Opening: Tell Us About Your Pharmacy World

• In one sentence, how would you describe your current pharmacy fulfillment model and the priority you most need solved right now?
• Roughly what percentage of your maintenance medication volume is currently filled as retail 30‑day fills? Options: >80%, 60–80%, 40–60%, 20–40%, <20%
• Do you have a maintained list of your top‑50 maintenance medications by volume we can use for modeling (or can you share the top 10 here)? Options: Full top‑50 available, Top 10–25 available, Only top 10 available, No list available
• Which outcomes are your leaders focused on this year (select all that apply)? Options: Lower per‑unit drug cost, Reduce total pharmacy spend, Improve adherence/clinical outcomes, Protect member relationships with local pharmacists, Simplify benefit administration, Meet CFO savings targets
• What timeline does leadership expect for showing measurable pharmacy savings? Options: Next quarter, Within 6 months, By next budget cycle (6–12 months), 12+ months, No defined timeline
• Which three metrics would convince you this effort is an unqualified success?

If We Keep Doing What We’ve Always Done…

• If you were honest, what’s the single biggest reason your plan still tolerates retail 30‑day fills despite higher unit costs?
• Which specific cost drivers do you believe explain the gap between retail 30‑day and mail‑order 90‑day unit costs? Options: Higher retail dispensing fees, Inventory and return costs, Formulary differences/contracting, Brand vs generic mix, Member convenience preferences, Other
• How much of the retail volume do you think is driven by member habit or loyalty to a local pharmacist versus plan design or prescriber behavior? Options: Mostly habit/loyalty, Even split, Mostly plan design/prescriber behavior, Unsure
• When prior nudges toward 90‑day or mail were tried, what were the most common reasons members resisted? Options: Concern about losing local pharmacist, Worry about delivery reliability, Cold‑chain concerns (insulin, injectables), Confusion about transfers, Preference for monthly budgeting, Other
• What internal tradeoffs has your team already been willing to accept to avoid upsetting members or retail partners?
• Are there existing contractual or network constraints that we should know about before modeling a 90‑day mail solution? Options: PBM/network contract limits, Carrier/TPA restrictions, Formulary exclusivity clauses, No major constraints, Unsure — need review

Who Holds the Keys — and Who’s Nervous?

• Who would actively block a move away from retail 30‑day fills if members suddenly relied on mail for maintenance meds?
• Please identify the key stakeholders and their typical stance (select roles that apply and note who is supportive vs neutral vs opposed). Options: Pharmacy Director, Benefits Director, CFO/Finance, HR/People Ops, Legal/Compliance, PBM Contract Manager, Clinical Leadership, Union/Employee Rep
• What are the Pharmacy Director’s top emotional concerns about mandating or heavily steering to mail‑order? Options: Member complaints/retaliation, Clinical oversight loss, Operational errors and safety, Relationship with local pharmacy, Data transparency, Other
• How does the Benefits Director prefer to present a savings case to the CFO (e.g., per‑script comparisons, net savings, ROI model, risk scenarios)? Options: Per‑prescription comparisons, Net program ROI, Scenario modeling (best/worst), Pilot results only, Other
• Who in your organization would be a natural internal champion for a pilot and why?
• Which external relationships (local pharmacy chains, brokers, union reps) will we need to navigate or communicate with?

Show Me the Receipts — Data We Can Trust

• How confident are you that your current claims and fulfillment data can support a robust mail vs retail side‑by‑side model? Options: Very confident, Somewhat confident, Doubtful, Not confident, Unsure
• Which data extracts are available for modeling (select all that apply)? Options: Member‑level claims (NDC, days‑supply, cost), Prescriber information, Zip code/geography data, Real retail transaction-level pricing, No extract currently available
• Can you provide average per‑prescription cost for your top‑50 maintenance meds on a 30‑day retail basis (yes/no — and timeline for delivery)? Options: Yes — can provide within 1 week, Yes — need 2–4 weeks, Partial data available, No
• What fulfillment timing metrics do you currently track for retail (time from prescription received to patient pickup) and are there known outliers by geography? Options: Same day, 1–2 days, 3–5 days, 5+ days, We don’t track
• Do you have sample patient scenarios we should model first (complex polypharmacy, insulin users, rural members) — please list priorities?
• What systems and access will be required for us to run modeling and verify pilot outcomes (claims feed, EHR, benefits portal)? Options: Claims feed (preferred), De‑identified sample files, EHR access for clinical validation, Benefits enrollment file, No systems access yet

Picture the Win — What’s Non‑Negotiable?

