AlignRx Diversified Revenue Tip of the Month

Earning Potential: Up to $115 per patient per year.
A pharmacy with 50 eligible patients completing half of their interventions could receive $2,500 to $5,000 in added revenue

Measures Evaluated: Diabetes PDC, RASA PDC, Cholesterol PDC, Statin Use in Persons with Diabetes (SUPD), Statin Use in Persons with Cardiovascular Disease (SPC)
Encounter Types and Potential Payouts:

Encounter Type	Payment Amount	Frequency/Availability	Notes
Quarterly Check-in (per measure)	$10	Up to 3 per patient/year	Check-in 1: Apr-Jun 2025 Check-in 2: Jul-Sep 2025 Check-in 3: Oct-Dec 2025
Extended Day Supply Conversion (per measure)	$10*	Up to 1 per patient/measure/year
Final Fill Intervention	$60*	Available late Sept–Dec 2025
SUPD Gap Intervention	$60*	Up to 1 conversion per patient	Diabetic patients with statin prescribed, filled, and picked up.
SPC Gap Intervention	$60*	Up to 1 conversion per patient	Statin prescribed, filled, and picked up. Moderate or high intensity is required.
SPC Intensity Conversion	$60*	Up to 1 conversion per patient	Patient on low-intensity statin. Converted to moderate/high intensity statin (prescribed, filled, and picked up).
	*Requires claims validation

Earning Potential: Varies by pharmacy and is based on patient volume and performance tier.
- Pharmacies with a high volume of Humana MAPD patients can potentially earn a payout of tens of thousands of dollars or higher.
Measures Evaluated: Diabetes PDC (non-insulin), Cholesterol PDC (statins), RASA PDC
Payout Details & Eligibility:
- Payouts are earned at the individual measure level, occurring once a year based on calendar year 2025 performance.
- Payouts will be based on January through December 2025 data available in EQUIPP with the February 2026 data refresh.
- To be eligible for a payout, pharmacies must have at least 10 patients in a measure.
- Reaching the 65th percentile in performance for a measure earns a partial payout, while reaching the 75th percentile for a measure earns a full payout.

Earning Potential: Varies by pharmacy and is based on patient volume and performance tier.

- Pharmacies with a high volume of Centene Medicare patients can potentially earn a payout of thousands of dollars or higher.
Payouts will be based on January through December 2025 data available in EQUIPP with the February 2026 data refresh.
Consists of Two Parts: Formulary Adherence and Quality Measure Performance

- Formulary Adherence: 2 payout opportunities during the year with the opportunity to earn bonus payments through achieving set market share adherence scores for a variety of drug classes. See the program guide or log into EQUIPP for full list of included medications
- Quality Measure Performance: one payout opportunity based on calendar year performance. Pharmacies can earn payouts by achieving set performance goals for the following measures: Cholesterol PDC, Diabetes PDC, RASA PDC, SUPD

For more details, including specific performance goals and payout amounts, log in to EQUIPP and review the program dashboard in My Programs.

Earning Potential: Payment amounts vary by plan sponsor though are typically around $60 for a CMR and wide range for TIPs. Successfully completed TIPs typically range from $5 up toward $100.
Plan sponsors are offering several high-reimbursement TIPs in Q4 including health test TIPs—measuring A1C or BP and bonus payments for some adherence TIPs if the patient achieves adherence (at least 80% PDC) before the end of the year. Health test TIP payments vary by payor but typically pay $40 for a BP measurement and $50 for A1C measurement.
Multiple TIP types can be completed by pharmacy technicians.

Log in to Outcomes to get started and review your pharmacy’s current opportunity counts and revenue in Clinical Connection.

Clinical Connection