As a pharmacy owner, you’re doing more work for less pay. It’s a story I know all too well.

I remember standing in my own pharmacy, looking at the reimbursement statement, and feeling that all-too-familiar frustration. DIR fees, PBM clawbacks, and razor-thin dispensing margins… it felt like the system was built for us to fail. We were counseling more, managing more complex patients, and doing more MTM “interventions” for free—all while our core dispensing revenue was shrinking.

The truth is, the business model for local pharmacies has fundamentally broken. But the need for our expertise has never been greater.

Your patients, your community, and the entire healthcare system need your clinical knowledge. The future of community pharmacies isn’t in what we dispense; it’s in the care we provide.

The key to unlocking that future? Building new, sustainable pharmacy revenue streams by getting paid for your expertise. This guide will show you how to start.

The Big Shift: From Product Revenue to Service Revenue

For decades, your pharmacy has operated on a “pharmacy benefit” model, managed by PBMs. This model pays you for a product (the pill in the bottle).

The new, sustainable model operates on the “medical benefit,” managed by payers like Medicare Part B, state Medicaid, and private insurers. This model pays you for a service (your clinical knowledge).

This shift is the single most important strategy for the survival and growth of your business. It’s how you move from a high-volume, low-margin model to a high-value, high-margin one.

But “new revenue” doesn’t just mean adding more greeting cards to your front end. It means launching billable clinical services. Here are the most impactful ones to start with.

4 High-Value Revenue Streams for Your Pharmacy

Let’s look at the most practical and profitable services that community pharmacists are launching right now.

1. Point-of-Care Testing (POCT)

POCT (or “Test and Treat”) is one of the most visible and in-demand services. This is where you use a CLIA-waived test to get an immediate result and, if your state allows, prescribe the appropriate treatment.

• What it includes: Strep, Flu A/B, COVID-19, RSV, A1c, Lipid Panels.
• Why it’s a Revenue Winner:
  1. Patient Demand: You are selling convenience. A parent can walk in, get their child tested and treated for strep in 15 minutes, and avoid a 3-hour wait at urgent care.
  2. Multiple Billing Opportunities: You bill for the test itself (e.g., CPT code 87880 for strep) and for the clinical assessment and prescribing (an E/M code like 99212).

2. Medication Therapy Management (MTM)

You’re already doing MTM. You just aren’t getting paid for it. MTM is the formal service of reviewing a patient’s entire medication profile (Rx, OTC, supplements) to identify and resolve problems.

• What it includes: Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs).
• Why it’s a Revenue Winner:
  1. Paid for Your Expertise: It’s the purest form of “getting paid for your knowledge.”
  2. Multiple Payer Sources: You can get paid by Medicare Part D plans (through platforms like Outcomes or Mirixa) and by billing medical insurance directly (using CPT codes 99605-99607).
  3. Improves Adherence: A well-run MTM program improves your store’s adherence scores, which positively impacts your DIR fees and PBM network standing.

(Editor’s Note: We’ve already created a complete guide to get you started: How to Launch MTM in Your Pharmacy: A 5-Step Guide for Owners.)

3. Chronic Care Management (CCM) & Specialty Programs

This is one of the most powerful but overlooked opportunities for local pharmacies. CCM is a specific Medicare program that pays providers a monthly fee to manage patients with two or more chronic conditions.

• What it includes: Monthly check-in calls, coordinating with doctors, managing side effects, and monitoring adherence for patients with conditions like diabetes, hypertension, COPD, or heart failure.
• Why it’s a Revenue Winner:
  1. Recurring Revenue: This isn’t a one-time service. You get paid every month for every enrolled patient, creating a stable, predictable new revenue stream.
  2. Deepens Patient Loyalty: You become the central care coordinator for your most complex patients. The trust and loyalty this builds is immense.
  3. Proves Your Value: This is the ultimate “pharmacist as provider” model, directly improving mtm outcomes and patient health.

4. Maximizing Your Vaccine Program

All pharmacies have a vaccine program. But are you maximizing its revenue? Many pharmacies only bill the PBM, leaving significant money on the table.

• What it includes: Flu, COVID, RSV, Shingles, Pneumonia, and (depending on your state) travel vaccines or B12 injections.
• Why it’s a Revenue Winner:
  1. Medical Benefit Billing: You should be billing the medical benefit (like Medicare Part B) for both the product and the administration fee. This is often reimbursed at a much higher rate than the PBM.
  2. Unlocks Other Services: The “flu shot” visit is the perfect time to offer other services. “While you’re here, Mrs. Jones, did you know we also offer…” This is your #1 marketing opportunity.

(Editor’s Note: To make sure you’re not leaving money on the table, read our guide: How to Maximize Reimbursement for Vaccines: Billing for Product & Administration.)

How to Start: A 3-Step Framework for Implementation

Okay, the “what” is great. But how do you actually do it?

Step 1: Fix Your Billing Foundation

This is the single most important step. You can’t offer new services if you have no way to get paid for them. You must have a system to bill the medical benefit.

This involves:

• Credentialing: Getting you and your pharmacy “in-network” with Medicare, Medicaid, and private payers.
• A New Workflow: Submitting claims on a CMS-1500 form, not an NCPDP layout.
• A New Language: Learning CPT and ICD-10 codes.

This is the biggest hurdle for every pharmacy owner I’ve ever spoken to. It’s complex, it’s tedious, and it’s completely different from PBM billing.

(Editor’s Note: This process is so critical, we made it our primary Pillar Page. Read it here: The Pharmacist-Owner’s Guide to Medical Billing & Reimbursement.)

Step 2: Redesign Your Workflow

You cannot and should not try to perform a 30-minute CMR at the drive-thru window. You must create a dedicated workflow for your clinical services.

• Create Space: Use a consultation room or a semi-private area.
• Create Time: Schedule these services like a doctor’s appointment. Block off two afternoons a week for only clinical services.
• Empower Your Team: Train your technicians to be your “Clinical Service Coordinators.” They can identify eligible patients, handle the scheduling, and gather initial information, freeing you up to be the clinician.

Step 3: Market Your Services (By Solving Problems)

You don’t have to become a “salesperson.” You’re a problem-solver.

• At the Counter: When you see a patient with a bag full of prescriptions, say: “I know it’s a lot to manage. I offer a service, covered by your insurance, where we can sit down and create a simple plan. Would that be helpful?”
• In the Bag: Use simple bag-stuffers. “Got the flu? Get tested and treated here in 15 minutes. Ask us how.”
• To Local Doctors: Send a one-page fax to local physician offices. “We’re now offering [CCM / POCT] to help you manage your high-risk patients and reduce readmissions. Let us be your partner.”

You Don’t Have to Do It Alone

Building new pharmacy revenue streams is a journey. It takes time and effort. But it is the only way to build a sustainable, profitable, and professionally fulfilling practice.As community pharmacists, our value is in our knowledge. It’s time we get paid for it.