美国可收费药学服务项目及收费实践

杨莉榕; 刘思雨; 吴舒珊

doi:10.6039/j.issn.1001-0408.2025.10.02

您当前的位置：

首页 >

文章列表页 >

美国可收费药学服务项目及收费实践

药事管理 | 更新时间：2025-05-23

- 美国可收费药学服务项目及收费实践
- Practice of billable pharmacy service programs and billing in the United States
- 中国药房 2025年36卷第10期页码：1161-1165
- 作者机构：
  
  1.上海交通大学医学院附属仁济医院药学部，上海　200127
  2.美国佛蒙特大学医学中心，美国佛蒙特　05401
  3.北京大学药学院药事管理与临床药学系，北京　100191
- 作者简介：
  
  药师，博士。研究方向：临床药学、药事管理。E-mail：lirongyang950@163.com
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2025.10.02
  中图分类号： R951
- 收稿日期：2024-12-06，
  
  修回日期：2025-04-02，
  
  录用日期：2025-04-17，
  
  纸质出版日期：2025-05-30
- 稿件说明：
移动端阅览
杨莉榕,刘思雨,吴舒珊.美国可收费药学服务项目及收费实践[J].中国药房,2025,36(10):1161-1165.

YANG Lirong,LIU Siyu,WU Shushan.Practice of billable pharmacy service programs and billing in the United States[J].ZHONGGUO YAOFANG,2025,36(10):1161-1165.
杨莉榕,刘思雨,吴舒珊.美国可收费药学服务项目及收费实践[J].中国药房,2025,36(10):1161-1165. DOI： 10.6039/j.issn.1001-0408.2025.10.02.

YANG Lirong,LIU Siyu,WU Shushan.Practice of billable pharmacy service programs and billing in the United States[J].ZHONGGUO YAOFANG,2025,36(10):1161-1165. DOI： 10.6039/j.issn.1001-0408.2025.10.02.

摘要

目的

介绍美国可收费药学服务项目特点及实践情况，为我国开展临床药学服务并制定相应的收费标准提供参考。

方法

检索美国药师协会、美国医疗系统药师协会、美国联邦医疗保险和辅助服务中心、美国疾病控制与预防中心官方网站和PubMed数据库，总结美国可收费药学服务项目的服务内容、收费标准、药师获取服务费的方式及临床实践证据。

结果

美国可收费药学服务项目主要包括药物治疗管理、门诊药学服务、过渡医疗管理、慢病管理、年度健康检查、糖尿病自我管理培训与教育。除糖尿病自我管理培训与教育缺乏可靠的实践证据外，其余项目均有证据表明其对患者结局产生了积极影响，能节约医疗费用和（或）带来经济收益。药师最常见的获取服务费的方式为“incident to”和使用程序代码。

结论

美国的药学服务项目正逐步实现专业化和收费标准化。我国可借鉴其成功经验，结合国情，以提升患者整体健康结局为目标，促进药学服务成为医疗服务体系的重要组成部分。

Abstract

OBJECTIVE

To introduce the characteristics and practice of billable pharmacy service programs in the United States， aiming to provide reference for the development of clinical pharmacy service and the establishment of corresponding billing criteria in China.

METHODS

By searching the official websites of American Pharmacists Association， American Society of Health-System Pharmacists， Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention， and the PubMed database， the contents of American billable pharmacy service programs， corresponding service billing criteria， the approaches to being paid as pharmacists and the clinical practice evidence were summarized.

RESULTS

Current major billable pharmacy service programs implemented in the United States included medication therapy management， outpatient pharmacy service， transition of care management， chronic disease management， annual wellness visits， as well as diabetes self-management training/education. Except for diabetes self-management training/education， which lacked robust data on practice outcomes， all other programs mentioned above were demonstrated to have positive impact on patient outcomes， reducing health care cost and/or generating revenues. The most common approaches for pharmacists to obtain reimbursement were “incident to” billing and using procedure codes.

CONCLUSIONS

Billable pharmacy practice programs in the United States are achieving progress in service specialization and billing standardization. China can learn from successful cases in the United States while considering its own national context， with the ultimate goal of improving the overall health outcomes of patients， so that pharmacy services can become an important part of the medical service system.

关键词

Keywords

references

BINGHAM J ， SCOVIS N ， TAYLOR A M ， et al . Past，pre-sent，and continued need for provider status legislation：navigating clinical practice with significant sustainability barriers [J ] . J Am Coll Clin Pharm ， 2018 ， 1 （ 1 ）： 32 - 37 .

