Who’s In The Room? — Quick roll call to get us started

• Who will be the primary sponsor for this specialty pharmacy relationship? Options: Pharmacy Director / VP Specialty Pharmacy, Chief Medical Officer / Medical Director, Network Management Lead, PBM Contract Lead, Chief Pharmacy Officer, Other
• Which functional roles will be actively involved in vendor evaluation and decisions (select all that apply)? Options: Pharmacy operations/fulfillment, Clinical pharmacy / pharmacists, Medical management / utilization review, Network/contracting, PBM contracting, IT / integrations, Data analytics / reporting, Legal / compliance, Finance / procurement, Member experience / care coordination, Other
• Please list the names, titles, and preferred contact method for each decision-maker or influencer you just selected.
• Are there external parties (manufacturers, specialty networks, distribution partners) who must be consulted or sign off? Options: Manufacturer access teams, Limited distribution network reps, Third‑party logisticians (3PL), State board / regulators, None, Other

If We Assume Everything Stays The Same, What Breaks?

• When specialty workflows aren’t tightly coordinated across pharmacy, medical, network and PBM, what tends to fail first for your members? Options: Prior authorization delays, Prescriber handoffs / documentation gaps, Cold‑chain / biologic delivery failures, First‑fill abandonment, Adherence drop‑off, Data/reporting gaps, Billing/coverage denials, Other
• How frequently do those failures occur today (approximate % of cases or frequency)? Options: Daily, Weekly, Monthly, Quarterly, Rarely, Don’t track
• Tell us about a recent case where a failure of the specialty supply chain caused meaningful patient harm, cost, or escalation—what happened and who felt the pain?
• Which internal KPIs or downstream costs are most affected when those failures happen? Options: Increased claims cost, Higher utilization (ER/hospital), Member churn, Provider dissatisfaction, Regulatory complaints, Contractual penalties, Other

Who Holds the Keys to Saying ‘Go’ — and Who Can Say ‘No’?

• Who has veto authority or final sign‑off on moving forward with a specialty pharmacy partner? Options: Executive committee, Pharmacy director, Medical director, PBM contracting lead, Network director, Legal/procurement, Board/Finance
• What formal approval gates or committees must this go through (and how long do those cycles typically take)? Options: Monthly contracting committee, Quarterly executive governance, Ad hoc clinical advisory panel, PBM vendor board, Procurement RFP cycle, None / informal
• Which types of evidence or artifacts most influence approvers (e.g., SLA data, cold‑chain validation, PA turnaround metrics, reference calls)? Options: SLA performance history, Cold‑chain validation & certificates, PA turnaround time reports, Member satisfaction scores, Clinical outcomes / adherence data, Reference site visits / calls, Security & compliance audits
• Are there known internal political dynamics (e.g., PBM vs plan pharmacy, procurement vs medical leadership) that typically shape decisions here? How should we navigate them?

The Deadline That Keeps You Up at Night

• If launch slips past your target date, what consequence worries you most? Options: Member access gaps, Manufacturer contract fallout, Missed quality / value milestones, Budget/financial exposure, Regulatory or contractual breach, Provider frustration
• What is your ideal go‑live date and what external or internal events drive that timing? Options: Start of plan year/contract term, Manufacturer launch window, CMS/reporting deadline, Provider network change, Other
• Are there hard blackout dates, enrollment periods, or formulary windows we must avoid? Options: Open enrollment, Annual formulary change window, Manufacturer rebate window, Major EHR change / go‑live, None
• How much schedule flexibility exists—what would you be willing to trade (scope, pilots, resources) to accelerate or decelerate the timeline?

