Central to any discussion of payment reform is the need for a rational scientific medication use system to ensure that drug-related morbidity and mortality are minimized. The care provision process is based on a comprehensive assessment of all of a patient's drug-related needs and it behooves pharmacists to conduct a comprehensive assessment as do all other health professions. This comprehensive assessment is the foundation of medication therapy management (MTM) services provided within the practice of pharmaceutical care. Care can be delivered in the community by clinically oriented pharmacists, although building a practice is hard work much different from the business of dispensing medications. The number of pharmacists needed to provide comprehensive MTM services for every American is projected to range from 30,000 to 100,000 based on data/experiences from Minnesota, Ontario, and elsewhere. These individuals may benefit from some type of provider recognition so that society can differentiate between pharmacists who provide comprehensive MTM services and those in drug distribution roles. Approaching the legislature and policymakers with cost savings data, partnering with the business community, and focusing on dual eligible patients and those with unmet mental health needs are important strategies to make this practice transformation a reality.