In July, CMS launched ACCESS, a 10-year Medicare model that pays organizations to manage chronic conditions through technology-supported care. More than 160 organizations are now participating. The headline rate is up to $420 per patient per year for the cardio-kidney-metabolic track.
It sounds like a major opportunity. And it might be (eventually), for the right organization. But read past the headline numbers.
If you’re a NCPA/CPESN member, you now have a way in. In September, NCPA opened enrollment to ACCESS to Pharmacy Care, run by CPESN in partnership with GamePlan Medical. GamePlan is the CMS participant: it holds the $420 payments, the physician oversight and the CMS reporting. The pharmacy works as a co-manager. It refers patients, helps collect baseline labs and vitals, and supports their care each month. To qualify, a pharmacy needs 30% of its patients on med sync, or it can enroll in NCPA’s Med Sync Fellowship.
Here’s what the pharmacy can bill. Each time it reviews a patient’s care update and takes a coordination step, such as a med rec, a provider call or a change to monitoring, it can bill Medicare $30. That’s allowed up to three times a year per condition track, plus a one-time $10 for onboarding. NCPA estimates this at about $150 per patient in year one for the average patient. These billing codes aren’t tied to outcome targets. NCPA has also described additional outcome-based payments, but it hasn’t published how those are calculated or shared.
The catch is the operating rhythm. Pharmacies commit to delivering and documenting active care every month, but they can bill only three times a year. They also need a Medicare Part B billing number (PTAN) before they can bill at all, which costs $750 per location and takes 30–60 days. In addition, the pharmacy must cover the cost of the monitoring device(s). NCPA’s own presenters advise starting with one or two patients and building the work around med sync or appointment-based visits the pharmacy already runs.
For pharmacies with a strong med sync program and devoted clinical team, ACCESS to Pharmacy Care may be worth exploring. Go in with realistic expectations about the per-patient revenue and the monthly workload.
Medsense is built on a different model. The clinical infrastructure is already in place: physician oversight, patient outreach, billing and device management. Pharmacies go live within weeks and receive $25 per enrolled patient per month for each program. The rate is published and paid every month.
ACCESS is testing whether clinical monitoring in chronic disease management creates measurable value. Pharmacies already running that kind of program aren’t waiting for the answer.
NOTE: Program details as of Sept. 30, 2026. CMS has changed the model several times since launch.