Success Stories

Subscribing to CPESN Medical Billing Supports has allowed Lino’s Pharmacy in Roma and Rio Grande City, TX to capture new revenue that also affords extra time with patients. Lino’s initiated medical billing with a vaccine hesitancy program that revealed new gaps in care. As the team was able to spend more time with patients, they learned of additional needs for pharmacy services, says Jesus Rios, Lino's Pharmacist and Owner. Watch this short video to learn more.

Carewell Pharmacy in Gilbert, WVA is one of three CPESN West Virginia pharmacies to participate in the Rx Healthy Heart program funded by the Pallottine Foundation of Hungtington. Patients in the program record their blood pressure at home and report the readings to the pharmacist who provides coordinates care with their physicians. Courtney Riffe, Carewell Pharmacist and Owner, says the services are documented through eCare plans that trigger reimbursement with bonus opportunities when patients reach their goals.

Walker's Pharmacy in Livonia, LA relies on Business Intelligence data to help identify and prioritize patients for med sync, adherence packaging, delivery services, and Pharmacy Care at Home services. Owner/pharmacist Wyatt Walker, who also is the CPESN Louisiana Managing Network Facilitator, describes how CPESN Business Intelligence supports informed decisions for his team.

A grant-funded program to increase pneumococcal vaccinations among underserved black and Spanish-speaking adults included a value-based payment model. Dakota Barr, CPESN Kentucky Managing Network Facilitator, shares details and says the model is one that other networks might replicate.

Since signing up for the Pharmacy Care at Home Special Purpose Program last fall. Nario Cantu, pharmacist and owner of Cantu's Pharmacy in Edinburg, TX has grown the program to serve 100 patients. The third-generation pharmacist encourages other CPESN pharmacists to consider the program that he says benefits his patients and his pharmacy.

Rebecca Brown, Clinical Pharmacy Director at Family Pharmacy’s Amelia location describes the benefits of participating in CPESN’s Pharmacy Care at Home program. The number of patients receiving pharmacy services at home increased from four to 25 in a short time, all at higher levels of reimbursement.

Kevin Day, president of Day's Pharmacy in Cincinnati and CPESN® Ohio's Managing Network, says network pharmacies delivered strong results in closing 2024 care gaps for CareSource patients. He points to the value-based care arrangement, along with fair dispensing, and reasonable fee-for-service programs within medical billing as wins for Medicaid patients and network pharmacies.

Cost Plus Drugs Co-Founder Mark Cuban tackles tough future state questions for an audience of CPESN USA independent community pharmacy owners and leaders during this interview with Troy Trygstad, CPESN USA Executive Director. The interview was pre-recorded and presented as the opening plenary at the 2025 CPESN USA Mid-Year Leadership Event held in Concord, NC.

Payment for patient encounters to address gaps in care allows CPESN Iowa community pharmacists more time for direct care that improves health outcomes. Tammy Bullock and Fabi Gallardo, pharmacists at Osterhaus Pharmacy in Maquoketa, IA describe how their team approach under the program helped a legally blind patient better manage his medications.

Community pharmacies are uniquely positioned to help address non-medical drivers of health, yet not all all community pharmacies are the same. Understanding why and how they differ was a key focus as CPESN® Health Equity and CPESN® Texas recently participated in a learning collaborative funded by the Episcopal Health Foundation. The result is a report that can serve as a resource for networks as they introduce CPESN pharmacies and tell their value story in local communities. You can find the full report here.

Abbi Linde, CPESN Wisconsin Managing Network Facilitator, shares tips for maximizing grants that do not allow use of funds for patient services. Creativity in applying for and writing grants has helped that network secure administrative funds, as well as support for program implementation, training, and documenting best practices.

UHC Medicaid patients receive same-day care, including physician visits; and expanded billing pays the pharmacy for the health services care the patient needs. Carley Moses, a pharmacist at Peoples Pharmacy in Norfolk, VA, shares how the program is benefiting the CPESN Virginia pharmacy and its patients.

For a second year in a row, Maryland pharmacists met their goals for patient encounters as part of a HEDIS care gap closure program with Elevance/CarelonRx. That's just one success for CPESN DMV - the first regional multi-state network - as shared by Managing Network Facilitator Dixie Leikach in this short video.

CPESN Northeast Tennessee pharmacies last year completed more than 3,500 combined flu (1,175) and fall (2,374) risk assessments for Emergent ACO patients. Rebecca Wagers, Managing Network Facilitator, says the assessments are much more than a means of learning whether a patient had a flu immunization or a recent fall. Watch this short video to see how pharmacies use the assessments to improve patient health and safety.

CPESN® Mississippi network pharmacies reported more than 200 encounters with 97 Medicaid plan members over just seven months. Pharmacies enrolled plan-identified asthma, ADHD, and diabetes patients in Med Sync programs and worked with health providers to drive follow up. The 2025 contract renewal is now expanding to include COPD patients.

Elizabeth Locklear, pharmacist and owner of Rocky Point Pavilion Pharmacy and a CPESN® North Carolina luminary, added a long-term care NPI and enrolled in the CPESN Pharmacy Care at Home special purpose program. She shares an example of how her profit on one prescription went from just over $1 to just over $18.

