Separate plan-sponsored medication review from support provided to a treating practice and from ordinary pharmacy operations.
RELEVANT PATHWAYS
Programs to consider for your patients
1. Provide MTM through your own contract
Best starting point if you already have assigned medication-review opportunities from a Part D plan or authorized contractor.
Your pharmacy’s work
Your qualified pharmacist performs contracted comprehensive or targeted reviews, gives required materials, communicates with prescribers, and completes the sponsor’s submission process.
Who pays your pharmacy?
The plan or authorized contractor pays your pharmacy under its provider agreement. The pharmacy arranges that agreement; PrimeVital can scope support around it.
How to start
Confirm participation requirements, assigned opportunities, accepted service units, fees, documentation, and payment deadlines before offering paid reviews.
2. Support a medical practice’s care program
An option when a treating practice needs a pharmacist’s medication expertise as part of an appropriate CCM, PCM, RPM, or verified RTM arrangement.
Your pharmacy’s work
Agree on the pharmacist’s lawful role, required supervision, permitted tasks, shared records, and clinical escalation. The eligible practice owns care and selects the appropriate program.
Who pays your pharmacy?
The eligible medical practice bills qualifying services. Your pharmacy is paid for agreed support under its contract with the practice; this is not a pharmacy-only Part B claim.
How to start
Identify a genuine clinical partner and patient need. Verify the specific code’s performer and supervision rules before agreeing staffing or buying devices.
3. Improve existing pharmacy operations
Useful when you need better scheduling and message follow-through, including while a clinical contract is still being arranged.
Your pharmacy’s work
Interactly can help with agreed administrative calls, appointments, and messages. Medication advice and clinical decisions remain with qualified professionals.
Who pays your pharmacy?
This is a purchased operations service. Evaluate staff capacity, patient experience, and existing-service receipts; assume no new Medicare program payment from administrative reminders.
How to start
Choose one bottleneck, define permitted messages and clinical handoffs, and compare the written service fee with current workload.
Choose the agreement first: your own MTM provider contract, a clinical-support agreement with a medical practice, or pharmacy operations support. Each has different work and a different payment route.
Dispensing, ordinary refill reminders, and services already paid under Part D are not separately payable Part B care-management work. Verify each program’s role and service rules; do not count the same work twice.
For Part D MTM, payment comes from the sponsor or authorized contractor under the provider arrangement. For clinical support, the eligible practitioner bills only qualifying services and compensates support through a contract. Neither is an automatic Part B pharmacy claim.
The treating practitioner may bill a qualifying Part B service—not automatically the facility or agency.
Check enrollment, the exact service, stay dates, place of service and existing services. A Part A stay and care after discharge are different situations.
MTM: accepted CMRs × your contracted CMR fee, plus accepted targeted services × their contracted fees, where your agreement pays separately for them. Use actual contract units and payment terms; there is no universal pharmacy MTM rate.
CMR is a comprehensive patient conversation with written materials; TMR is a focused review. Part D programs offer an annual CMR and perform at least quarterly TMRs. That program schedule does not promise your pharmacy a paid review every month or every quarter.
Medical-practice support: the eligible practice submits any supported clinical claim. Your pharmacy invoices only the work agreed in its support contract. The practice’s Medicare collections are not the pharmacy’s revenue.
Contribution = actual pharmacy receipts − pharmacist delivery cost − outreach and documentation cost − platform and agreed service fees. Check payment delays, rejected submissions, staff capacity, and whether costs are per review, per hour, or recurring.
A small pilot before a larger commitment
For example, reserve a pharmacist review block for a small set of assigned MTM opportunities. Track invitations, completed reviews, accepted submissions, actual payments, and total delivery hours separately. Expand only after you know your contract’s realized payment and your cost per accepted service.
An illustrative operating workflow. Agree on the exact roles, clinical protocol, records, and service scope before launch.
1
Confirm the opportunity
Pharmacy + plan or contractor
Check the patient’s plan assignment, service eligibility, whether the review is already completed, required deliverables, and the agreed fee. A customer who takes several medicines is not automatically an assigned MTM opportunity.
2
Book protected pharmacist time
Pharmacy; Interactly can assist scheduling
Invite the patient to a private in-person or permitted remote appointment. Ask them to bring every prescription, over-the-counter product, supplement, and medication concern. Administrative outreach is separate from the clinical review.