What Success Actually Looks Like (Not Just What You Say)

• If we could only deliver three measurable wins in the first 6–12 months, which would you pick? Options: PA turnaround time, First‑fill abandonment reduction, Adherence improvement (PDC/MPR), Cold‑chain delivery success rate, Time to therapy from prescription, Total cost of care impact, Member satisfaction
• For each win you selected, what is the numeric target and the timeline (e.g., PA <48 hours for 90% within 6 months)?
• Which of those metrics will be used for commercial incentives, shared savings, or penalties? Options: Yes — financial incentives, Yes — operational scorecards only, No — informational only, Undecided
• Who on your team will own measurement and reporting for these metrics once live? Options: Clinical analytics, Pharmacy operations, PBM analytics, Vendor-managed reporting, Other

Unwritten Rules and Non‑Negotiables — What We Must Know Upfront

• What contractual or operational constraints are absolute deal‑stoppers for you? Options: No data sharing, No access to raw claims/clinical data, No integration with EHR/eRx, No cold‑chain certification, Unacceptable SLA terms, State licensure gaps, Other
• Are there mandatory security/compliance standards or audits we must pass (SOC2, HIPAA, HITRUST, vendor security questionnaires)? Options: SOC2, HITRUST, HIPAA attestation, Vendor security questionnaire, Other
• Do you require specific accreditations, licenses, or third‑party validations for specialty fulfillment or clinical services? Options: Accredited specialty pharmacy (URAC/PCAB), State pharmacy licenses, Cold‑chain 3PL certifications, Manufacturer onboarding approvals, None
• Are there non‑negotiable data ownership, patient consent, or reporting terms that must be included in the contract? Please explain.

How Decisions Get Made When Things Go Off‑Script

• When a critical failure occurs during pilot or launch, who is empowered to authorize remedial action immediately? Options: Pharmacy operations lead, Medical director, Network lead, PBM operations, Executive sponsor, Cross‑functional incident response team
• Describe your expected escalation path and target response SLAs for high‑severity incidents (e.g., lost biologic shipment, mass PA denial).
• Who needs to be included in post‑incident root cause reviews and what outcomes would satisfy your team? Options: Operations leadership, Medical director, PBM representative, Vendor leadership, Legal/Compliance, Other
• Do you expect pre‑defined remediation budgets, credits, or service credits for failures? If so, how should they be structured? Options: Service credits tied to SLA breaches, Joint remediation plans (no automatic credits), Financial penalties, Other

Closing the Loop — What Would Make You Say Yes?

• What would make you pick a specialty pharmacy partner immediately—what combination of proof, price, and trust seals the deal? Options: Best clinical outcomes data, Lowest operational risk (SLAs & accreditations), Strong local provider relationships, Competitive commercial terms, Manufacturer endorsements, Other
• What outstanding information, demonstrations, or reference checks do you need before you can make a recommendation? Options: Live demo of workflow, Reference calls with similar plans, Detailed SLA & penalty language, Cold‑chain validation evidence, Data feed samples / reporting dashboard
• Who would need to attend an executive alignment session to finalize the decision, and what date windows work for your leadership?
• What next step here feels most useful to you—a focused pilot, technical integration workshop, executive briefing, or something else? Options: Pilot program, Technical integration workshop, Executive alignment meeting, Commercial term sheet review, Other

A Fast Snapshot — Who Are We Talking With?

• Tell us who you are and the single biggest specialty-pharmacy issue you want resolved in this partnership
• Which organization type best describes your role here? Options: Health plan / payer, PBM, Integrated delivery network / hospital system, TPA / Third-party administrator, Manufacturer, Other
• Which therapeutic areas represent the majority of specialty spend for your population today? Options: Oncology, Immunology / autoimmune, Neurology / MS, Infectious disease (HIV/HCV), Rare disease / genetic, Other
• Roughly how many members/patients do you expect this specialty program to cover? Options: < 5,000, 5,000–25,000, 25,000–100,000, > 100,000, Unsure
• Who will be the primary decision-makers and influencers for selecting a specialty pharmacy? List names/titles and their top concern in one sentence each.

