Community Pharmacy Total Care
What if the local pharmacist could help improve care quality and reduce Medicaid costs?
With Community Pharmacy Total Care (CPTC) from CarelonRx, it’s possible. Through this program, we partner with CPESN® USA pharmacies in 12 states to support Medicaid members with complex health needs. Powered by Care Control, our real-time care platform, CPTC helps pharmacists close care gaps, improve medication adherence, and alert providers when follow-up is needed — enhancing health outcomes for members while delivering value to community pharmacies and state Medicaid programs.
Local care, national impact
CPTC combines the accessibility of neighborhood pharmacies with the scale and analytics of a national pharmacy benefit manager (PBM). According to internal CarelonRx data, the program’s reach and impact include:
- 500+ pharmacies in 12 states
- 12,000+ Medicaid members engaged
- 3,000+ HEDIS® gaps closed
Expanding access to pharmacy-centered care
When CarelonRx and community pharmacies work together, we deliver outcomes that neither of us could achieve alone.
The CPTC model is built on a curated, high-performing pharmacy network, real-time access to the Care Control platform, and personalized pharmacy care. Each of our 500 partner pharmacies meets rigorous clinical standards and plays an active role in care delivery, helping members improve adherence, avoid harmful interactions, and get the most from their medications.
By providing hands-on care and support across a broad range of health conditions, including asthma, chronic obstructive pulmonary disease (COPD), mental health, and opioid use disorders, these pharmacists help close critical care gaps while improving the member experience.
“As a neighborhood pharmacy deeply rooted in the Brooklyn community, CPTC has helped us go beyond simply filling prescriptions."
— Nostrand Pharmacy, Brooklyn, NY
Measurable improvements in quality and cost
Our data show that CPTC is driving meaningful improvements in both clinical quality and total cost of care:
- 6% to 11% rise in overall medication adherence
- 20% increase in statin therapy adherence for cardiovascular disease
- $1 million medical cost avoidance through HEDIS gap closures
We are also seeing reductions in avoidable medical utilization. CarelonRx data indicate that members who participate in CPTC experience:
- 30% drop in inpatient admissions
- 18% fewer emergency room visits
- 14% less visits to primary care
“With steep competition in getting patients, this program provides a seamless way to increase patient volume, coordinate and manage patient engagement, while giving valuable feedback on our performance. Additionally, it offers a positive financial return for the patient care we provide.”
— A-Class Pharmacy LLC, Pharr, TX
A collaborative path forward
As states continue to seek innovative ways to improve Medicaid outcomes while managing costs, pharmacy-centered care models offer a practical, scalable solution. By aligning incentives, equipping pharmacists with actionable data, and focusing on measurable outcomes, CPTC demonstrates how PBMs can partner across healthcare to strengthen quality, expand access, and reduce avoidable utilization.
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Ready to learn more?
We welcome the opportunity to discuss how Community Pharmacy Total Care can support Medicaid quality and cost goals.