For most pharmacies, prescription volume still sits near the center of the business model. More prescriptions generally mean more opportunities for revenue.
Yet some of the most valuable things a pharmacist can do may move in the opposite direction.
A pharmacist might eliminate an unnecessary medication, switch a patient to a less expensive option, find a cheaper source, simplify a complicated regimen, or help a patient avoid a medication-related problem. Those interventions can save money for patients and health plans. However, a business model built around prescription volume does not always reward the pharmacy for creating those savings.
A new study asks what happens when that incentive begins to change.
Published online October 27 in the Journal of the American Pharmacists Association, the retrospective cohort study evaluated a pharmacist-led model called Adaptive Medication Management, or AMM. The model uses direct-pay contracting to separate pharmacy revenue from prescription throughput while still allowing patients to use traditional pharmacy benefit manager channels when appropriate.
That is the interesting part of the study.
This is not simply another example of pharmacists providing an additional clinical service. It is an experiment in changing how the economic model around pharmacy works.
Instead of asking how many prescriptions a pharmacy can fill, AMM asks a different question: how much medication value can a pharmacist create?
The traditional incentive can conflict with the pharmacist’s clinical goal
Medication management creates a strange economic tension.
Clinically, the pharmacist should recommend whatever produces the best outcome for the patient. Sometimes that means starting a drug. Sometimes it means improving adherence to an existing therapy.
Other times, the best decision is to stop something.
A pharmacist might identify duplicate therapy, recommend a lower-cost alternative, find a better acquisition route, or determine that a medication no longer provides enough value to justify its use.
Those decisions can lower medication spending.
However, a pharmacy that earns revenue mainly when prescriptions move through its dispensing operation may not capture the financial value created by reducing spending elsewhere.
The authors of the new study describe this as one of the limitations of traditional pharmacy-benefit structures. Their AMM model attempts to change the incentive by paying for medication-management services directly rather than tying all pharmacy revenue to prescription throughput.
HaloScrips, the company operating the model studied, describes its approach in similar terms. Its pharmacists coordinate medications across different pharmacies, search for lower-cost options, manage prior authorizations, monitor therapy, and help patients navigate medication access. The company says its economic model allows it to earn from savings created rather than relying only on drug markups or prescription volume.
That changes what the pharmacist is financially encouraged to optimize.
The pharmacy does not have to capture every prescription
One of the most unusual parts of AMM is that it does not require every prescription to move through one dispensing channel.
The program operated alongside the employer’s existing PBM benefit. In the published study, between 43% and 66% of enrolled members’ pharmacy spending continued to run through the PBM.
That detail matters.
The pharmacist could coordinate where medications were obtained rather than automatically assuming that every prescription needed to generate revenue through the same pharmacy.
HaloScrips says its pharmacists may compare prices across a network of pharmacy partners and move prescriptions when another option offers better economics. The company also provides medication synchronization, clinical review, prior authorization support, and direct pharmacist access.
In other words, the pharmacist becomes more like a medication manager than the operator of one fixed dispensing channel.
The economic model begins to reward optimization across the patient’s medication journey.
That is very different from a system where the business benefits primarily when another prescription passes through the register.
The prescription-level savings were substantial
Researchers evaluated AMM within a self-insured employer health plan. Among 1,231 engaged members, 541 met the study’s analytic eligibility criteria. After propensity-score matching, researchers compared 172 matched pairs.
The prescription-level findings were significant.
Across 13,248 prescriptions routed through the program, the researchers calculated $2,080,996 in rebate-standardized savings compared with the expected PBM cost for the same prescriptions. That equaled approximately $157 per prescription and a 38% reduction.
That number deserves attention because it shows how much economic variation can exist around the same medication.
The drug itself may not change.
What changes is how the medication is acquired, priced, managed, or routed.
For a pharmacist, that creates a broader definition of medication optimization. Clinical appropriateness still matters, but so do acquisition cost, benefit design, fulfillment strategy, and patient access.