Where the Rub Really Lives: Problems We Pretend Aren’t Ours

• If you had to name one recurring specialty-workflow breakdown that costs you the most money or member trust, what is it?
• Which failure modes do you see most often (select all that apply)? Options: Prior authorization delays, Cold-chain shipping failures, Hospital-to-home transfer gaps, Limited distribution drug routing errors, Claims reconciliation discrepancies, Clinical documentation mismatches, Other
• When those failures happen, who usually notices first and how long does it take to surface the problem? Options: Prescriber/care team, Patient / caregiver, Plan clinical team, Specialty pharmacy, PBM / claims team, Other
• How frequently do these failures lead to an adverse member outcome (missed dose, hospital readmission, therapy abandonment)? Options: Weekly, Monthly, Quarterly, Rarely, Unknown
• Tell us about one recent example — what happened, whose process broke down, and how it felt for the patient and the care team?

Follow the Paper Trail (and the Data Gaps)

• Why do your current data feeds leave you blindfolded at critical moments — what specific data do you wish you had that you don’t?
• Which systems currently exchange data for specialty workflows (select all that apply)? Options: EHR (Epic/Cerner/other), PBM claims system, Payer claims / MMIS, Specialty pharmacy system, Manufacturer portals, Hub vendors, Other
• For each integration you selected, how reliable is the data flow (near real-time, daily batch, weekly batch, inconsistent, none)? Options: Near real-time, Daily, Weekly, Inconsistent / ad hoc, No integration
• Which data elements do you consistently find missing or inaccurate when reviewing specialty reports? Options: Prior authorization status, Dispense date / ship date, Cold-chain temperature logs, Adherence metrics (PDC/MPR), Patient contact attempts, Clinical outcome markers, Other
• How quickly do you need critical operational signals (e.g., PA approval, failed delivery) to arrive in your systems for them to be useful? Options: Within 1 hour, Same day, 24–48 hours, Within a week, Any delay is problematic

Who Owns What (and Who Doesn’t)?

• Where do responsibilities blur today—what process step regularly becomes ‘no one’s job’?
• Who currently owns prior authorization initiation, appeals, and authorizations in your arrangement? Options: Prescribing provider, Health plan clinical team, PBM, Specialty pharmacy, Hub vendor, Shared / unclear
• Who is accountable for cold-chain validation during transit and at delivery? Options: Specialty pharmacy, 3PL / logistics vendor, Hospital discharge team, Manufacturer, Other
• Which party manages patient education and adherence interventions after discharge from a facility? Options: Specialty pharmacy care coordinators, Health plan case management, Prescriber's clinic staff, Third-party adherence vendor, Other
• Have you documented handoffs and escalation paths between these parties? If yes, where are the largest handoff delays?

When Things Break: The Real Costs and Emotions

• How do you quantify the downstream cost when a specialty workflow fails — what gets measured and what is invisible?
• Which of these consequences have you observed from specialty failures (select all that apply)? Options: Increased hospital readmissions, Member churn / leakage, Higher medical spend, Adherence decline, Provider dissatisfaction, Manufacturer complaints, Regulatory risk
• How do these failures affect provider relationships and willingness to prescribe specialty therapies for your members? Options: Significantly reduces willingness, Somewhat reduces, No change, Improves trust in rare cases, Unsure
• When a high-severity failure occurs, what immediate steps are taken and who signs off on remediation?
• Thinking emotionally for a moment: how do these recurring issues affect your team's morale or confidence in your specialty network? Options: Saps confidence regularly, Creates periodic stress, Neutral, Motivates improvement, Other

The Member Journey: Stories That Stick

• Tell us about a member experience that made you uncomfortable—what went wrong and why it still matters?
• Which patient touchpoints do members complain about most often (select up to three)? Options: Prior authorization delays, Confusing benefit/cost info, Missed or late shipments, Poor clinical counseling, Difficult copay assistance access, Fragmented transitions from hospital
• How do members typically report issues—call center, provider, online portal, case manager? Which path produces the fastest resolution? Options: Call center, Provider, Online portal, Case manager, Manufacturer hub, Other
• What are your target member experience metrics for specialty therapy (select all that apply)? Options: First-fill abandonment rate, PA turnaround time, Adherence (PDC/MPR), NPS / satisfaction, Cold-chain delivery success, Time-to-first dose
• Share one brief patient story where exceptional specialty pharmacy support made a measurable difference for the member — what changed?

