For decades, the traditional retail pharmacy business model has relied primarily on prescription volume, reimbursement margins, front-end sales, and relationships with healthcare providers.

That model continues to face significant financial pressure.

Independent pharmacies must navigate pharmacy benefit manager contracts, reimbursement uncertainty, rising payroll expenses, inventory costs, and growing administrative requirements.

Many pharmacy owners respond by attempting to increase prescription volume, negotiate better purchasing arrangements, expand delivery services, or introduce new revenue streams.

Those strategies can be valuable.

But another opportunity deserves serious consideration: Remote Patient Monitoring (RPM) and Chronic Care Management (CCM).

These services allow healthcare teams to support patients between traditional office visits, creating opportunities for ongoing clinical engagement and recurring reimbursement.

For independent pharmacies, the opportunity is not simply to sell connected medical devices or enroll patients in a monthly program.

It is to become a meaningful participant in coordinated healthcare delivery.

For Ramin Faramarzifar, founder of Rombool Group, this represents an important area for pharmacy owners to investigate when evaluating profitability, operational diversification, and long-term business value.

With more than 25 years of experience in pharmacy operations, Faramarzifar has worked with retail pharmacy, compounding, long-term care services, acquisitions, and business consolidation.

His broader business philosophy emphasizes understanding the profitability of each service line and developing revenue sources that are sustainable rather than dependent on a single product or reimbursement category.

What Is Remote Patient Monitoring?

Remote Patient Monitoring, commonly abbreviated RPM, is a healthcare service that uses connected medical devices to collect and transmit patient health information outside a traditional clinical setting.

Instead of relying exclusively on readings obtained during office visits, a healthcare team can review information collected while a patient is at home.

Examples of monitored information include blood pressure, body weight, and certain other physiologic measurements.

A patient with hypertension, for example, may use a connected blood pressure monitor that automatically transmits readings to a clinical platform.

The healthcare team can review those readings, identify concerning trends, communicate with the patient, and determine whether further evaluation or treatment changes are appropriate.

RPM is not simply a technology subscription.

It is a clinical service that must be medically necessary, appropriately supervised, documented, and furnished according to payer requirements.

Why RPM May Be Relevant to Community Pharmacies

Independent pharmacies already interact with patients who have chronic medical conditions.

Pharmacists routinely counsel patients receiving medications for hypertension, diabetes, cardiovascular disease, and other conditions.

They may identify adherence problems, answer medication questions, coordinate refills, and communicate with prescribers.

These existing relationships can make pharmacies valuable participants in remote monitoring programs.

However, participation must be structured within applicable professional scope, supervision, contracting, and billing requirements.

A traditional pharmacy’s ability to furnish clinical support does not automatically mean it can independently bill Medicare for RPM.

What Is Chronic Care Management?

Chronic Care Management, or CCM, is a Medicare-covered service designed to support eligible patients living with multiple chronic conditions.

Under CMS requirements, qualifying patients generally have at least two chronic conditions expected to last 12 months or longer, or until death, and those conditions place the patient at significant risk of adverse health outcomes or functional decline.

Examples may include hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, and other chronic conditions.

CCM involves coordinated care outside conventional office visits.

Services may include medication reconciliation, care-plan coordination, communication with healthcare providers, patient follow-up, and other qualifying clinical activities.

A comprehensive care plan and appropriate documentation are central to the program.

Why Pharmacies May Be Well Positioned to Participate

Medication management is a major component of chronic disease care.

A patient taking numerous prescriptions may benefit from medication reconciliation, adherence support, coordination among specialists, and communication with the prescribing practitioner.

Community pharmacists often have frequent contact with these patients.

This can create opportunities to participate in CCM programs operated by eligible billing practitioners.

Under Medicare rules, pharmacists may provide qualifying services as auxiliary personnel under appropriate incident-to arrangements, subject to applicable supervision, scope-of-practice, and billing requirements.

The eligible physician or other qualified practitioner generally remains responsible for billing the CCM service.

RPM vs. CCM: Understanding the Difference

Although RPM and CCM are related, they are not interchangeable.

RPM focuses on collecting and clinically managing physiologic data transmitted through connected devices.

CCM focuses on ongoing care coordination for patients with multiple qualifying chronic conditions.

For example, a patient with hypertension and diabetes may receive CCM services involving medication review, care-plan coordination, and communication with providers.