• If this program proved successful, what three outcomes would convince your CFO and quell the Pharmacy Director’s concerns?
• What minimum per‑prescription savings threshold would justify scaling mail‑order to a broader population? Options: >40%, 30–40%, 20–30%, 10–20%, Any positive savings
• What delivery SLA thresholds are non‑negotiable before you’d consider expanding beyond pilot? Options: On‑time delivery ≥99%, On‑time delivery ≥97%, On‑time delivery ≥95%, On‑time delivery ≥90%
• For insulin and other temperature‑sensitive products, which cold‑chain assurances are required (select all that apply)? Options: Continuous temperature logs, Courier certification, White‑glove preferred, Return/compensation policy for breaches, Real‑time tracking alerts
• What voluntary enrollment rate in a pilot would you consider a signal to scale vs a reason to rethink the approach? Options: >60%, 40–60%, 20–40%, <20%
• What level of prescriber notification or opt‑out control is required so clinicians feel comfortable with transfers and 90‑day substitution? Options: Automatic transfer + notification, Pre‑transfer prescriber consent, Prescriber opt‑out allowed, Case‑by‑case prescriber engagement, Unsure — want recommendations

Where Things Tend to Break — Let’s Name the Worst‑Case

• What single failure mode would cause you to pause or cancel the program immediately?
• Which operational risks keep you awake about mail‑order adoption? Options: Prescription transfer errors causing gaps, Delivery failures in rural/extreme weather, Cold‑chain breaches for insulin/biologics, Member confusion and increased complaints, Prescriber or retail backlash
• Have you experienced any of these issues before? Describe one incident, the impact, and how it was resolved.
• Which contingency responses must be guaranteed before launch (select all that apply)? Options: Rapid same‑day retail fallback, Emergency courier for cold‑chain, Dedicated member care escalation team, Prescriber hotline, Manual refill override process
• What regulatory, consent, or privacy constraints should we be aware of for transfers and member communications?
• What early‑warning KPIs would you want to see during the first 30 days to either escalate or let the pilot continue? Options: Fill accuracy, On‑time delivery %, Cold‑chain compliance, Days‑supply continuity, Member complaints per 1,000

A Small Pilot, A Big Signal — Let's Design It

• If we ran a short, focused pilot that either failed fast or proved the model, what single question would you want it to answer first?
• Which pilot cohort do you prefer for a meaningful first test (select up to two)? Options: Top 50 meds by volume, Chronic conditions cohort (diabetes, HTN, cholesterol), Insulin & temperature‑sensitive products only, Geography‑based (rural vs urban), Voluntary opt‑in employees
• How large should the pilot be to produce credible results for your finance and clinical teams? Options: <250 members, 250–1,000, 1,000–5,000, 5,000+, Unsure — need our recommendation
• What reporting cadence and formats do you need during the pilot to feel comfortable (select all that apply)? Options: Daily operational alerts, Weekly KPI dashboard, Bi‑weekly executive summary, Final ROI and outcomes report, Ad hoc deep dives on exceptions
• What data‑sharing, security, or legal clearances must be completed before we can begin modeling or a pilot?
• Who will be the day‑to‑day point of contact for pilot operations, and who has final sign‑off on pilot acceptance? Options: Pharmacy Director, Benefits Director, CFO/Finance, HR Lead, Clinical Pharmacist, Other
• List three concrete acceptance criteria we should agree to up front for pilot success (e.g., % savings, on‑time %, adoption rate).

