PQA Pilot of Adult Immunization Pharmacy Measure Concepts Yields Insights on Payer-Pharmacy Partnerships 

Pilot Demonstrates Measure Concept Feasibility and Strong Interest in Payer-Pharmacy VBAs 

Alexandria, Va. (March 26, 2026) – The Pharmacy Quality Alliance (PQA) has completed a pilot studying the use of immunization measure concepts in payer-pharmacy value-based arrangements (VBA) to better understand pharmacy-payer data exchange, which strongly influences the feasibility of pharmacy quality measurement. The pilot also evaluated participants’ performance on the measure concepts and gathered their feedback to refine the measure specifications. Results are detailed in a report released today.  

“The use of value-based arrangements to drive quality care and improve outcomes for patients is well-established,” PQA Chief Executive Officer Micah Cost, PharmD, MS, CAE, said. “Pharmacies are optimally positioned to contribute to the success of these programs, and quality measures specified for use at the pharmacy level of care are important tools to support VBAs.  

“Despite a very challenging climate for immunizations, this pilot confirmed that PQA’s immunization measure concepts are feasible and also demonstrated pharmacies’ ability to create a patient-centric approach to vaccine-related care.” 

The pilot evaluated eight measure concepts involving immunization status and gap closure for the influenza, Td/Tdap, herpes zoster and pneumococcal vaccines. The key learnings include: 

  1. Standardized measures and measure rate validation provide value. 
  2. VBA participants should expect extended upfront contracting timelines lasting 12 months or longer. 
  3. Immunization interventions are challenging, and timing and multi-channel approaches are important. 
  4. Use of non-claims data is challenging, and many organizations are limited to claims. 
  5. Strong demand continues to exist for payer-pharmacy VBAs, although demand specific to immunization may be mixed. 

“This pilot is an important step towards developing standardized pharmacy measures,” PQA Chief Quality and Innovation Officer Lisa Hines, PharmD, said. “It demonstrated the feasibility of pharmacy quality measures in a real-world setting, generated much-needed learnings on how data is exchanged in payer-pharmacy arrangements and showed how standard quality measures can reduce burden. Based on these results and PQA’s earlier blood pressure and A1C VBA pilots, we will explore how to make pharmacy measures available for use in VBAs to promote standardized measurement across the ecosystem.” 

While the pilot was a success, bidirectional data exchange between payers and pharmacies and use of non-claims data was limited. Greater use of clinical or case management data from pharmacies and other providers is needed to support scale and better demonstrate the value of payer-pharmacy VBAs. The pilot took place during a challenging time for immunizations, which likely contributed to lower-than expected performance and some negative sentiments on future immunization VBAs.  

The pilot included two payer and two pharmacy participants: CareSource, in conjunction with CPESN Ohio pharmacies and Kroger pharmacies within Ohio; and Kroger Prescription Plans (a pharmacy benefit manager that administers prescription coverage for Kroger employees), in conjunction with Kroger pharmacies. 

This work was conducted through the PQA Quality Innovation and Research Center and leveraged the center's unique approaches to addressing challenges in developing, testing, and refining complex measure concepts.  

The pilot was supported by funding from GSK, Johnson & Johnson, Pfizer and Sanofi. 

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Contact: Rachel Cormier, Senior Manager, Communications, [email protected]