The same patient might also receive medically necessary RPM services using a connected blood pressure monitor.

Certain RPM and CCM services may be furnished during the same period when all requirements are satisfied.

However, the same clinical work or staff time cannot be counted twice.

Pharmacies considering these programs must understand the distinction before developing operational workflows or projecting reimbursement.

Why Monthly Recurring Revenue Is Attractive to Pharmacy Owners

Traditional retail pharmacy revenue is transaction-driven.

A prescription must be dispensed, adjudicated, and reimbursed.

Profitability depends on acquisition costs, dispensing expenses, reimbursement, and prescription volume.

Clinical service programs can introduce a different revenue pattern.

When eligible patients receive qualifying services month after month, the billing practitioner may receive recurring reimbursement.

A pharmacy participating under an appropriate service agreement may, in turn, earn recurring compensation for legitimately furnished clinical support.

This creates the possibility of a more predictable service revenue stream.

But recurring revenue should not be confused with guaranteed revenue.

Patients may discontinue participation, fail to meet eligibility requirements, stop using devices, change providers, or no longer require a particular service.

Claims may also be denied or adjusted.

A responsible pharmacy business plan should model actual service utilization and collections rather than assuming every enrolled patient generates the maximum possible payment every month.

The Most Practical Business Model: Partnering With Physicians

For many independent retail pharmacies, the most realistic approach is a collaborative relationship with an eligible medical practice.

A physician, nurse practitioner, or other qualified billing practitioner may establish an RPM or CCM program for eligible patients.

The pharmacy may support appropriate portions of that program through a properly structured agreement.

Potential activities may include patient education, medication reconciliation, adherence support, device onboarding, permitted monitoring support, and communication with the medical team.

The exact activities depend on applicable law, clinical staff qualifications, supervision requirements, and contractual responsibilities.

How a Pharmacy–Medical Practice Relationship Might Work

Consider a primary care practice with a substantial population of patients managing hypertension, diabetes, and cardiovascular conditions.

The practice wants to improve follow-up and care coordination between appointments.

A community pharmacy already serving many of those patients may have trained pharmacists, established communication channels, and experience with medication management.

The parties could evaluate a formal arrangement under which the pharmacy provides specified support services.

The billing practitioner would remain responsible for applicable clinical oversight, patient eligibility, claims, and compliance.

The pharmacy would receive compensation according to a legally reviewed agreement.

Such an arrangement must reflect legitimate services and fair-market-value compensation, not payments for prescription referrals.

Federal and state fraud-and-abuse laws, including the Anti-Kickback Statute where applicable, require careful consideration.

The purpose must be genuine patient care, not using clinical-service payments to purchase access to a physician’s prescription business.

Understanding RPM Billing Codes

Medicare uses distinct procedure codes for various components of remote physiologic monitoring.

Examples include:

CPT 99453: Initial setup and patient education for qualifying RPM services.

CPT 99454: Device supply and transmission of physiologic data over the applicable monitoring period.

CPT 99457: The initial qualifying 20 minutes of remote monitoring treatment-management services in a calendar month.

CPT 99458: Additional qualifying treatment-management time.

Beginning in 2026, the RPM code family also includes:

CPT 99445: A device-supply reporting pathway for qualifying monitoring involving two to fifteen days of data within the relevant period.

CPT 99470: A treatment-management pathway for the first qualifying ten minutes in a calendar month.

The new codes are important because they recognize certain lower-duration monitoring scenarios that previously did not fit traditional reporting thresholds.

They do not eliminate medical necessity, documentation, supervision, or other billing requirements.

Not every code can be reported together, and the correct code depends on the actual service furnished.

A pharmacy should never build financial projections by automatically stacking every available RPM code for each patient.

Understanding CCM Billing Codes

Common CCM codes include:

CPT 99490: At least 20 minutes of qualifying clinical staff CCM services during a calendar month under the direction of an eligible billing practitioner.

CPT 99439: Additional qualifying clinical staff CCM time, subject to the applicable reporting rules.

CPT 99491: CCM services personally furnished by a physician or other qualified healthcare professional for the required time.

Complex CCM has separate codes and additional requirements.

Billing depends on the specific care-management services provided, the personnel furnishing them, the applicable time thresholds, and the practitioner’s eligibility.

For an independent pharmacy, the most important operational distinction is that furnishing support services and being eligible to submit the Medicare claim are separate questions.

