Why Pharmacists Are Named in This Model
CMS highlighted the ACCESS Model in its June 11 MLN Connects newsletter as a resource specifically for primary care providers, health centers, pharmacists, and other referring clinicians whose patients may qualify. The CMS page explains how ACCESS may supplement care for patients with diabetes, high blood pressure, chronic musculoskeletal pain, and depression.
Pharmacists are explicitly named alongside primary care physicians and health centers as referring clinicians for whom CMS built dedicated guidance. Starting July 5, eligible Original Medicare beneficiaries can sign up with participating ACCESS organizations, and those organizations are expected to coordinate care updates back to referring clinicians when key clinical moments occur.
That coordination pathway is the specific mechanism pharmacists need to understand.
The co-management payment structure uses new HCPCS G-codes specific to ACCESS: G0676 for hypertension, type 2 diabetes, chronic kidney disease and related cardiometabolic conditions; G0677 for chronic musculoskeletal pain; G0678 for behavioral health. These G-codes create a formal, CMS-sanctioned coordination pathway that generates both clinical communication and payment in a way that traditional fee-for-service pharmacy never has.
ACCESS participating organizations can receive a Medicare co-management payment with no beneficiary cost-sharing for coordinating care at key clinical moments, with structured care updates sent back to referring clinicians when those moments occur. For pharmacists embedded in or partnering with ACCESS-participating organizations, this creates a referral and coordination loop that puts the pharmacist’s medication management expertise directly into the outcome measurement infrastructure that determines whether the ACCESS organization gets paid.
The Four Clinical Tracks and What They Mean for Your Patient Panel
ACCESS is organized into four distinct clinical tracks, each grouping comorbid conditions that are frequently treated together.
Early Cardio-Kidney-Metabolic (eCKM): Covers hypertension, dyslipidemia, obesity and overweight with central adiposity, and prediabetes. Outcome measures include blood pressure control, lipid panel improvement, weight and BMI, and lifestyle adherence tracked via connected devices.
Cardio-Kidney-Metabolic (CKM): Covers diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease. Outcome measures include HbA1c, blood pressure, lipids, and weight through lab values and device feeds, plus medication adherence. This track directly parallels the cardiorenal protection framework from the 2026 ADA Standards and the 2026 AHA/ACC CKM Syndrome guideline, both covered in prior issues of this newsletter.
Musculoskeletal (MSK): Covers chronic musculoskeletal pain. Outcome measures include clinically meaningful pain and function improvements including opioid-sparing outcomes over time.
Behavioral Health (BH): Covers depression and anxiety. Outcome measures include standardized depression and anxiety scale improvement over the participation period.
Look at those four tracks and compare them to the medications you dispense every week. Antihypertensives, statins, GLP-1s, metformin, SGLT2 inhibitors, finerenone, antidepressants, SSRIs, opioid alternatives and adjuncts for chronic pain. The drug classes that ACCESS measures outcomes for are the drug classes your pharmacy fills every day. The patient population ACCESS targets is your patient population.
The Private Payer Alignment That Makes This a Decade-Long Structural Shift
Major health plans have pledged to offer an ACCESS-aligned payment option for technology-supported chronic care. Private payers representing 165 million members across Medicare Advantage, Medicaid, and commercial coverage have committed to aligning with the ACCESS Model’s payment approach, with many beginning alignment in 2026.
Leading medical societies have expressed support for CMS’s efforts, including the American Academy of Family Physicians, the American College of Physicians, the American Diabetes Association, and others.
When the commercial payer infrastructure aligns behind a CMS innovation model at this scale, the model tends to define the standard of care for a decade. ACCESS is not a small Medicare pilot with uncertain longevity. It is a 10-year model with private payer alignment that covers the majority of insured Americans, backed by named medical society endorsements and nearly 200 participating organizations on day one. The payment approach ACCESS tests this decade will likely shape how chronic disease management is reimbursed across all payer types by 2030.
What CMS Is Specifically Requiring and What ACCESS Organizations Need
To participate, organizations must be enrolled in Medicare Part B as providers or suppliers. Although each organization must have a physician clinical director, the only Medicare payments they can submit claims for are the ACCESS-specific monthly Outcome-Aligned Payments. ACCESS organizations cannot submit claims for any individual services like visits, tests, or procedures to Medicare, as these are still provided by patients’ regular physicians and referring clinicians outside the model.
