No Payment, No Program: What the 2025 Medicaid Summit Means for Pharmacy-Based OUD Treatment

Community pharmacists are ready to help close the treatment gap for opioid use disorder. Ninety percent of Americans live within five miles of a pharmacy, and evidence supports pharmacist-delivered buprenorphine as a viable pathway to expand access to lifesaving care. But readiness alone isn't enough — pharmacists need to be paid for the clinical services that make OUD treatment sustainable.

That's why the findings from the first national Invitational Summit on Medicaid Payment for Pharmacist Clinical Services, published in the Journal of the American Pharmacists Association, matter directly for the future of pharmacy-based addiction care.

The Payment Problem

Pharmacists still aren't recognized as providers under federal Medicare law, and Medicaid payment structures for pharmacist-led clinical services remain inconsistent across states. As of mid-2025, 44 states have introduced bills related to pharmacist scope or payment, but only 12 states have signed any into law. For pharmacies considering launching a buprenorphine program, the question isn't just "Can we do this clinically?" — it's "Can we afford to?"

What Leading States Have Learned

The summit brought together nearly 200 stakeholders from all 50 states, including Medicaid administrators and pharmacy leaders. States at the forefront of reform — Idaho, Minnesota, Wisconsin, Pennsylvania, Washington, and Virginia — pointed to three pillars that determine whether payment systems actually work in practice:

Infrastructure. Credentialing pathways, billing platforms, and clinical workflows must be built before pharmacists can realistically bill for services. Pennsylvania constructed a 200+ pharmacy care network and secured over 30 managed care contracts before pursuing formal Medicaid recognition. Without this groundwork, even strong legislation stalls — exactly the kind of delay that pharmacy-based OUD programs cannot afford.

Collaboration. Every successful state emphasized partnerships across pharmacy associations, Medicaid agencies, managed care organizations, medical societies, and legislators. Wisconsin engaged its medical society before introducing legislation, reducing opposition. Virginia enlisted physician champions. These coalition-building strategies are directly applicable to advancing pharmacy-delivered buprenorphine at the state level.

Time. Minnesota's pharmacist payment system evolved over nearly two decades. Wisconsin saw over 400 claims in its first four months after launching in 2024 — a strong start, but a reminder that operationalization takes patience and phased planning.

Why This Matters for Buprenorphine Access

For community pharmacies to serve as access points for OUD treatment, clinical service payment must be part of the equation. A pharmacy that can prescribe or dispense buprenorphine but can't bill Medicaid for the associated clinical assessments, counseling, and care coordination faces a financial model that simply doesn't work — especially in the rural and underserved communities where both pharmacy closures and overdose deaths are concentrated.

The summit's takeaways offer a roadmap: separate scope-of-practice from payment legislation, align pharmacist credentialing with other mid-level providers, invest in billing toolkits and training, and build multi-stakeholder coalitions early.

What You Can Do

Clinicians: Explore your state's Medicaid billing pathways and connect with your state pharmacy association for credentialing support. Legislators: Ensure that scope-of-practice expansions are paired with payment infrastructure so new authorities translate into real patient access.

Payment is the bridge between policy and practice. Without it, pharmacy-based OUD treatment remains a promise instead of a reality.