What Would ‘Zero Friction’ Actually Feel Like?

• If you could eliminate one recurring specialty friction today, which would move the needle most and why?
• What realistic SLA targets would make you feel confident in a specialty partner (select all that apply)? Options: PA turnaround within 24 hours, First contact with patient within 24 hours of script, Ship next-day for standard items, Cold-chain delivery success > 99%, Adherence outreach within 3 days of missed refill
• Which outcome metrics must be included in reporting to justify value-based contracting? Options: PA speed, First-fill rates, Adherence (PDC), Clinical outcomes specific to therapy, Hospital readmission reductions, Patient satisfaction (NPS)
• How frequently would you want joint performance reviews and what format works best (dashboard, deep-dive quarterly, ad-hoc RCA)? Options: Real-time dashboard, Weekly operational syncs, Monthly summaries, Quarterly deep dives, Ad-hoc RCA as needed
• What would need to be demonstrably different inside 90 days for you to call an initial pilot a success?

Trade-offs and Hard Constraints We Can’t Ignore

• What contractual or regulatory constraints are non-negotiable for any specialty solution we propose?
• Which of these constraints apply to your program (select all that apply)? Options: Limited distribution drug restrictions, State-by-state licensing limits, Formulary / step therapy rules, Patient privacy / data-sharing limits, Medicare / Medicaid-specific rules, Manufacturer contracting terms
• What budget or procurement timelines are driving your decision process? Options: Next quarter, Immediate / within 30 days, Within 6 months, Longer than 6 months, Unclear
• Where have past vendors tried to workaround constraints and failed — what should we avoid trying to do?
• If we proposed a phased approach that required waiving one internal preference temporarily, which preference would you be most open to re-evaluating? Options: Specific integration method, Vendor exclusivity, SLA levels in pilot, Reporting cadence, Other

Small Changes, Big Wins: Where to Start

• What one operational fix could be implemented in 30–90 days that would visibly improve member experience?
• Which quick-win areas do you prefer (select up to two)? Options: Faster PA routing, Automated ship notifications, Dedicated discharge coordination, Cold-chain vendor validation, Targeted adherence outreach, Reporting refresh
• Who would need to own these pilot activities from your side (titles or teams)?
• What minimum success signal would make a 90-day pilot worth expanding? Options: % reduction in PA time, % drop in first-fill abandonment, Improved adherence (absolute gain), Fewer cold-chain incidents, Positive provider feedback
• Are there specific patient cohorts you’d prioritize for a pilot (by disease, geography, or risk)? Please list and explain why.

Agreement, Data Deliverables, and Decision Rhythm

• What exact data extracts, reports, or artifacts do you need from a specialty partner before you’ll advance to contracting?
• Which of these items must be included in the SOW or contract (select all that apply)? Options: PA SLA, Cold-chain validation and indemnity, Data access / raw feeds, Outcome KPI thresholds, Escalation paths and governance, Training and onboarding deliverables
• What is your target decision timeline and what approvals are required to move from pilot to enterprise? Options: Within 30 days, 30–60 days, 60–90 days, More than 90 days, Unsure
• Who are the three people we should loop into a weekly operational sync as we stand up a pilot (name, title, best contact)?
• What would success look like at the end of our initial engagement and how will you measure it?

Getting Oriented: Who's in the Room?

