Specialty Pharmacy Networks

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.