• Current-State Confirmation & Data Lock
• Financial Model Run & Consequence Quantification
• Member Scenario Walkthroughs — Enrollment to First Fill
• Operational Proofs, SLAs & Acceptance Criteria
• Decision & Next Steps — Pilot Approval and Timeline

• Agree pilot acceptance criteria, measurement approach, and reporting cadence.
• One‑sentence Future State
• Validate that the modeled 90‑day mail flow matches real member scenarios and that timelines are achievable.
• Identify and document scenario‑specific risks (prescriber delays, transfer errors, rural delivery) and mitigation steps.
• Agree on member communications and opt‑out/continuity scripts for pharmacy relationships.
• Seller to produce timeline diagrams for each walked scenario (enrollment -> first fill) and circulate.
• Customer to flag any scenarios that are non‑representative or require special handling (e.g., PA, specialty).
• Seller to provide sample member notifications and prescriber templates for review and approval.
• Recap Current State → Consequence → Future State
• Confirm operational evidence meets the customer's minimum SLA and quality thresholds for pilot go/no‑go.
• Document exception handling ownership and escalation paths for identified risks.
• One‑sentence Current State
• Seller to deliver SLA evidence pack (temp logs, accuracy reports, delivery manifests) and SOP excerpts.
• Customer and seller to finalize and sign the pilot measurement plan and acceptance criteria document.
• Schedule pilot kickoff and assign operational owners for monitoring and weekly reporting.
• Concise Recap (State, Consequence, Future)
• Obtain formal approval to run the pilot with the agreed scope and acceptance criteria.
• Confirm timeline, assign owners, and set the date for the first validation checkpoint.
• Ensure all parties understand what evidence will be used to evaluate pilot success and move to deployment scale.
• Customer to sign pilot scope & measurement agreement and return signed copy.
• Seller to schedule pilot kickoff, provision test shipments, and deliver pilot reporting template.
• Both parties to confirm data feeds and monitoring access required for the Validation Checklist meeting.
• Achieve an agreed single‑sentence current‑state description that all participants validate.
• Lock the canonical dataset (fields, date range, owner, delivery date) for use in modeling.
• Identify and assign remediation tasks for any data quality issues that would invalidate the model.
• Confirm the baseline cost elements and unit definitions to be used in the financial model.
• Customer to deliver cleaned canonical dataset (claims + top‑50 mapping + unit costs + cold‑chain flags) by agreed date.
• Seller to provide the data validation checklist and sample mapping templates for top‑50 meds.
• Assign data owner contacts for any follow‑up clarifications and confirm SLAs for answers.
• Establish sensitivity ranges and which scenarios will be reported to finance/stakeholders.
• One‑sentence Consequence
• Agree on the modeling methodology and assumptions used to calculate per‑prescription savings.
• Validate and accept the model outputs for top‑50 drugs and the aggregate savings estimate.
• Seller to deliver the editable model spreadsheet with documented assumptions and a CFO one‑pager.
• Customer to review and return any alternate pricing inputs (rebates, specialty carve‑outs) within 3 business days.
• Seller to re‑run model for two alternate enrollment scenarios requested during the meeting.
• Operational KPI & SLA Definitions
• Select & Confirm Representative Scenarios
• Present Final Model & SLA Summary
• Data Inventory & Source Walkthrough
• Model Assumptions & Methodology
• Live Model Run — Top‑50 & Aggregate
• Quality & Gaps Triage
• Pilot Scope, Timeline & Cohort
• Walkthrough: Enrollment Flow & Prescription Transfer
• Supply Proof Points
• Fulfillment & Cold‑Chain Handling
• Sensitivity & Scenario Analysis
• Exception & Contingency Flows
• Commitments & RACI
• Pre‑work and Dataset Lock
• Next Validation Checkpoint
• Draft Consequence Framing
• Compare Turnaround: 90‑day Mail vs Retail 30‑day
• Tie Results Back to CFO Questions
• Pilot Acceptance Criteria & Measurement Plan
• Force Validation

• Dispense 90-Day Maintenance Medication Supply
• Ship Initial 90-Day Prescription with Tracked Delivery
• Activate Automated Refill and Auto-Ship Enrollment
• Coordinate Prescription Transfer from Retail to Mail Order
• Ship Temperature-Controlled Insulin and Biologics
• Synchronize Multi-Medication Refills into Single Shipment
• Provide Pharmacist Teleconsultation and Medication Counseling
• Process Prior Authorization and Insurance Appeals
• Expedite Next-Day Resupply for Interrupted Therapy
• Dispense Specialty Injectables with Patient Training
• Fulfill Controlled-Substance Maintenance Prescriptions
• Provide Turnaround-Time Tracking and Shipment Notifications