MEGELLAS M M . Medicare modernization：the new prescription drug benefit and redesigned Part B and Part C [J ] . Proc（Bayl Univ Med Cent）， 2006 ， 19 （ 1 ）： 21 - 23 .

GAFFNEY A ， MCCORMICK D . The Affordable Care Act：implications for health-care equity [J ] . Lancet ， 2017 ， 389 （ 10077 ）： 1442 - 1452 .

PIPER L E . The Affordable Care Act：the ethical call for value-based leadership to transform quality [J ] . Health Care Manag（Frederick）， 2013 ， 32 （ 3 ）： 227 - 232 .

American Pharmacists Association . Successful integration of pharmacists in accountable care organizations and medical home models：case studies [EB/OL ] .（ 2020-03-01 ）[ 2025-01-02 ] . https：//www.pharmacist.com/Portals/0/PDFS/Practice/APhA_Medical_Home_ACO_Report_Final.pdf？ver=0vbHcscSN_2-3x3UmFLZ5Q%3D%3D https://www.pharmacist.com/Portals/0/PDFS/Practice/APhA_Medical_Home_ACO_Report_Final.pdf?ver=0vbHcscSN_2-3x3UmFLZ5Q%3D%3D .

National Council for Prescription Drug Programs . Billing guidance for pharmacists’ professional and patient care services：version 2.0 [EB/OL ] .（ 2018-06-01 ）[ 2025-01-02 ] . https：//www.ncpdp.org/NCPDP/media/pdf/WhitePaper/Billing-Guidance-for-Pharmacists-Professional-and-Patient-Care-Services-White-Paper.pdf?ext=.pdf https://www.ncpdp.org/NCPDP/media/pdf/WhitePaper/Billing-Guidance-for-Pharmacists-Professional-and-Patient-Care-Services-White-Paper.pdf?ext=.pdf .

Centers for Medicare & Medicaid Services . MLN matters [EB/OL ] .（ 2016-8-24 ）[ 2025-01-02 ] . https：//www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE0441.pdf https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE0441.pdf .

American Pharmacists Association . Billing primer A pharmacist’s guide to outpatient fee-for-service billing [EB/OL ] .（ 2019-08-01 ）[ 2025-01-02 ] . https：//www.pharmacist.com/Practice/Practice-Resources/Billing-Payment-Center https://www.pharmacist.com/Practice/Practice-Resources/Billing-Payment-Center .

American Pharmacists Association . Delivering medication therapy management services [EB/OL ] .（ 2024-07-03 ）[ 2025-01-02 ] . https：//www.pharmacist.com/Education/Certificate-Training-Programs/Medication-Therapy-Management https://www.pharmacist.com/Education/Certificate-Training-Programs/Medication-Therapy-Management .

FERRIES E ， DYE J T ， HALL B ， et al . Comparison of medication therapy management services and their effects on health care utilization and medication adherence [J ] . J Manag Care Spec Pharm ， 2019 ， 25 （ 6 ）： 688 - 695 .

Centers for Disease Control and Prevention . Evidence of impact for community pharmacists and medication therapy management [EB/OL ] .（ 2023-03-02 ）[ 2025-01-02 ] . https：//hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Community-Pharmacists-and-Medication-Therapy-Management https://hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Community-Pharmacists-and-Medication-Therapy-Management .

Centers for Disease Control and Prevention . Collaborative practice agreements and pharmacists’ patient care services [EB/OL ] .（ 2013-06-27 ）[ 2025-01-02 ] . https：//www.cdc.gov/dhdsp/pubs/docs/Translational_Tools_Pharmacists.pdf https://www.cdc.gov/dhdsp/pubs/docs/Translational_Tools_Pharmacists.pdf .

Centers for Disease Control and Prevention . Evidence of impact for collaborative drug therapy management [EB/OL ] .（ 2024-11-09 ）[ 2025-01-02 ] . https：//hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Collaborative-Drug-Therapy-Management https://hdsbpc.cdc.gov/s/article/Evidence-of-Impact-for-Collaborative-Drug-Therapy-Management .

American Society of Health-System Pharmacists . Billing for transitional care management services [EB/OL ] .（ 2018-06-01 ）[ 2025-01-02 ] . https：//www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/tran-sitional-care-management-codes.ashx?la=en&hash=668D50-A1EC1C57494BF81333FB63402A5C12A325 https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/tran-sitional-care-management-codes.ashx?la=en&hash=668D50-A1EC1C57494BF81333FB63402A5C12A325 .

MERCURO N J ， MEDLER C J ， KENNEY R M ， et al . Pharmacist-driven transitions of care practice model for prescribing oral antimicrobials at hospital discharge [J ] . JAMA Netw Open ， 2022 ， 5 （ 5 ）： e2211331 .