The Importance of Proper Software

A pharmacy cannot responsibly launch an RPM or CCM program using only a spreadsheet and an ordinary prescription dispensing system.

Clinical-service programs require technology capable of supporting patient care, documentation, privacy, and billing compliance.

Remote Patient Monitoring Software

An RPM platform should support connected medical devices, reliable data transmission, patient enrollment, alerts, clinical review, and documentation.

The pharmacy or medical practice should be able to identify whether required data were collected during the appropriate monitoring period.

The system should also support records of patient communications and qualifying management time.

Device connectivity matters.

A program that depends on patients manually reporting measurements may not satisfy the technical requirements of RPM device-transmission codes.

Chronic Care Management Software

A CCM platform should support longitudinal care plans, clinical documentation, staff activity tracking, patient communication, and coordination among healthcare professionals.

It should allow appropriate personnel to document qualifying work and identify when required service thresholds have been met.

It should also help prevent duplicate time reporting across overlapping programs.

Integration and Data Security

Pharmacy owners should evaluate whether the technology integrates with the medical practice’s electronic health record and supports secure information exchange.

HIPAA compliance, access controls, audit trails, business associate agreements, data portability, and breach-response procedures are essential considerations.

Software should make compliance easier.

It should not simply maximize the number of billable codes generated.

Choosing the Right RPM or CCM Technology Vendor

Software companies may advertise the ability to generate substantial recurring reimbursement.

Those projections deserve careful scrutiny.

Before selecting a vendor, pharmacy owners should investigate:

• Whether the platform supports current Medicare billing requirements.
• Which connected devices are compatible and how data are transmitted.
• Whether qualifying service time is accurately recorded.
• Whether patient consent and clinical documentation are supported.
• Whether the platform integrates with physician EHR systems.
• How billing responsibility is divided among the parties.
• Whether the vendor provides compliant reporting and audit support.
• How patient records and devices are handled if the contract ends.
• What implementation, training, device, and monthly fees apply.
• Whether the pharmacy can export its data and transition to another vendor.

An attractive software demonstration is not evidence that a program will be profitable.

The vendor should be able to explain exactly how the clinical workflow supports legitimate reimbursement.

Which Patient Populations May Be Appropriate?

Several patient populations may benefit from coordinated monitoring or care-management services.

Hypertension

Patients with hypertension may benefit from connected blood pressure monitoring when their healthcare provider determines it is medically necessary.

The care team can evaluate readings over time and identify situations requiring follow-up.

Diabetes

Patients with diabetes may benefit from care coordination, medication review, and appropriate monitoring.

However, continuous glucose monitoring has its own coverage and billing framework. Pharmacies should not assume that CGM services can simply be billed using general RPM device codes.

Cardiovascular Conditions

Certain patients with cardiovascular disease may benefit from clinically appropriate monitoring of weight, blood pressure, or other physiologic measurements.

The specific service must be selected based on the patient’s condition and treatment plan.

Multiple Chronic Conditions

Patients managing several chronic illnesses may benefit from CCM services involving medication reconciliation, care coordination, and ongoing communication with the medical team.

Long-Term Care and Home-Based Patients

Pharmacies serving assisted living facilities, group homes, and patients receiving medication assistance at home may already have relationships that support care coordination.

However, eligibility, patient setting, payer restrictions, and duplication of services must be reviewed carefully.

Not every facility resident or home-delivery patient qualifies for every program.

A Hypothetical Recurring Revenue Model for a Retail Pharmacy

Consider a retail pharmacy that establishes a compliant service agreement with an eligible medical practice.

The pharmacy provides defined clinical support activities and receives an agreed monthly service payment for each patient for whom qualifying work is actually completed.

Assume the pharmacy eventually supports 250 active patients.

For illustration, suppose the pharmacy earns an average of $45 per patient per month in collected service revenue under its agreement.

That would produce:

250 patients × $45 = $11,250 in monthly service revenue.

Annualized, that equals $135,000.

Now assume the pharmacy incurs $6,000 per month in incremental staffing, software, device-related, and administrative expenses.

Monthly contribution would be $5,250.

Annual contribution would be $63,000.

These figures are hypothetical business assumptions.

The $45 amount is not a Medicare reimbursement rate, and the example does not establish that a pharmacy is entitled to a particular payment.

Actual economics depend on the contract, the services furnished, eligibility, collections, staffing requirements, and applicable laws.

