Goodwill Is Not a Referral System in Independent Pharmacy

On September 1, NCPA announced the next phase of ACCESS to Pharmacy Care. A new Co-Management and Referral pathway is under development, one that would give community pharmacies a formal role in the CMS ACCESS care model for patients with Original Medicare. It's on the agenda at NCPA 2026 in Kansas City next month.

Add to that the collaborative practice agreements expanding state by state, the federal PBM reform and the state-level FAIR Rx laws separating PBM ownership from pharmacy control.

For years, independent pharmacies argued they were being locked out of the care ecosystem.

The door is opening and most independent pharmacies aren't ready to walk through it.

The False Comfort

Our prescribers know us, our patients love us, and our community already sees us as different, so when the referrals come, they'll come to us.

Some will but most won't.

Being eligible for referrals isn't the same as being chosen for them. Prescribers refer to who they remember, patients refer to who they feel comfortable naming, and care coordinators refer to whoever returned their call the same day. None of that is about your service, having a system is what matters.

The Diagnosis

Look at the last month in your pharmacy.

How many prescribers got a personal touch from you or your team? A voice on the phone, a hand-delivered note, a brief follow-up on a patient you both share. Faxes and portal messages don't count. How many patients and caregivers were asked, in a specific and low-pressure way, whether someone in their family should have the same relationship with a pharmacy? How many former patients got a reactivation contact this quarter?

For most independent pharmacies, the honest answer to all three is close to zero, and it isn't because the owner doesn't care. There's no system, so referrals get treated as something that happens to the pharmacy instead of something the pharmacy operates on a schedule.

That's referral leakage. Every week, referral opportunities pass through your pharmacy without conversion, and nobody in the building sees them go.

What Makes This Moment Different

The regulatory environment is turning, and each shift opens another channel through which patients could flow to your pharmacy.

It’s important to differentiate channels from customers.

A channel is a possibility, and a referral is a decision. Someone has to decide to send you the patient, and that decision goes to the pharmacy the prescriber can name from memory, the pharmacy the care coordinator has actually met, the pharmacy that made it easy to say yes.

If your pharmacy has no ritual for prescriber contact, no engagement with the caregiver conversation, and no scorecard tracking either one, the widening channels will flow right past you.

The Frame That Works

The pharmacies that turn this window into growth will have three things installed before they need them. A weekly cadence of prescriber contact, owned by a named team member rather than by whoever remembers. A referral prompt your staff can say out loud at real moments in the patient conversation, rather than a poster on the wall. And a Patient Connection Letter that reminds families you're still here, still useful, and still worth telling their sister about.

Behind those three sits a weekly scorecard that tracks prompts made, referrals started, and referrals received, so the leakage becomes visible instead of invisible.

None of this is a marketing campaign, it became a standard flow..

Lived Proof

In my own pharmacy, our best referral quarters were never the ones with the most creative promotion. They were the ones with the tightest cadence: a short weekly review, a clear scorecard, and a staff that knew the sentences to say and the moments to say them.

That rhythm produced referrals from prescribers we'd never asked directly, because their office staff had seen the follow-up on shared patients. It produced referrals from caregivers, because a Patient Connection Letter arrived the same week a family member asked about medication management. It produced referrals from patients, because the staff had a specific, respectful prompt they were comfortable using.

All of this became a system.

The Invitation

The care ecosystem is opening to independent pharmacy for the first time in a generation. That's worth celebrating, and it's also worth being honest about.

The pharmacies that convert this opening into actual referred patients over the next twelve months won't be the ones with the best reputation. They'll be the ones with the best system.

If you can't name who owns prescriber contact in your pharmacy this week, and you can't name how many referrals your team started last month, that's worth knowing before these pathways open. The Independent Pharmacy Growth Index shows you where your growth system is holding and where it's leaking, across referrals, retention, attraction, and the places opportunity passes through without anyone seeing it. It takes a few minutes, and it tells you the truth.

Mike Hodges

Founder, Pharmacy Breakthroughs Mastermind

Former independent pharmacy owner