The PharmD begins to sit between clinical care and pharmacy economics.
But the study did not prove that total healthcare spending fell
This is where the results become more nuanced.
The researchers estimated that AMM enrollment was associated with a reduction in total plan spending of $419 per member per quarter before program fees. After accounting for program fees, the estimated reduction was $223 per member per quarter.
However, the confidence intervals were wide and crossed zero.
After fees, the 95% confidence interval ranged from a $1,326 reduction to a $777 increase per member per quarter. The estimated pharmacy-cost reduction of $292 per member per quarter was also not statistically conclusive because its confidence interval crossed zero. Medical spending showed essentially no clear difference.
Therefore, the published paper does not establish that AMM reduced overall healthcare spending.
The authors reached a more careful conclusion. The model produced substantial savings at the individual prescription level, but those savings did not translate into a clearly demonstrated reduction in total plan spending within this analysis. Its overall economic value depends partly on how much medication spending flows through the program and how much the service costs to deliver.
That distinction makes the study more useful, not less interesting.
It tells us the model has potential while also showing where the business case still needs stronger evidence.
The final paper is more cautious than the earlier conference results
There is another important detail for anyone following the research.
An earlier version of the analysis appeared at AMCP 2026. That conference abstract reported larger reductions in pharmacy and total healthcare spending. It included 1,183 members and reported a 26.5% decline in total healthcare costs among enrolled patients over 24 months, along with $2.43 million in savings across 9,279 prescriptions.
The final journal article used a different analytical approach.
It included propensity-score matching, difference-in-differences methods, two-part generalized linear models, and calendar-year fixed effects. The final analysis produced 172 matched pairs and more conservative conclusions about total plan spending.
That evolution is worth noting.
Conference abstracts often present early analyses. Peer review can lead researchers to refine methods, populations, assumptions, or statistical models before final publication.
For pharmacists reading healthcare research, the published study should therefore carry more weight than the earlier poster.
The prescription-level savings remained substantial.
The broader claim about total healthcare savings became more cautious.
The bigger question is what we want pharmacists to optimize
The study raises a question that goes far beyond one company.
What should the pharmacy business model reward?
If revenue depends heavily on prescription volume, the economic engine values dispensing.
If payment instead reflects medication optimization, the pharmacist can be rewarded for a wider range of decisions.
That could include finding a lower-cost therapy, improving adherence when treatment is appropriate, eliminating unnecessary medications, reducing duplication, resolving access barriers, or choosing a more efficient fulfillment channel.
Those actions may create value even when they reduce prescription revenue somewhere in the system.
This is where pharmacy’s long-running argument about clinical value becomes an economic question.
Pharmacists often say their expertise extends beyond putting medication into a container.
If that is true, then the payment model eventually has to recognize the value of the decisions surrounding the medication.
Otherwise, the profession asks pharmacists to create value that the business model does not consistently capture.
A PharmD can become a tool for managing medication spend
Consider how the pharmacist’s questions change under a model like this.
The first question remains clinical: is this medication appropriate?
Then several additional questions appear.
Is there an equivalent treatment that costs less? Is the employer paying more than necessary? Is the patient paying more than necessary? Could the regimen be simplified? Does the patient still need this medication? Should the prescription use the PBM benefit, another pharmacy, or a different acquisition route?
The pharmacist may also ask what happens downstream.
Will a cheaper medication improve adherence? Could a medication change reduce adverse effects? Would removing unnecessary therapy lower the risk of another healthcare encounter?
Now the pharmacist is operating at the intersection of therapeutics, access, benefit design, and economics.
Medication knowledge becomes a form of financial leverage.
One well-informed decision may save $20. Another could save hundreds or thousands of dollars. Across a large employer population, those decisions can accumulate.
That is a very different way to describe the economic value of a PharmD.
