To maximize the patient benefit of drug treatments, preferred specialty pharmacy networks are used to deliver high-quality, accessible pharmacy services. By contracting with select pharmacies, PBMs can ensure consistent care management and access to specialty medications while promoting affordability in the specialty channel.

Payers rely on PBMs to identify the highest-quality and most cost-efficient specialty pharmacies. Due to the proliferation of specialty pharmacies now involved in the acquisition and distribution of specialty products, PBMs create quality standards and metrics to ensure that the specialty pharmacies they contract with offer the highest quality of care in the industry. By contracting with preferred specialty pharmacies, plan sponsors have the potential to:

  • Improve patient adherence,
  • Improve clinical outcomes,
  • Reduce inappropriate utilization,
  • Reduce product waste,
  • Achieve lower unit costs through effective formulary management,
  • Negotiate better discounts from manufacturers, and
  • Reduce non-drug medical care costs.

Any willing pharmacy (AWP) laws assume that all pharmacy services are the same, no matter who provides them or how they are organized. Specialty pharmacy is based on a coordinated care model and requires a higher degree of organization, care management, and clinical knowledge about rare disorders and biologic products than is often available in a retail pharmacy.

Since retail and manufacturer-affiliated pharmacies are not typically equipped to manage the full range of products and services that PBMs and payers require for the distribution and management of specialty drugs, they rely on the technology and expertise of specialty pharmacies to properly dispense these drugs.

Visit the What is a specialty pharmacy network? card stack in the Knowledge Center to learn more.

Resources

White Paper: The Management of Specialty Drugs, sPCMA, February 2016

Drugstore Lobby “Any Willing Pharmacy” Bill Would Increase Costs by $21 BillionPCMA, February 2015

The Impact of Preferred Pharmacy Networks on Federal Medicare Part D Costs, 2014-2023Milliman, October 2013, PCMA sponsored

Medicare Part D Plans Provide the Average Beneficiary Convenient Access to Preferred Pharmacies with Significant SavingsVisante, December 2014, PCMA sponsored

Impact of the Elimination of Preferred Pharmacy Networks on the Medicare Part D ProgramOliver Wyman, March 2014, PCMA sponsored

A Survey of Seniors on Their Medicare Part D Preferred Pharmacy Network PlanHart Research Associates, September 2014, PCMA sponsored

How Pharmacy Networks Could Save Medicare, Medicaid, and Commercial Payers $115 BillionVisante, January 2013, PCMA sponsored

Additional Resources

New Drug Plan Regulations Protect Pharmacies, Harm Consumers, National Center for Policy Analysis, April 2015

Estimating the Budgetary Impact of H.R. 4577, the “Ensuring Seniors Access to Local Pharmacies Act of 2014”, Moran Company, July 2014

2014 Premiums and Star Ratings for Medicare Part D Prescription Drug Plans with Preferred Pharmacy NetworksAvalere Health, December 2013