Jeroen van de Pol

170 Chapter 6 The current community pharmacy reimbursement model is based primarily on the dispensing of medicines [60]. This foundation probably also (partly) explains current time-utilization, as discussed in chapter 2.1 and 2.2. Based on data from 2019, only 1% of community pharmacy revenues were generated by providing CPS [65]. This result has two possible reasons: community pharmacists rarely perform CPS-related activities or community pharmacists are not (sufficiently) reimbursed for CPS. Chapter 2.1 suggests that community pharmacists spend 15% of their time on CPS but only receive 1% of their funding for these services, suggesting the latter is true. A lack of (sufficient) reimbursement has also been stated as the primary reason for the lack of CPS focus by the Royal Dutch Pharmacists Association [66]. This result was also found in a report revealing that CPS provided by community pharmacists received lower reimbursement than other healthcare professionals offering similar services [52]. In addition to the reimbursement barrier, other financial factors may hinder implementation of CPS [66]. First, by paying the community pharmacy primarily to dispense medication, the general public views the community pharmacist mostly as a dispenser and is less receptive to CPS provision by community pharmacists. This perception affects the opportunity for community pharmacists to focus on CPS provision. Secondary, healthcare insurers are primarily focused on paying for dispensing because dispensing (i.e., accessibility to medicines for the general public) is the only Dutch government requirement they have to meet. Thirdly, the current reimbursement model is volume driven and not focused on adding value to healthcare. However, for the patient’s benefit, it is sometimes desirable to stop certainmedication and thereby reduce volume. In the current system, pharmacists who help patients discontinue treatment are not reimbursed for their help and concomitantly miss their dispensing fee. Thus, this reimbursement model does not stimulate large-scale deprescribing of medication. The current volume driven reimbursement model can act as a barrier regarding collaboration with GPs and other healthcare professionals (as they can also see the community pharmacists as volume driven healthcare providers) [67]. Also, the current reimbursement model stimulates dispensing and not the provision of CPS, motivating community pharmacists to increasedispensing andorganize itmore efficiently (e.g., automated medicine dispensing machines instead of a pharmacy technician at the counter). This practice may render the profession less attractive for recently graduated pharmacy students who have actually been trained to focus predominantly on CPS and lead to shortages in the community pharmacy workforce. TheGP reimbursementmodel couldprovide inspiration for a revised reimbursement model for community pharmacy practice. This model consists predominantly of two elements: capitation (standard fee per patient per time period) and a fee per activity performed. In addition, a smaller amount of revenue can be generated via integrated