Jenna Eccles, pharmacist/owner at Wheatridge Professional Pharmacy in Denver, describes how integrating RxE2 clinical study program steps to overall pharmacy workflow increases efficiency, patient engagement, and pharmacy non-dispensing revenue. Eccles, who is also the Managing Network Facilitator for CPESN Colorado, says having a program champion encourages pharmacies to tap into the opportunity.

Pharmacist Allysa Mack with Gibbs Pharmacy in Lebanon, TN describes how involving a Commiunity Health Worker in patient outreach for health risk assessments has increased profit for the pharmacy, and is improving care for patients.

Shannon Schultz, owner and lead pharmacist at Nebraska LTC Pharmacy, says an invitation to provide COVID vaccines to patients at the Dialysis Center of Lincoln was a success for the pharmacy, the patients, and the nonprofit. The Lincoln clinic shared its positive experience with CPESN Nebraska pharmacy with other members of the American Society of Nephrology. That groups Kidney Community Vaccination Collaborative is exploring with CPESN Health Equity an opportunity to expand the partnership model. Watch the short video to learn more.

The Elevance/Carelon Medicaid program makes it easier to postively impact patient health, says Dustin Williams, phamacy manager at Tru-Valu Drugs in Sanford, Florida. He shares an outcomes story about a patient who lowered her A1c level from 11 to 9.7 in three months.

Rachel Whitesitte, Clinical Services Manager at Streu's Pharmacy Bay Natural in Green Bay, WI, describes how the Special Purpose Program Medical Billing Supports has helped her increase reimbursement under new medical codes. The CPESN Wisconsin pharmacy is getting paid for clinical services they were providing free with $8K in new revenue for a single code in just 6 months.

Maggy Pharmacy, in northern New York, was among 17 CPESN pharmacies to participate in a statewide grant-funded workforce training program for Community Health Workers. Mark Maggy, pharmacist and co-owner, describes the positive impact for both Maggy Pharmacy technicians and the continuing benefit to patients in their community. CPESN New York was recognized by the quality improvement organization with the 2024 IPRO Quality Award.

CPESN has been named a 2024 Health Quality Innovator of the Year, an annual award presented by Health Quality Innovators (HQI). CPESN partnered with HQI in 2024 to address vaccine hesitancy and improve access in Kansas, Missouri, South Carolina and Virginia. Trained pharmacy teams leveraged community trust to provide education, increase vaccinations and close care gaps. From September 25 to October 30, 2024, 279 clinics administered 12,795 immunizations, saving over $59M in healthcare costs. Each vaccine saved $4,000 in healthcare spending, underscoring the role of pharmacy teams in improving public health.

A second two-year renewal of a medication review program for older adults is the result of CPESN Hawaii's strong overall network performance, says Dayna Wong-Otis, Managing Network Facilitator, The renewal with Hawaii Medical Services Association (HMSA) includes increases in case rates and in the network administration fees.

The expanded UnitedHealthcare Pharmacy Care Hub Program benefits rural patients, and others who may lack transportation or broadband internet service by allowing them to access telehealth visits from CPESN pharmacy locations.The program is currently available to UHC Community Plan members through CPESN pharmacies in Kansas, Virginia, North Carolina, and Florida. Alison Haas, CPESN Director of Value Based Contracting, says the program also allows pharmacy-led services including testing and treatment for minor illness, strep, or flu; as welll as MTM and patient education.

Andrew Wagner, pharmacist and owner at Eagle Grove Pharmacy, says he has seen a lot of different patient needs presented at the rural Iowa pharmacy. But a patient with a painful zip tie stuck on his tooth was a new one. Watch this short video to see how the Eagle Grove staff drew on CPESN training and a "patient first" attitutde for a positive and cost-effective patient outcome,

CPESN Ohio pharmacies are seeing new service opportunities that also expand patient access to care under the CareSource Medicaid MCO payer agreement. In additional to fee-for-service payments, pharmacies can earn bonuses based on overall network performance. Jackie Boyle, a network facilitator and Assoc. Dean, Student Success, Practice Transformation at Northeast Ohio Medical University shares benefits of the partnership.

Lynh Warnken, pharmacist and co-owner of Lamar Plaza Drug Store and Dripping Springs Pharmacy in Austin, TX, describes how a relationship with a local non-profit created an opportunity to hold profitable onsite vaccine clinics for visually-impaired and blind employees. The CPESN® Texas pharmacist is already thinking about other ways the pharmacies might support community members in their efforts to live more independently.

Preliminary data for a diabetes management program with a Medicaid MCO shows that 64% of patients that engaged at least twice with CPESN North Carolina pharmacists maintained or improved their A1c values. Madeline Clark, one of the network facilitators, says participating pharmacists are excited about the opportunity to reach even more patients with an increased budget under the contract renewal.

In partnership with six regional Quality Improvement Organizations, pharmacists and their staffs in 23 CPESN® local networks adminstered nearly 40,000 vaccines to residents and staff of long-term care facilities across the country. Lindsay Christensen, CPESN Minnesota Executive Director, served as program support lead and she shares details in this short video about the more than 600 clinics that expanded access and improved safety in these care settings.