It’s the question that keeps pharmacy owners up at night: “How do I stop losing money?”

As a pharmacist and former owner, I know that feeling in the pit of my stomach. You look at the P&L sheet, and the math just doesn’t work. DIR fees are out of control, dispensing margins are thinner than paper, and you’re doing more work for less pay.

The old model of relying 100% on prescription volume is broken.

For pharmacies across the U.S., survival and success now depend on answering a new question: “What is my pharmacy revenue beyond prescriptions?”

The good news is, you are sitting on the most valuable, untapped asset in healthcare: your clinical expertise. Patients, payers, and local physicians are desperate for the services you can provide. They just don’t know it yet, and you haven’t had a clear way to get paid for it.

Until now. Let’s stop giving away our knowledge for free. Here is a practical guide to the pharmacy services that actually pay.

1. Optimize Your “Low-Hanging Fruit”: The OTC Aisle

Before you launch a complex service, let’s optimize what you already have. Your OTC aisle is not just a retail space; it’s a revenue and trust-building engine.

• Stop Being a Shopkeeper, Start Being a Consultant: Don’t just point to the cold-and-flu aisle. Offer 3-minute, “Ask Your Pharmacist” consultations. “I see you’re grabbing Sudafed. Are you taking anything for your blood pressure? Let me show you a safer option.”
• The Business Case: This “mini” pharmacy consulting builds massive patient loyalty. You can also create “Pharmacist-Recommended” bundles (e.g., “The Ultimate Cold & Flu Kit”) and use it as a bridge to…
• The “Cash” Sale: …charging a small, cash-based fee for a 10-minute consultation that results in a curated, personalized OTC recommendation list. You’d be surprised how many patients will pay $20 for your expert advice instead of guessing.

2. The Core Billable Service: Medication Therapy Management (MTM)

You are already doing MTM every single day. You’re catching duplicate therapies, flagging interactions, and counseling on adherence. You’re just not getting paid for it.

Formalizing your MTM service is the most logical first step into paid clinical services.

• What It Is: A systematic review of a patient’s entire medication profile (Rx, OTC, supplements) to identify and resolve medication-related problems.
• How You Get Paid:
  1. Payer Platforms: Medicare Part D plans pay for CMRs (Comprehensive Medication Reviews) through platforms like Outcomes and Mirixa. This is the easiest-entry-point.
  2. Direct Medical Billing: This is the real goal. You can bill medical insurance (like Medicare Part B) for MTM services using CPT codes, provided you’re credentialed. This opens up MTM to all your high-risk patients, not just those flagged by a platform.

(Editor’s Note: We’ve built a complete playbook for this. Read it here: How to Launch MTM in Your Pharmacy: A 5-Step Guide for Owners.)

3. The “Test & Treat” Model: Point-of-Care Testing (POCT)

This is one of the fastest-growing pharmacy revenue streams because it solves an immediate patient problem: convenience.

• What It Is: Using CLIA-waived tests to get immediate results for common illnesses. In many states, you can now “Test and Treat,” meaning you can diagnose and prescribe all in one 15-minute visit.
• The Most Common Tests: Flu, Strep, COVID-19, RSV, and A1c/Lipid panels for health screenings.
• How You Get Paid:
  1. Cash-Pay: This is the simplest. “Strep Test: $45. Strep Test + Treatment: $85.” Patients are happy to pay this to avoid a 3-hour wait at urgent care.
  2. Medical Billing: You can bill the patient’s medical insurance for both the test (e.g., CPT 87880 for strep) and your clinical time (an E/M code), which often results in higher reimbursement.

4. The “Vaccines & More” Clinical Services

You already give flu shots, but are you getting paid correctly? Many pharmacies leave thousands on the table by not billing the medical benefit for vaccines.

But it goes far beyond the flu shot. Think of your pharmacy as a “clinical services” hub.

• What It Includes:
  • Vaccine Administration: Billing medically for Flu, COVID, RSV, Shingles, Pneumonia, etc.
  • Chronic Care Management (CCM): Getting paid a monthly fee from Medicare to manage your most complex patients (those with 2+ chronic conditions). This is a stable, recurring revenue stream.
  • Clinical Injections: B12 shots, travel vaccines, etc. These are often simple, high-margin, cash-based services.

The One Thing That Powers All New Revenue

Do you see the common thread?

You can’t get paid for MTM, POCT, or your clinical vaccine services without one foundational system: Medical Billing.

This is the hurdle that stops 9/10 pharmacy owners. It’s a different language—CPT codes, ICD-10, CMS-1500 forms, and credentialing. It’s complex, frustrating, and a massive time-suck.

As a pharmacist, I’ve been there. I built these services in my own pharmacy. I learned the hard way that you can have the best clinical service in the world, but if you can’t get paid for it, it’s just a hobby.

Your expertise is valuable. Your pharmacy services are the future of healthcare. Don’t let the billing paperwork be the one thing that holds your business back.

(Editor’s Note: Before you do anything else, you must understand this foundation. Read our complete pillar guide: The Pharmacist-Owner’s Guide to Medical Billing & Reimbursement.)

The Future of US Pharmacies is You

The business model for pharmacies is no longer just “pills in bottles.” It’s “care in the community.” You are the most accessible, trusted, and underutilized healthcare provider.

By launching these new pharmacy revenue streams, you’re not just saving your business. You’re building a more sustainable, profitable, and professionally rewarding practice.

You are a provider. It’s time to get paid like one.