This structure creates the referral relationship that matters for pharmacists. The ACCESS organization is not designed to replace the patient’s existing care team. It is designed to add a layer of technology-supported chronic care management that supplements the care the patient already receives from their primary care physician, their specialist, and their pharmacist. The clinical data the ACCESS organization generates through connected devices, outcome monitoring, and structured care coordination flows back to those referring clinicians as structured care updates.
The pharmacist who receives those structured care updates, and who sends back medication management documentation in return, is participating in exactly the coordinated care infrastructure the model is designed to create.
The Specific Opportunity for Community and Health-System Pharmacy
Every independent pharmacy in America manages patients with hypertension, diabetes, musculoskeletal pain, and depression every day, often on complex multi-drug regimens that no other provider sees in full. The pharmacist reviewing a patient’s complete medication profile has visibility that no ACCESS organization, no RPM platform, and no primary care physician has at the same time.
ACCESS runs alongside, not instead of, existing Medicare programs. Providers can continue billing RPM and Chronic Care Management codes while also participating in ACCESS, since the programs are distinct. The newsletter coverage of RPM billing infrastructure in the prior issue is directly relevant: a community pharmacy running RPM programs for hypertension and diabetes patients generates CPT 99454, 99457, and 99458 billing revenue while simultaneously serving as the referring clinician partner who connects those patients to ACCESS organizations for the population-level outcome measurement that unlocks the ACCESS payment.
The pharmacist who understands ACCESS can make an articulate case to any ACO, primary care practice, or health system participating in the model: “Your ACCESS payment depends on the share of enrolled patients who hit their hypertension and diabetes targets. I see these patients every month. I monitor their blood pressure trends through RPM. I manage their medication regimens under a CPA. I can be the continuous care layer that improves your outcome percentage, documents the interventions that support your G-code billing, and reduces your medication-related adverse events. Build me into your ACCESS care coordination infrastructure.”
That pitch requires knowing the model. The pharmacists who have read the CMS guidance before the meeting will make it. The ones who haven’t will learn about ACCESS after the contract is already signed with someone else.
Your Action This Week
The next cohort application deadline is August 17, 2026. Organizations applying after that date will be considered for a January 1, 2027 start.
Visit cms.gov/priorities/innovation/innovation-models/access and read the model’s full structure, particularly the Outcome-Aligned Payment financial structure and the referring clinician guidance page that CMS specifically built for pharmacists and primary care providers.
Then identify whether any health system, ACO, primary care practice, or digital health organization in your market is an accepted ACCESS participant. CMS maintains a public participant directory. If they are, request a meeting with their care management leadership this quarter and position yourself as the pharmacy partner who can deliver structured medication management, adherence monitoring, and drug therapy optimization for their ACCESS-eligible patients.
If you are a health system pharmacy director or an independent pharmacy owner who wants to participate directly as an ACCESS organization rather than as a referring clinician, contact the ACCESS Model team directly at ACCESSModelTeam@cms.hhs.gov for current application guidance and eligibility requirements.
The model is built to need what you do. The pharmacists who show up first will define what pharmacist participation in ACCESS looks like at scale for the next decade.
Sources: CMS.gov (ACCESS Model Official Page, July 2026), CMS (MLN Connects Newsletter, June 11, 2026, Pharmacist and Referring Clinician Resource for ACCESS), CMS (ACCESS Model Financial Structure and Clinical Tracks), CMS (Request for Applications, Rolling Application Timeline), AMA Moving Medicine Podcast (ACCESS Model, Dr. Sutton Interview, December 2025), American Medical Association (ACCESS Model Launches in July: What Doctors Should Know, July 2026), Telehealth.org (CMS Launches New ACCESS Model Resource for Chronic Disease Management, July 2026), AHA News (CMS to Launch Payment Model for Expansion of Technology-Supported Care Access), Foley Hoag LLP (CMS Announces ACCESS Model), ArentFox Schiff (CMS Innovation Center Unveils ACCESS Model), Prevounce Blog (CMS Unveils the ACCESS Model: A New Era for Technology-Enabled Chronic Care), DrKumo (CMS ACCESS Model 2026: RPM, Chronic Care, and Practice Readiness, July 2026), Manatt (ACCESS Unlocked: CMS’s Bold New Model for Tech-Enabled Chronic Care Management)