Dispense 90-Day Maintenance Medication Supply

• Do you want to offer 90-day fills for all maintenance medications or a subset? Options: All eligible maintenance meds, Selected therapeutic classes, Pilot cohort only, No, not at this time
• Which therapeutic classes or specific NDCs/RxNorms should be included or excluded?
• What is the estimated monthly volume of 90-day maintenance prescriptions at launch? Options: Less than 500, 500-2,000, 2,000-10,000, More than 10,000
• Are there formulary or plan rules (step therapy, quantity limits) that affect 90-day dispensing? Options: Yes, No
• If yes, please summarize formulary constraints or provide a file reference.
• Do you require synchronized billing or member cost-share adjustments for 90-day fills? Options: Yes - adjust cost-share, No - leave existing cost-share, Need discussion

Ship Initial 90-Day Prescription with Tracked Delivery

• Should every initial 90-day shipment include tracked door-to-door delivery confirmation? Options: Yes - tracked delivery required, Optional - tracked on request, No - tracking not required
• What delivery carrier preferences or contractual carriers must be used?
• Are there geography-specific delivery constraints (PO boxes, APO/FPO, rural zones)? Options: Yes, No
• If yes, please list affected ZIP codes or region notes.
• What is the acceptable shipment delivery SLA for initial fills (business days)? Options: 1-2 days, 2-4 days, 4-7 days, Custom
• Do you require proof-of-delivery workflows for member disputes or audits? Options: Yes, No

Activate Automated Refill and Auto-Ship Enrollment

• Should automated refill enrollment be opt-in, opt-out, or mandatory for enrolled members? Options: Opt-in, Opt-out (default enrolled), Mandatory for program participants
• Do you want automatic medication synchronization (ship multiple meds together on same cadence)? Options: Yes - synchronize where possible, No - independent cadence per med, Partial - only selected meds
• What member communications are required to notify about auto-ship enrollment and reminders? Options: Email, SMS, Phone call, Portal notification
• Do members need to confirm or opt-out before the first auto-ship occurs? Options: Yes - confirmation required, No - auto proceeds after enrollment, Custom
• Are there regulatory or consent documentation requirements for automated refills in your jurisdiction? Options: Yes, No, Not sure
• Describe expected refill frequency (e.g., 90-day cycle, synchronized by calendar month).

Coordinate Prescription Transfer from Retail to Mail Order

• Will transfers be initiated by the member, the employer/PBM, or automatically by the mail pharmacy? Options: Member-initiated, Employer/PBM-initiated, Automatic/proactive from mail pharmacy
• Do you have authority to transfer prescriptions on behalf of members (signed consent or Rx transfer form)? Options: Yes - centralized consent available, No - member signature required per Rx, Varies by plan
• What percentage of members do you anticipate requiring manual intervention to transfer (e.g., controlled substances, specialty)? Options: Less than 10%, 10-30%, 30-60%, More than 60%
• Are there specific retail chains or legacy systems that require bespoke transfer processes? Options: Yes, No
• If yes, list retailers or systems and any known API/connectivity methods.
• What is the maximum acceptable transfer timeline to avoid therapy gaps (days)? Options: Same day, 1-3 days, 4-7 days, Custom

Ship Temperature-Controlled Insulin and Biologics

• Do you require cold-chain shipping for insulin and biologics for the entire member population or selective cohorts? Options: All members on insulin/biologics, Select cohorts only, No cold-chain required
• What maximum in-transit temperature and time thresholds must be met?
• Do you require real-time temperature logging and retention of temperature logs for audits? Options: Yes - real-time + retention, Yes - post-delivery logs only, No
• Are there preferred cold-chain packaging types or vendor approvals we must use? Options: Yes - approved vendor list provided, No - vendor flexible, Need vendor recommendation
• Do members require special delivery instructions (e.g., appointment window for refrigerated handoff)? Options: Yes, No
• List any payor or regulatory documentation requirements specific to cold-chain products.