3
Review the whole medication picture
Qualified pharmacist
For a comprehensive medication review (CMR), speak with the patient, reconcile what they actually take, identify problems, and agree on next steps. A targeted medication review (TMR) focuses on a specific actual or possible medication problem.
4
Give a plan and contact prescribers
Pharmacist + responsible prescriber
Provide the required written medication list and action plan for the CMR. Send recommendations securely to the prescriber; medication changes follow the authorized clinician’s decisions and applicable pharmacist scope.
5
Follow through and submit
Pharmacy; agreed support team
Record the encounter, materials delivered, recommendations, responses, and follow-up. Submit through the sponsor’s specified system. Resolve missing information or rejected submissions under the contract.
6
Reconcile payment and workload
Pharmacy owner or billing lead
Match accepted services to actual remittances. Compare pharmacist time, outreach, documentation, platform charges, and PrimeVital fees with receipts. Use that result to decide whether to expand.
Your first step
Bring your existing MTM agreement and assigned service opportunities. If you have no agreement, ask the plan’s MTM team or its authorized service contractor about provider participation, credentialing, available opportunities, and payment terms. The pharmacy arranges its own MTM contract; PrimeVital does not supply that contract.
What a medical-practice partnership could look like
An illustrative alternative: a primary-care practice wants help with medication barriers for a patient with diabetes and high blood pressure. The practice assesses whether CCM and any separate RPM service are appropriate; your pharmacy agrees to a specific support role.
The practice enrolls and directs care. Its practitioner verifies eligibility, consent, existing services, and the care plan, and defines the pharmacist’s permitted role and applicable supervision. Home measurements are added only if a qualifying RPM service fits.
Your pharmacist does the agreed clinical work. Reconcile the medication information, discuss adherence barriers within scope, and send findings securely to the treating practice. The responsible clinician evaluates concerns and decides treatment changes. Record eligible work separately from dispensing, administrative messages, and any Part D-paid review.
The two organizations close different payment loops. The practice checks the complete clinical service and submits any supported claim. Your pharmacy submits its contractually agreed support records and invoice to the practice. Agree on that fee and its payment conditions before work starts.
Agree on responsibilities before the first patient starts.
Your organization
The qualified medication-review provider performs the review and routes clinical recommendations to prescribers. The pharmacy verifies sponsor eligibility, contract, protocol, and records.
PrimeVital’s agreed support
Interactly can provide agreed front-desk services. Medication-program outreach, records support, or care-team collaboration would be scoped with the pharmacy and its actual sponsor or treating-practice arrangement.
Service hours, professional qualifications, technology, integrations, records access, and fees are confirmed in the engagement. Front-desk automation handles agreed administrative tasks; clinical judgment and claims remain with the responsible qualified professionals.
WHAT YOU NEED TO DO
A practical launch checklist.
Verify sponsor selection and the actual MTM provider contract.
Confirm who performs the review, required materials, follow-up, and payment.
For a practice collaboration, identify the responsible clinician, clinical need, scope, supervision, and documentation.
Keep dispensing, plan MTM, clinical support, and administrative work distinct.
Agree on record access and secure prescriber handoffs.
Can I offer RPM, CCM, or PCM to my pharmacy customers?
You can explore a real clinical-support role with their treating practice. That practice must select eligible patients, own the plan, meet the program’s requirements, and provide the applicable supervision. A referral alone or permission to use a clinician’s NPI is not a service arrangement.
Does a medication reminder app qualify for RTM?
A reminder alone does not qualify. RTM needs a supported therapeutic domain, qualifying device or software, a treating and billing professional eligible for the service, and the required data and management work. Establish that pathway before buying technology.
What can PrimeVital help us start with?
We can map the workflow, scope outreach and records support, and use Interactly for agreed scheduling and messages. A medical-practice collaboration may include the agreed care team and applicable devices. The pharmacy supplies its MTM contract, qualified clinical services, and sponsor-approved submission process.
Agree on the measures that matter to your patients and team.
Completed eligible medication reviews
Medication issues resolved with prescribers
Patient understanding
Contract payments and delivery costs
Sources and scope
Reviewed October 7, 2026. Practice type alone does not establish clinical eligibility or payment. Detailed program pages maintain the code references; use the patient’s actual payer, professional, setting, and date of service.
Share your practice type, patient group, payer mix, and current team. We can map the care pathway, available support, launch gaps, and assumptions to verify.