The lesson is that recurring service revenue must be evaluated after expenses.

A pharmacy generating $135,000 in additional revenue but spending $150,000 to provide the services has not improved profitability.

Why Patient Retention and Clinical Engagement Matter

A successful program requires more than enrollment.

Patients must understand the services, participate voluntarily, and receive clinically meaningful support.

RPM programs depend on appropriate device use, transmission of readings, and clinical management.

CCM programs depend on continuing care coordination and documented qualifying services.

Patients who receive little benefit may discontinue participation.

A pharmacy should therefore monitor patient engagement, completed service rates, clinical workflow quality, and program retention.

These indicators can be more informative than the total number of enrolled patients.

Can RPM and CCM Increase Pharmacy EBITDA?

Potentially.

EBITDA represents earnings before interest, taxes, depreciation, and amortization.

If a pharmacy earns recurring service revenue and its incremental operating expenses are lower than that revenue, the resulting operating contribution may improve EBITDA.

However, EBITDA improvement is not automatic.

Owners must account for pharmacist time, clinical staffing, software subscriptions, device costs, patient onboarding, billing administration, denials, compliance oversight, and management expenses.

If a separate physician practice or service company receives the revenue, the pharmacy cannot automatically include that company’s earnings in its own EBITDA.

Ownership, contracts, accounting treatment, and the actual recipient of the income matter.

This distinction is especially important when preparing financial statements for a lender or prospective purchaser.

How Recurring Clinical Revenue May Affect Pharmacy Valuation

When evaluating a pharmacy acquisition, buyers examine the quality and sustainability of earnings.

A pharmacy with diversified revenue sources may be more attractive than one dependent entirely on traditional prescription reimbursement.

Recurring clinical-service revenue can be particularly interesting when it is supported by documented contracts, stable patient participation, and reliable collections.

However, buyers will examine several important questions.

Who owns the service contracts?

Can those contracts be assigned after a sale?

Are the relationships dependent on the current pharmacy owner?

Who is legally permitted to bill?

Will the participating physicians continue working with the pharmacy after an ownership change?

Are the revenue and expenses accurately reflected in the financial statements?

A program may be profitable today but have limited transferable value if the revenue depends entirely on a contract that terminates upon acquisition.

A Hypothetical EBITDA Valuation Example

Suppose a pharmacy develops a compliant clinical-services business that contributes an additional $100,000 in sustainable annual EBITDA.

At an illustrative enterprise valuation multiple of four times EBITDA, that contribution could correspond to $400,000 of enterprise value.

At five times EBITDA, the mathematical result would be $500,000.

These are valuation illustrations, not established acquisition multiples or guaranteed increases in sale price.

A buyer may apply a lower multiple, exclude the earnings entirely, or require additional operating history if the program is new, highly dependent on one medical practice, or difficult to transfer.

For acquisition purposes, predictable and verifiable earnings are more important than projected revenue.

Why a New Revenue Stream Must Survive Due Diligence

A sophisticated pharmacy buyer will not simply accept the seller’s statement that an RPM or CCM program generates recurring income.

The buyer may request:

• Service agreements with medical practices.
• Documentation of the legal billing structure.
• Historical revenue and collections.
• Patient retention and service completion records.
• Staffing and software expenses.
• Compliance policies and audit history.
• Evidence that contracts remain effective after ownership changes.
• Financial reporting separating clinical services from prescription dispensing.

A pharmacy with twelve or more months of documented operating results may be easier to evaluate than one presenting only projections, although longer operating histories can provide greater confidence.

The objective should be to develop a genuine operating business that can withstand financial, legal, and regulatory review.

A New Development: Medicare’s ACCESS Model

The future of pharmacy-related clinical services extends beyond conventional RPM and CCM billing.

CMS launched the Advancing Chronic Care with Effective, Scalable Solutions, or ACCESS, Model in July 2026.

This initiative tests an outcome-aligned approach to technology-supported chronic disease management.

It includes opportunities for eligible healthcare organizations to receive recurring payments tied to qualifying care and outcomes.

Importantly for pharmacy owners, CMS has also established a co-management payment pathway that includes qualifying Medicare-enrolled pharmacies beginning October 1, 2026.

This is not the same as granting pharmacies unrestricted authority to bill all traditional RPM or CCM codes.

Rather, it represents a separate, defined opportunity for eligible pharmacies to participate in care coordination for patients enrolled in the ACCESS Model.