Synchronize Multi-Medication Refills into Single Shipment

• Should multi-med synchronization be attempted automatically or only when member requests it? Options: Automatic synchronization, Member-requested only, Hybrid - automatic with member confirmation
• Do you want rules for grouping meds (by refill date window, clinical priority, or payer rules)? Options: By refill date window, By clinical priority, By payer/formulary rule, Custom
• Are there medications that must never be combined in the same shipment (e.g., different temperature needs, controlled vs non-controlled)? Options: Yes, No
• If yes, list examples and reasoning.
• What is the desired maximum number of different medications per shipment? Options: 1-2, 3-5, 6-10, No limit
• Do you require consolidated member invoices or per-medication billing lines? Options: Consolidated invoice, Per-medication billing lines, Both

Provide Pharmacist Teleconsultation and Medication Counseling

• Which counseling services should be offered (initial fill counseling, adherence outreach, clinical review)? Options: Initial fill counseling, Adherence outreach, Clinical medication review, All of the above
• What hours or availability window is required for teleconsultation? Options: Business hours, Extended hours (evenings/weekend), 24/7
• Do you require documented counseling notes to be pushed into employer or PBM portals? Options: Yes, No
• Are there language or accessibility requirements (languages, TTY, translation)? Options: Yes, No
• If yes, list languages and special accommodations required.
• Do you want scheduled pharmacist outreach for missed refills or adherence gaps? Options: Yes - automatic schedule, No - reactive only, Custom cadence

Process Prior Authorization and Insurance Appeals

• Will the mail pharmacy manage prior authorizations (PAs) end-to-end or only provide documentation support? Options: End-to-end PA management, Documentation support only, No PA support
• What is the typical PA denial/appeal volume you expect monthly? Options: Less than 50, 50-200, 200-1,000, More than 1,000
• Do you require pre-populated PA templates and clinical justification language for faster approvals? Options: Yes, No
• Are there specialty drug cases where appeals must be escalated to medical directors? Options: Yes, No
• What target SLA do you require for PA determination (hours/days)? Options: 24 hours, 48-72 hours, Up to 7 days, Variable
• Do you require reporting on PA outcomes, denial reasons, and appeals success rates? Options: Yes, No

Expedite Next-Day Resupply for Interrupted Therapy

• Should expedited next-day resupply be available for all medications or limited classes (e.g., insulin, critical meds)? Options: All meds, Critical meds only, By case basis
• Who is authorized to request an expedited shipment (member, prescriber, case manager)? Options: Member, Prescriber, Employer/Case manager, All of the above
• What cutoff time is acceptable for next-day processing (e.g., orders received by 2pm local time)?
• Are there cost or billing rules for expedited shipments (member copay, employer absorbs cost)? Options: Member pays expedited fee, Employer/PBM absorbs cost, No additional charge, Custom
• Do you require cold-chain expedited shipments for temperature-sensitive products? Options: Yes, No
• What documentation is required to confirm delivery and support member continuity of care?

Dispense Specialty Injectables with Patient Training

• Do you require in-person training, virtual training, or self-directed materials for injectable administration? Options: In-person training, Virtual live training, Recorded/self-directed materials, Combination
• Which specialty injectables are in scope and do any require remote observation (e.g., first-dose monitoring)?
• Should nurse/educator outreach be scheduled automatically after first shipment? Options: Yes - schedule outreach, No - outreach on request, Conditional based on med
• Are additional supplies required with shipments (e.g., sharps containers, ancillaries)? Options: Yes - include supplies, No
• Do you require training documentation and competency acknowledgment to be stored in member records? Options: Yes, No
• Are there payer or REMS requirements that affect training or dispensing protocols? Options: Yes, No

• Statement of Work (SOW)
• Pricing & Measurement Exhibit
• Service Level Agreement (SLA) & Remedies
• Voluntary Enrollment Window Agreement
• Acceptance Criteria & Go‑Forward Checklist
• Prescription Transfer Authorization & Consent
• Data Sharing & Integration Addendum (DPA/Integration Spec)
• Cold‑Chain Shipping Addendum
• Implementation Schedule & Rollout Plan
• Billing, Invoicing & Payment Terms
• Change Order & Scope Modification
• Governance, Escalation & Reporting Cadence
• Confidentiality & Data Use Agreement (NDA)
• Termination & Transition Plan
• Insurance, Liability & Indemnification Certificate