Self-insured employers create an interesting customer for pharmacy expertise
The study also highlights a customer that pharmacists do not always think about: the employer paying for healthcare.
A self-insured employer ultimately bears much of the cost when its workforce uses medications and medical services. That gives the organization a financial reason to care about medication optimization.
If a pharmacist can lower prescription costs without harming outcomes, the employer may benefit directly.
If better medication management prevents unnecessary healthcare use, the employer could benefit again.
That creates the possibility of contracting around value rather than simply around product distribution.
AMM is one version of that idea.
Other models could look very different.
Employers could contract with pharmacists around chronic disease, medication access, specialty-drug management, polypharmacy, or high-cost medication populations. Health plans and health systems could experiment with similar arrangements.
The larger principle remains the same.
Identify who financially benefits when the pharmacist improves medication use.
Then ask whether the pharmacist’s payment model can align with that value.
Value-based pharmacy needs better measurement
This is also where the challenge begins.
It is relatively easy to count prescriptions.
Measuring pharmacist-created value is harder.
Suppose a pharmacist switches a patient to a medication that saves the employer $1,000 per year. The direct savings are visible.
Now suppose the pharmacist improves adherence and helps prevent a hospitalization.
How much of the avoided cost should be attributed to the pharmacist?
What if the pharmacist recommends stopping a drug but the patient’s medical spending later rises for unrelated reasons?
These questions make value-based contracting more complicated than traditional dispensing economics.
The published AMM study illustrates that challenge. Researchers found clear prescription-level savings, yet those savings did not produce a statistically certain reduction in total plan spending.
A good payment model therefore needs more than a compelling clinical theory.
It needs measurement.
Who gets enrolled? What counts as savings? What would the medication have cost otherwise? How should rebates be estimated? How much does the service itself cost? What happens to medical spending?
The better pharmacy becomes at answering those questions, the easier it becomes to negotiate payment around value.
The study also has important limitations
This was not a randomized controlled trial.
Researchers used a retrospective cohort design involving members of one self-insured employer health plan. Patients entered the program based on medication-related savings potential and whether they accepted enrollment.
The authors used propensity-score matching and statistical adjustment to improve comparability, but those methods cannot eliminate every difference between groups.
The final matched analysis was also relatively small, with 172 pairs.
In addition, the direct prescription savings relied on a comparison between realized acquisition costs and expected PBM prices, adjusted for estimated manufacturer rebates. Those estimates are useful, but they depend on assumptions about what costs would otherwise have occurred.
There are also relevant financial relationships to disclose.
The Community Pharmacy Foundation funded the research. HaloScrips supplied dispensing records and operational data. Two study authors, Philip J. Baker, PharmD, and Michell Zulu, PharmD, were HaloScrips employees. The paper states that the funders had no role in study design, analysis, interpretation, or the decision to publish.
None of these issues invalidate the study.
They simply define how confidently we should interpret it.
The results justify more research. They do not yet prove that separating pharmacy revenue from prescription volume will reduce total healthcare costs across different populations.
The idea may be bigger than the evidence so far
That is what makes this an important Pharmacy Unlocked story.
The most interesting part is not that one program saved $157 per prescription.
It is the incentive structure being tested.
Traditional pharmacy economics often connect revenue with product movement. AMM asks whether pharmacy economics can instead connect revenue with medication optimization.
If that model eventually works at scale, it could reshape what pharmacists spend their time doing.
A pharmacist could be rewarded for reducing unnecessary drug spending rather than protecting volume.
They could choose the best fulfillment channel without worrying that moving a prescription elsewhere automatically destroys the business case.
They could spend more time analyzing therapy, access, adherence, costs, and outcomes because those activities would become central to what the customer is purchasing.
The pharmacist’s product would increasingly become the decision.
This is what value-based pharmacy would actually require
The phrase “value-based care” gets used constantly in healthcare.
For pharmacy, it can remain abstract until the incentives change.