American Society of Health-System Pharmacists . FAQ：chronic care management and principal care management [EB/OL ] .（ 2024-10-01 ）[ 2025-01-02 ] . https：//www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/chronic-care-management-faq.ashx https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/chronic-care-management-faq.ashx .

MCCARTHY C ， Jr THOMAS BATEMAN M . Impact of pharmacist-led chronic disease management in a Federally Qualified Health Center [J ] . J Am Coll Clin Pharm ， 2022 ， 5 （ 12 ）： 1263 - 1277 .

MARTIN R ， TRAM K ， LE L ， et al . Financial performance and reimbursement of pharmacist-led chronic care mana-gement [J ] . Am J Health Syst Pharm ， 2020 ， 77 （ 23 ）： 1973 - 1979 .

HOHMANN L A ， HASTINGS T J ， QIAN J J ， et al . Medicare annual wellness visits：a scoping review of current practice models and opportunities for pharmacists [J ] . J Pharm Pract ， 2020 ， 33 （ 5 ）： 666 - 681 .

MOFFATT E K ， WARGO R ， JOHNSON C ， et al . Comparative performance of annual wellness visits between pharmacists and physicians at primary care clinics [J ] . J Am Coll Clin Pharm ， 2021 ， 4 （ 12 ）： 1524 - 1533 .

ALHOSSAN A ， KENNEDY A ， LEAL S . Outcomes of annual wellness visits provided by pharmacists in an accountable care organization associated with a federally qualified health center [J ] . Am J Health Syst Pharm ， 2016 ， 73 （ 4 ）： 225 - 228 .

Centers for Disease Control and Prevention . Approaches to increasing access to and participation in diabetes self-management education [EB/OL ] .（ 2016-09-01 ）[ 2025-01-02 ] . https：//www.cdc.gov/diabetes/pdfs/programs/stateand-local/emerging_practices-increasing_dsme.pdf https://www.cdc.gov/diabetes/pdfs/programs/stateand-local/emerging_practices-increasing_dsme.pdf .

GAWLIK G ， NGUYEN E ， ROBINSON R . Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support [J ] . J Am Pharm Assoc （2003）， 2023 ， 63 （ 1 ）： 74 - 79 .

American Society of Health-System Pharmacists . Alternatives to incident to billing for revenue generation in non-facility ambulatory clinics [EB/OL ] .（ 2019-03-01 ）[ 2025-01-02 ] . https：//www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/alternatives-to-incident-to-billing-2019.ashx?la=en&hash=0A941EB2C-12D4474005A59AB3A12E800C98BB5F9 https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/alternatives-to-incident-to-billing-2019.ashx?la=en&hash=0A941EB2C-12D4474005A59AB3A12E800C98BB5F9 .

VASCIMINI A ， SABA Y ， BASKHAROUN F ， et al . Pharmacist-driven continuous glucose monitoring in community and ambulatory care pharmacy practice：a scoping review [J ] . J Am Pharm Assoc （2003）， 2023 ， 63 （ 6 ）： 1660 - 1668 .

KLEPSER M E ， ADAMS A J ， SRNIS P ， et al . U.S. community pharmacies as CLIA-waived facilities：prevalence，dispersion，and impact on patient access to testing [J ] . Res Social Adm Pharm ， 2016 ， 12 （ 4 ）： 614 - 621 .

HOOVER N D ， BRIGG TURNER R ， SAMPSON J ， et al . Financial sustainability of an Oregon rural health，primary care，and pharmacist-run comprehensive medication mana-gement program through direct medical billing [J ] . J Manag Care Spec Pharm ， 2020 ， 26 （ 1 ）： 30 - 34 .

闫婷，伍琳，熊抚辰，等 . 医疗机构药学服务收费政策落地的关键挑战及优化策略 [J ] . 卫生经济研究， 2025 ， 42 （ 3 ）： 51 - 54，58 .

杜姗，李晋奇，杨勇，等 . 我国药学服务收费探索与现状分析 [J ] . 医药导报， 2024 ， 43 （ 9 ）： 1398 - 1404 .

钟安妮，罗俊，蒋文硕，等 . 全国新增和（或）修订药学服务收费项目分析与研究 [J ] . 临床药物治疗杂志， 2025 ， 23 （ 2 ）： 45 - 52 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

中美两国GMP认证体制比较研究

中美两国药品安全监管体制的比较研究

美国医院药学部门学习见闻

美国临床药学的发展与实践

智能药柜在美国医院的应用概况及在我国的发展