• Executive Savings Review
• Clinical & Adherence Review
• Delivery & Cold‑Chain Performance Review
• Member Feedback & Experience Workshop
• Continuous Improvement & Escalation Cadence

• Publish a member FAQ and short how‑to video addressing first‑fill expectations and tracking (owner: member experience).
• Confirm delivery and cold‑chain performance meet contractual SLAs or define remediation plan.
• Identify and approve immediate corrective actions for high‑risk exceptions.
• Set monitoring tests and acceptance criteria to validate fix effectiveness.
• Schedule carrier re‑qualification or pilot alternate carrier for affected ZIP clusters within 10 business days (owner: logistics ops).
• Deploy automated temperature‑alerting thresholds and assign on‑call owner for exceptions (owner: QA engineering).
• Run a 20‑shipment cold‑chain validation batch and share logs for validation (owner: cold‑chain vendor).
• Current State: Member Sentiment Snapshot
• Surface the top 3 member experience friction points and their root causes.
• Agree on prioritized fixes with owners and timelines for communication updates.
• Define metrics to validate experience improvements (complaint rate, NPS uplift, enrollment conversion).
• Revise prescriber notification script to address the top 2 points of confusion and circulate for approval (owner: prescriber outreach).
• Opening & Current State Statement
• Implement a weekly member complaint dashboard and assign triage owners (owner: call center ops).
• Open Issues & Current Backlog
• Create an agreed shared channel with named owners and SLA targets for issue triage and escalation.
• Adopt a prioritization framework so the team can resolve high‑impact items quickly and transparently.
• Set the ongoing reporting cadence and confirm owners for the next 90 days.
• Create the shared ticketing channel, seed it with current open issues, and invite stakeholders (owner: CustomerNode admin).
• Publish the prioritization rubric and SLA definitions to the team and start the weekly triage meeting (owner: program manager).
• Schedule recurring weekly ops check‑ins and monthly executive reviews on the calendar for the next 90 days (owner: executive assistant).
• Validate realized savings meet or explain the expected financial targets vs baseline.
• Decide whether to scale participation, change enrollment policy, or maintain current approach.
• Assign owners and timelines for any approved changes or remediations.
• Deliver a detailed per‑prescription CSV comparing baseline retail vs realized mail costs for the top‑50 meds (owner: analytics).
• Update the financial model with realized enrollment and rebate differences and circulate to CFO within 3 business days (owner: Benefits lead).
• If scaling approved, produce an implementation plan with timeline and expected incremental savings within 7 business days (owner: deployment lead).
• Current State: Adherence Summary
• Confirm adherence improvements and link to measurable clinical or utilization outcomes.
• Identify top medication groups with persistent adherence gaps requiring targeted outreach.
• Agree on next clinical interventions, metrics to monitor, and timing for re‑review.
• Run targeted outreach campaign for the top 5 meds with worst adherence and report weekly uplift (owner: clinical ops).
• Enable enhanced pharmacist callback workflow for members with missed first fill within 48 hours and track resolution rate (owner: pharmacy ops).
• Prepare a 30/60/90 day adherence tracking deck for executive cadence (owner: data analyst).
• Current State: SLA & Accuracy Dashboard
• Representative Case Reviews
• Cold‑Chain Exception Review
• Quantified Clinical Consequences
• Savings Summary vs Baseline
• Prioritization Framework
• Root Cause Analysis
• Consequence & Variance Analysis
• Rural/Extreme Weather Failures
• Medication‑Level Performance (Top‑50)
• Shared Channel & Escalation Rules
• Brainstorm & Prioritize Fixes
• Reporting Cadence & KPIs
• Intervention Effectiveness
• Carrier & Process Remediation
• Decision: Scale, Mandate Window, or Adjust Target
• Operational Validation
• Validation & Clinical Decisions
• Owner Commitments & Communication Plan
• Commitments & Schedule
• Next Steps & Owner Commitments