The co-management pathway requires specific documentation and activities and has limits on payment frequency.

For independent pharmacy owners, this development is worth monitoring because it demonstrates the continuing evolution of pharmacy participation in clinical care delivery.

Five Mistakes Pharmacy Owners Should Avoid

Mistake 1: Assuming a Pharmacy NPI Allows Direct Billing

Traditional pharmacy enrollment does not automatically authorize direct Medicare billing of practitioner-based RPM and CCM services.

Billing authority must be verified before launching the program.

Mistake 2: Buying Software Before Establishing the Clinical Model

Technology does not create reimbursement eligibility.

The pharmacy should establish the clinical workflow, billing structure, supervision arrangements, and legal agreements before committing to substantial software expenses.

Mistake 3: Treating Enrollment as a Billable Service

A patient agreeing to participate does not automatically create a reimbursable claim.

The required services must actually be furnished and documented.

Mistake 4: Ignoring Patient Cost Sharing

Traditional Medicare RPM and CCM services may involve patient coinsurance or other cost-sharing obligations.

Patients should receive clear information about potential financial responsibility before enrollment.

Mistake 5: Building a Business Around One Physician Relationship

A pharmacy whose entire clinical-services revenue depends on one medical practice may simply be replacing prescription concentration risk with contract concentration risk.

Diversification remains important.

How an Independent Pharmacy Can Begin Evaluating RPM and CCM

The first step is not purchasing devices.

It is assessing whether the pharmacy has the professional capacity, patient population, and physician relationships necessary to support a compliant clinical program.

Owners should identify the services their pharmacists and technicians can legitimately provide.

They should evaluate potential medical-practice partners and establish clear clinical responsibilities.

A healthcare attorney and knowledgeable billing advisor should review the proposed arrangements.

The pharmacy can then compare technology platforms, staffing requirements, expected patient participation, and operating costs.

A limited pilot program may be preferable to enrolling hundreds of patients immediately.

The pilot should demonstrate that services can be delivered correctly, patients remain engaged, documentation is complete, and compensation covers the associated expenses.

Only then should the pharmacy consider broader expansion.

Ramin Faramarzifar’s Perspective: Build Revenue That Adds Real Enterprise Value

For Ramin Faramarzifar and Rombool Group, the underlying business opportunity is not simply adding another service to the pharmacy’s menu.

It is developing a more diversified operating model.

Independent pharmacies already occupy an important position in their communities.

They maintain relationships with patients, physicians, caregivers, and long-term care facilities.

Those relationships may create opportunities to participate in ongoing healthcare services that extend beyond dispensing medications.

However, the value of those opportunities depends on execution.

A successful clinical-services program must deliver legitimate patient care, comply with applicable billing rules, generate positive operating cash flow, and remain sustainable as the business grows.

From an ownership and acquisition perspective, recurring revenue becomes valuable when it is dependable, documented, and transferable.

The objective should be to create a pharmacy business that is less dependent on any single source of income while maintaining the professional standards required of healthcare providers.

Conclusion: The Future of Pharmacy Profitability May Extend Beyond the Prescription Counter

Remote Patient Monitoring and Chronic Care Management deserve consideration as independent pharmacy owners evaluate new sources of revenue.

These programs can create opportunities for ongoing patient engagement, collaboration with medical practices, and recurring clinical-service income.

They can also introduce substantial regulatory, operational, technological, and financial responsibilities.

The strongest approach begins with appropriate clinical care and compliant contracting—not reimbursement projections.

For pharmacies that develop these services successfully, recurring revenue may improve financial diversification, contribute to sustainable EBITDA, and potentially increase acquisition interest.

A pharmacy becomes more valuable when it develops reliable earnings that do not depend exclusively on the next prescription being filled.

That is an important principle for owners who want to build a stronger business today and preserve their options for an eventual exit.

About Ramin Faramarzifar and Rombool Group

Ramin Faramarzifar is the founder of Rombool Group and a pharmacy owner and operator with more than 25 years of experience in the pharmacy industry.

His background includes retail pharmacy, compounding, long-term care pharmacy services, business acquisitions, and operational management.

His ownership experience includes Venice Apothecary & Compounding Center and Sarasota Compounding Pharmacy in Southwest Florida.

Through Rombool Group, Faramarzifar explores strategies involving pharmacy profitability, operational improvement, recurring revenue, acquisitions, and long-term enterprise value.

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