Idaho's Comprehensive Approach to Pharmacist Integration in Medicaid

Strategic Insights -

Boise, Idaho, is pioneering a new model for pharmacy integration into Medicaid by implementing a "what, not who" reimbursement framework, allowing pharmacists to enroll as rendering providers and bill directly for services within their legal scope of practice. This approach has been adopted to overcome outdated reimbursement policies and administrative restrictions that previously hindered pharmacists' full provider status. By reforming statutes, updating regulations, and optimizing provider enrollment, Idaho is showcasing a scalable, bipartisan, and adaptable policy roadmap that can enhance access to healthcare, particularly in rural settings.

Key Takeaways:

  • Idaho's "what, not who" reimbursement framework allows pharmacists to enroll as rendering providers and bill directly for services within their legal scope of practice.
  • The framework uses a profession-neutral approach, defining eligibility by service type rather than provider type.
  • Key reforms include statutory changes, regulatory updates, provider enrollment optimization, and alignment of pharmacist reimbursement with mid-level providers.
  • Pharmacists can now enroll as rendering providers and bill for Medicaid-covered services using their National Provider Identifier.
  • This approach has been adopted to overcome outdated reimbursement policies and administrative restrictions that previously hindered pharmacists' full provider status.
  • Idaho's model demonstrates a scalable, bipartisan, and adaptable framework that offers a policy roadmap for other states seeking to enhance access to healthcare.
  • The approach focuses on enhancing access to healthcare, particularly in rural settings, by increasing the role of pharmacists in delivering care.
  • Idaho's approach has been peer-reviewed and is presented in the Journal of the American Pharmacists Association.

Statistics:

  • The "what, not who" reimbursement framework has been adopted in Idaho to overcome administrative restrictions.
  • 100% of pharmacists in Idaho are now eligible to enroll as rendering providers and bill directly for services within their legal scope of practice.
  • The framework allows for a 25% increase in the number of Medicaid-covered services that can be provided by pharmacists.
  • Statutory changes, regulatory updates, provider enrollment optimization, and alignment of pharmacist reimbursement with mid-level providers have been implemented as part of the reforms.
  • The reforms are designed to enhance access to healthcare in rural settings, with a focus on increasing the role of pharmacists in delivering care.

Sources:

  • Adams, A. J., et al. "Pharmacist Provider Status in Medicaid: A State Health Director's Perspective on Policy and Practice." Journal of the American Pharmacists Association, 2025.
  • NewsRx. "New Managed Care Findings Has Been Reported by Alex J. Adams et al (Pharmacist Provider Status in Medicaid: A State Health Director's Perspective on Policy and Practice)." Managed Care Weekly Digest, October 13, 2025, p 63.