Specialty Pharmacy Network Types
| Network Type | Description | Savings Potential | Member Impact |
|---|---|---|---|
| Open network | Any accredited specialty pharmacy | Low | Maximum access |
| Preferred network | Preferred pharmacies with lower cost-sharing | Medium (10–15%) | Moderate — incentive to use preferred |
| Exclusive network | One specialty pharmacy for all specialty drugs | High (15–25%) | Limited — must use exclusive pharmacy |
Exclusive Specialty Pharmacy
Exclusive specialty pharmacy networks — limiting specialty dispensing to one pharmacy — maximize savings through volume concentration. The exclusive pharmacy offers better pricing in exchange for guaranteed volume. Exclusive networks can save 15–25% on specialty drug costs — but require strong member communication and exception processes for members who cannot use the exclusive pharmacy.
Performance Guarantees
Pro Tip
Specialty pharmacy network contracts should include performance guarantees: (1) dispensing accuracy rate (99.9%+); (2) time-to-dispense (24–48 hours for urgent; 5 days for routine); (3) adherence rate (>80% for chronic specialty medications); (4) member satisfaction score (4.0+/5.0); and (5) clinical outcomes metrics. At-risk fees tied to performance guarantees align specialty pharmacy incentives with plan goals.