• Which stakeholder type are you representing in this conversation? Options: Health plan (payer), PBM, Hospital system, Network management, Pharmacy director/VP specialty, Medical director, Other
• Who will be directly involved in the decision and implementation (select all that apply)? Options: Pharmacy director / VP specialty, Medical director, Network contracting, PBM contracting / ops, CIO / IT, Care management / case mgmt, Provider relations, Other
• What is your target timeline to select and onboard a specialty pharmacy partner? Options: Immediately / <30 days, 1-3 months, 3-6 months, 6-12 months, No fixed timeline
• Briefly describe a prior experience with a specialty pharmacy that shaped your expectations (what went well or poorly?).
• Which top outcomes are you most focused on achieving with a partner? (pick up to three) Options: Faster prior authorization turnaround, Lower first-fill abandonment, Reliable cold-chain delivery, Improved adherence, Better patient satisfaction, Transparent outcomes reporting, Access to limited distribution drugs (LDDs)
• How will your organization measure success at 6 months and at 12 months? Please name the key metric(s).

What Keeps Your Leaders Up at Night?

• If you had to name the one recurring problem that costs you the most money, time, or credibility today, what would it be?
• Which failure modes do you observe most frequently in specialty drug journeys? Options: Prior authorization delays/denials, Cold-chain delivery failures, First-fill abandonment, Breakdowns during discharge transfers, Data/reporting gaps, Limited distribution drug access issues, Adherence drop-off
• How long have these problems been recurring in your organization? Options: Under 6 months, 6–12 months, 1–3 years, 3+ years, Varies by issue
• Tell us about a recent case that demonstrates how this problem affected a member or your operations.
• In what ways do these failures show up politically or emotionally inside your organization (e.g., blame, risk aversion, executive pressure)?

Where Does the Process Break Down?

• Where in the specialty workflow do handoffs most frequently stall or fail? Options: Benefits investigation, Prior authorization submission, Clinical documentation/medical necessity, Prescriber communication, Dispensing/fulfillment, Shipping / cold-chain, Post-dispense adherence follow-up, Reporting/reconciliation
• For prior authorizations specifically, what is your average turnaround today and what would you consider acceptable? Options: <24 hours, 24–48 hours, 48–72 hours, >72 hours, We don't track
• What are the top reasons PAs are delayed or denied in your experience? Options: Missing clinical documentation, Prescriber unavailable / slow response, Formulary / benefit misalignment, Coding or authorization errors, Step therapy requirements, Other
• Describe a recent cold-chain or shipping failure and its downstream impact on therapy or care.
• Which data connections exist today and which would you need the pharmacy to support (select all that apply)? Options: Real-time EHR/e-prescribing integration (APIs), Batch claims feed (SFTP), HL7/CCDA clinical summaries, Prior auth portal/electronic PA, Lab results feed, None of the above
• Who currently owns escalation when a member's specialty therapy is at risk? Options: Pharmacy operations, Care management / case management, Provider office, PBM, Member services, Other
• How timely and granular is the vendor performance reporting you receive today? Give an example of a report you rely on.

If You Could Snap Your Fingers, What Would Change?

• Imagine the specialty junction ran perfectly for your members—what three outcomes would immediately make you feel relieved and proud?
• Which of the following outcomes must be measurable from day one versus desirable over time? Options: PA turnaround time, First-fill abandonment rate, Cold-chain delivery success rate, Adherence at 3/6/12 months, Time to therapy (days), Member satisfaction (NPS)
• What numeric targets would you set for your top one or two priority metrics (e.g., PA <48h, first-fill >90%)?
• Which patient cohorts or drug classes would you prioritize to demonstrate early impact? Options: Oncology (injectables/infusibles), Biologics (autoimmune), Multiple sclerosis, HIV / infectious disease, Rare disease / high-cost meds, Limited distribution drugs (LDDs), Transitions-of-care discharges
• What would a near-term failure look like to you—how would you know things weren’t working in the first 90 days?

What Would It Take to Trust a Partner?