A truly value-oriented medication model would need to answer three questions.
First, what outcome is the pharmacist responsible for improving?
Second, who financially benefits when the pharmacist improves it?
Third, how does some of that value flow back to the pharmacist or pharmacy organization?
Without those pieces, value remains something pharmacists create for someone else.
The AMM model attempts to connect them more directly.
A self-insured employer pays for medication management. The pharmacist searches for clinical and economic optimization opportunities. The employer potentially captures lower medication spending. The pharmacy earns through the service and savings model rather than simply through more prescriptions.
Whether this exact structure becomes widely adopted remains uncertain.
The underlying alignment is what deserves attention.
Pharmacists should start learning to quantify what they already do
There is a practical lesson here for pharmacists even if they never work in an AMM model.
Start putting numbers around medication interventions.
Think about one intervention you made recently.
Maybe you changed an expensive therapy to a lower-cost alternative. Perhaps you stopped duplicate treatment, identified an unnecessary drug, resolved an access problem, or improved adherence.
Now ask what happened economically.
What would the original treatment have cost? What did the alternative cost? Did the patient avoid an unnecessary prescription? Did an intervention prevent waste? Could it plausibly reduce another healthcare expense?
Then ask one more question.
Who benefited financially?
Was it the patient? The health plan? The employer? The PBM? The health system?
Finally, ask whether the pharmacist received any additional compensation for producing that value.
That exercise begins to move pharmacy thinking from activity to economics.
Healthcare organizations do not only need to know that pharmacists are valuable.
They need to understand where the value appears and how large it might be.
The future pharmacy may sell expertise more directly
Pharmacy will always need medication fulfillment.
Someone has to procure, store, prepare, verify, and distribute medications safely.
The more interesting question is whether dispensing has to remain the primary economic engine around pharmacist expertise.
The AMM study offers one possible alternative.
The pharmacist becomes a medication strategist for the patient and the payer. Dispensing remains available, including through conventional PBM channels, but the pharmacist can optimize across those channels instead of relying on one of them for all revenue.
That structure creates a different incentive.
The goal is not simply to maximize how many prescriptions pass through one pharmacy.
The goal becomes getting the patient the right medication, through the right pathway, at the right cost.
That is a much bigger idea than another pharmacy service.
It asks whether the profession can build a business model around the thing pharmacists have argued for years is their greatest asset: judgment.
The future pharmacy business model may depend less on how many prescriptions pharmacists fill and more on how much medication value they create.
The published evidence is not strong enough yet to say that future has arrived.
But it is strong enough to make the question worth asking.
Resources & Citations
- Duru EE, Kissi-Twum K, Baker PJ, Hohmeier KC, Zulu M, Mattingly TJ II. “Healthcare cost savings from an adaptive medication management program: A retrospective cohort study.” Journal of the American Pharmacists Association. Published online October 27, 2026. The final peer-reviewed analysis reported $2,080,996 in rebate-standardized savings across 13,248 prescriptions, equal to $157 per prescription and 38% below expected PBM costs. Estimated reductions in total plan spending were not statistically conclusive.
- AMCP Annual 2026. “Healthcare cost savings from an adaptive medication management program: A retrospective cohort study.” Earlier conference presentation of the AMM analysis. The poster described AMM as a pharmacist-led, direct-pay membership model operating alongside existing PBM coverage and reported earlier results that differed from the final peer-reviewed analysis.
- HaloScrips. “What We Do: Adaptive Medication Management.” Current description of the commercial AMM model, including pharmacist coordination, medication synchronization, prior authorization support, pharmacy-price comparison, alternative fulfillment sources, and a value-based economic model tied to savings rather than only drug-price markup.
- Journal of Managed Care & Specialty Pharmacy. AMCP 2026 Abstract Supplement. The AMM study appeared among the 2026 benefit-design and management research presented at the AMCP annual meeting before publication of the final journal article.
