UPMC Health Plan


Denise Hughes
UPMC Health Plan

UPMC for You and PA Pharmacists Care Network Partnership Expands: Medicaid Members Now Receive Diabetes and Social Determinants-Related Services in Community Pharmacies

Participating pharmacists will be paid for providing additional clinical services

Pittsburgh (Aug. 29, 2023) – UPMC Health Plan and Pennsylvania Pharmacists Care Network (PPCN) today announced that their "whole person-focused" partnership has added diabetes and social determinants of health-(SDoH) related screenings and services. The expanded partnership will make these additional clinical services available to UPMC for You Medicaid members at the pharmacy counter. Through the partnership, PPCN community pharmacists are reimbursed for delivering these and other services to patients at their pharmacies.

"The expansion of our successful, collaborative approach builds on our commitment to reach people where they are and to support community pharmacists, who are frontline health providers for many of our most vulnerable Medicaid members," said Chronis Manolis, RPh, Chief Pharmacy Officer at UPMC Health Plan. "This is a good example of a value-based reimbursement model where we can leverage the clinical expertise of community pharmacists to address two health care issues that impact health quality and costs: diabetes and impacts from health inequity."

The newly expanded program augments the existing asthma and COPD (chronic obstructive pulmonary disease) screening service, which was created in 2021 and originally focused on comprehensive care planning and increased coordination of care for members of UPMC for You, a Medicaid managed care plan offered by UPMC, with respiratory diseases. By adding diabetes managing as a clinical service, pharmacists in the network will provide educational materials and make clinical recommendations on appropriate nutrition, medication administration, and ongoing diabetes management to UPMC for You members who fill a diabetes medication at one of their participating network pharmacies. Throughout this program expansion, PPCN pharmacists will be able to develop care plans related to diabetes care, including assessing diabetes control, while collaborating with UPMC for You's pharmacists and care management teams to make additional disease-state and lifestyle program referrals and create feedback mechanisms.

Additionally, UPMC for You has continued their commitment to health equity in the community by adding on services to allow PPCN pharmacists to administer screenings for social determinants of health factors and refer members to resources offered in the community or by UPMC Health Plan to address individual needs. This additional service is an extension of the work the UPMC Health Plan pharmacy team is doing, which has embedded clinical pharmacists into care teams since 2012 and supported clinical pharmacists to offer SDoH screening for members during their outreach.

"Our PPCN pharmacies have a proven ability to provide SDoH screenings and referrals along with disease-state management services in collaboration with care teams across numerous settings," said Brandon Antinopoulos, PharmD, President and Chief Operating Officer at PPCN. "Our pharmacies go above and beyond to identify patients' needs that keep them from effectively managing their chronic conditions and connect them with resources to meet those needs so they can focus on their health, manage their chronic conditions, and improve health outcomes. We are excited for the continued partnership with UPMC Health Plan that recognizes our community pharmacists as clinical care providers to their UPMC for You members through these expanded services."


About PPCN

The Pennsylvania Pharmacists Care Network (PPCN), a CPESN® USA network, is a clinically integrated network of over 200 community pharmacies in Pennsylvania that provide enhanced patient care services and work to advance community-based pharmacy practice. In collaboration with payers and providers, PPCN pharmacists provide high quality medication management services to patients ensuring appropriate medication use and improved health outcomes. PPCN is a service of the Pennsylvania Pharmacists Association (PPA), the state's leading voice for advocating the profession of pharmacy and advancing the quality of patient care.


CPESN® USA is a clinically integrated, nationwide organization of pharmacy networks organized to advance community-based pharmacy practice. CPESN® Networks empower community-based pharmacies that are deeply rooted within their community by fostering their ability to provide high quality, patient-centered enhanced services. CPESN® pharmacies integrate with the other providers on the patient’s care team and coordinate medical treatment which has led to better medication adherence, higher patient satisfaction, and lower healthcare costs. You can now find CPESN® Networks of pharmacy providers in 42 states across America. To learn more, please visit cpesn.com.

About UPMC Insurance Services

UPMC Insurance Services serves nearly 4.5 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. UPMC Insurance Services provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers' compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); special needs plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children's Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation's largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.