• What evidence or proof would instantly move a skeptical director to say, 'we can rely on this pharmacy'?
• Which of the following proof points matter most before you finalize a partnership? Options: SLA guarantees with penalties, Reference customers in our vertical, Audited cold-chain logs and temperature telemetry, Claims- and clinical-level outcomes data, Security and HIPAA certifications, Third-party accreditation (URAC, ACHC)
• How would you prefer to validate cold-chain reliability during evaluation? Options: Live shipment telemetry during pilot, Third-party cold-chain audit, Historical incident and resolution reports, Photographic delivery evidence, Other
• What are the non-negotiable 'red lines' that would make you walk away from a prospective pharmacy partner?
• Who in your organization must sign off on operational readiness versus technical integration (name roles or teams)?
• Are you open to a staged ramp or pilot tied to defined KPIs before full roll-out? Options: Yes — with defined KPIs and go/no-go gates, Yes — but KPIs are flexible, No — full integration required up front, Unsure

Money, Contracts, and Value — What's Non-Negotiable?

• If your CFO could lock in one contractual promise, what would it be (cost certainty, penalties, data rights, etc.)?
• Which contracting structures are you most comfortable negotiating with a specialty pharmacy? Options: Fee-for-service, Fixed PMPM, Shared savings, Outcome-based/value-based, Pay-for-performance (penalties and bonuses), Capitated arrangements
• Which operational KPIs would you be willing to tie to financial incentives or penalties? Options: PA turnaround, First-fill abandonment, Adherence improvement, Cold-chain failure rate, Time-to-therapy, Reporting delivery timeliness
• What reporting cadence and level of data access do you require to feel confident in a value-based arrangement? Options: Daily operational dashboard, Weekly exceptions report, Monthly executive summary + raw data extract, Quarterly outcomes deep-dive, On-demand raw data access
• Which legal or compliance clauses typically add the most negotiation time for you? Options: Data sharing and privacy, Indemnification, Liability caps, Audit rights, Subcontracting restrictions, Termination language
• Describe your preferred governance cadence (stakeholders, frequency, and escalation path) to manage contract performance.

Operational Reality Check: Can You Launch on Day One?

• If we attempted to go-live on the planned date, what single operational gap would most likely derail that launch?
• Which integrations are currently live, which are planned, and which would require new builds? (select all that apply) Options: EHR e-prescribing API, Electronic prior authorization portal, Eligibility/benefit feed, Batch claims extracts (SFTP), Lab results feed, Provider messaging (secure), None of the above
• Do you have named owners or simply roles assigned for launch activities across pharmacy, IT, network, and PBM? Options: Named owners with contact info, Owners by role only, No owners assigned yet, Other
• What test data sets are available now for pre-deployment validation (patient roster, prior auth backlog, historical claims)? Options: Full masked test data available, Partial/masked data available, Synthetic data only, No test data available
• What internal approvals, security reviews, or vendor onboarding steps remain before systems can be connected live?
• Who will be the day-one escalation contact for clinical, IT, and logistics issues? Please provide roles and preferred contact method.
• Realistically, how many weeks would you commit to for pre-deployment validation and end-to-end testing? Options: 1–2 weeks, 3–4 weeks, 1–2 months, 3+ months, Unsure

Your Minimal Viable Pilot — Let's Make It Unavoidable

• If you only ran a 90-day pilot, what single outcome would compel you to expand the program?
• Which patient population or product scope should the pilot include to prove meaningful value? Options: Specific drug list (provide names), Therapeutic area (e.g., oncology, autoimmune), High-cost members only, Transitions-of-care discharges, Limited distribution drugs only, New starts only
• What minimum sample size or volume would you require to consider pilot results statistically or operationally credible? Options: 25–100 patients, 100–500 patients, 500–1,000 patients, Over 1,000 patients, Unsure / depends on cohort
• Which go/no-go gates should we include at 30, 60, and 90 days? Options: PA turnaround met, First-fill rate threshold, Cold-chain failure under target, Adherence improvement observed, Reporting delivered on time, Member satisfaction target
• How would you like remediation steps, root cause, and owner assignments to be documented and tracked during the pilot? Options: Shared ticketing system (preferred), Weekly remediation report, Dedicated war room calls, Email threads with summaries, Other
• Who from your side should sit on the pilot steering committee and how often should the committee meet?
• Realistically, how soon could you begin a pilot once scope and contracts are agreed? Options: Immediately / <2 weeks, 2–4 weeks, 1–2 months, 3+ months, Depends on integrations

Who's in the Room (and who needs to be?)

• Which people or teams from your organization will actively participate in selecting and standing up a specialty pharmacy partner? Options: Pharmacy Director/VP Specialty, Medical Director, Network Management, PBM Contract Team, IT/Integration Lead, Care Management/Case Managers, Legal/Compliance, Finance, Other (please name)
• Who holds final decision authority for awarding the specialty pharmacy contract? Options: Pharmacy Director/VP Specialty, Medical Director, Chief Medical Officer/Executive Sponsor, PBM Lead/Director, Procurement/Contracts, Cross-functional committee, Other (please specify)
• What is your target timeline for selection → contract → go‑live? Options: Immediate (30 days), Near-term (31–60 days), Quarter (61–90 days), 2–6 months, 6+ months, Undetermined
• Which success metrics will determine whether this partnership is a win for your organization? Options: PA turnaround time, First‑fill abandonment rate, Medication adherence (PDC/ MPR), Cold‑chain delivery success, Patient satisfaction/experience, Total specialty spend trend, Readmissions/clinical outcomes, Data/reporting completeness, Other (please specify)
• Are there mandatory constraints we must honor (e.g., existing LDD relationships, vendor exclusions, contract clauses or state regulatory limitations)? Please list.

Why are we still treating prior authorization as a sunk cost?

• How long (on average) does a specialty PA take from initiation to approval in your environment today? Options: <24 hours, 24–48 hours, 48–72 hours, 3–7 days, >7 days, Unknown
• Who typically initiates the PA and who completes it (roles and vendors)? Options: Prescriber office, In‑house pharmacy team, External prior auth vendor, PBM, Patient/caregiver, Other (explain)
• What are the top three root causes for PA delays you encounter (be specific: documentation, clinical justification, missing forms, payer rules, electronic routing, staffing)?
• What percentage of your PAs are submitted and adjudicated electronically versus phone/fax/manual? Options: >90% electronic, 60–90% electronic, 30–59% electronic, <30% electronic, Unknown
• Tell us about a recent PA that caused a serious member or clinical impact—what happened and how did it feel for clinicians and the patient?

Where members get left behind — why first fills still fail

• What is your current first‑fill abandonment rate for specialty therapies, and how is this measured? Options: <5%, 5–10%, 11–20%, >20%, Unknown / not measured
• When a member abandons a first fill, what are the most common reasons you see? Options: Cost/copal assistance gaps, PA delays/denials, Shipping or cold‑chain delays, Patient confusion about self‑admin, Clinical side‑effect concerns, Care transition failures (hospital→home), Other (please explain)
• Do you have documented handoffs for hospital discharge → specialty pharmacy? If so, where do they tend to break down? Options: Yes — robust, Yes — inconsistent, Planned but not implemented, No documented handoffs, Other (explain)
• Share a recent member story where the logistics (shipping, PA, or coordination) made the difference between therapy start vs. avoidable delay.
• Which interventions have you already tried to reduce first‑fill abandonment, and what worked vs. what didn’t?

Cold chain is a promise — what happens when it breaks?

• How do you currently validate a specialty pharmacy’s cold‑chain process before launch? Options: Third‑party temperature validation, Vendor self‑attestation, Site visit/audit, Sample shipping tests, SLA with penalties, No formal validation
• What temperature breach threshold and remediation timeline would you require to consider an incident acceptable vs. critical? Options: Any breach unacceptable — immediate remediation, Breach within X hours acceptable with replacement, Specific temperature range tolerated with documentation, No firm threshold — depends on drug, Undecided / need guidance
• How many cold‑chain incidents have you documented in the last 12 months, and what were the member impacts? Options: 0, 1–2, 3–5, 6+, Unknown
• Who in your organization would own cold‑chain escalation, remediation, and communication to members and providers? Options: Pharmacy Director, Clinical Ops / Care Management, Quality & Risk, Vendor Management, Legal/Compliance, Other (specify)
• If a cold‑chain failure costs you a patient’s trust or a clinical setback, what would you need the pharmacy partner to do within 24–72 hours to restore confidence?

Data: What decisions are you making in the dark?

• Which data feeds are essential for you to manage specialty spend and outcomes (pick all that apply)? Options: Claims adjudication, Real‑time dispensing/fulfillment, PA status and reasons, Adherence and refill history, Cold‑chain telemetry, Clinical outcomes/progress notes, Patient satisfaction surveys, Inventory/LDD availability, Other (specify)
• How do you prefer those feeds delivered or integrated (select all that apply)? Options: HL7 interfaces, FHIR APIs, Secure SFTP/flat files, Dashboard & scheduled reports, Direct EHR messaging/eRx integration, Manual reports (CSV/PDF), Other (specify)
• Which reporting cadence and SLAs do you require for operational KPIs (e.g., PA aging, first‑fill status, cold‑chain breaches)? Options: Real‑time / near‑real‑time, Daily, Weekly, Monthly, Ad‑hoc on request, Undecided
• What legal, privacy, or contractual constraints limit how much member data you can share with or receive from a specialty partner? Options: HIPAA constraints, State privacy laws, Existing OEM/manufacturer NDAs, PBM contract clauses, None / minimal, Other (explain)
• Describe a recent time when a lack of data led to a missed opportunity or a bad outcome—what would timely data have changed?

If outcomes mattered more than process, what would you change first?

• Which measurable outcomes would make you willing to shift volume or payment to a specialty partner? Options: Reduced PA turnaround to X hrs, Lower first‑fill abandonment by Y%, Increase adherence PDC to Z%, Reduce readmissions for specialty patients, Improved patient satisfaction scores, Achieve manufacturer outcome benchmarks, Other (specify)
• What target thresholds (numbers) would you define as an acceptable success for a 6‑month pilot?
• How comfortable are you with outcome‑linked contracting that includes financial upside/downside tied to these metrics? Options: Very comfortable, Somewhat comfortable, Interested but need framework, Not comfortable
• Which patient cohorts or therapy classes would you prioritize for outcome‑based pilots (e.g., oncology injectables, biologics, MS, HIV)? Options: Oncology injectables, Autoimmune biologics, Multiple sclerosis, HIV/antiretroviral specialty, Hep C/curative therapies, Rare disease therapies, Other (specify)
• If we could guarantee one improved outcome in 90 days, which would be most valuable to your executive sponsors and why?

Small bets that prove this will work — what’s your smallest test?

• What is the smallest, fastest pilot you would accept to validate partnership capabilities (population size, therapy class, duration)? Options: Single drug / 30–60 patients / 30 days, Single clinic / 30–90 patients / 60–90 days, Regional cohort / 100+ patients / 3 months, Phased roll by product family / 3–6 months, Undecided — need recommendations
• Which acceptance criteria would make the pilot an unambiguous success (link metrics, tolerances, and reporting cadence)?
• What resources and approvals must be in place before a pilot can start (data access, EHR integration, patient consent, formulary changes)? Options: Data access/feeds, EHR/eRx integration, Patient consent or opt‑in, Formulary / benefit design updates, Budget/contract holdbacks, Training for care coordinators/prescribers, Other (specify)
• Who would be the day‑to‑day owners on your side for a pilot and who is the executive sponsor we should brief on results?
• What are the three biggest blockers that would stop you from launching a pilot within your target timeline? Options: Legal/contract delays, Data/integration gaps, Budget constraints, Stakeholder alignment issues, LDD/vendor conflicts, Clinical resistance, Other (explain)