A short snapshot of your maintenance pharmacy picture

• Tell me the current split of maintenance fill volume between retail 30-day and home mail-order 90-day, by percentage. Options: 0-20% mail-order, 21-40% mail-order, 41-60% mail-order, 61-80% mail-order, 81-100% mail-order
• List the top five maintenance medications by paid-claim volume you want us to evaluate first.
• On average, how many members per month request a prescription transfer for a maintenance medication? Options: 0-50, 51-200, 201-1,000, 1,001-5,000, >5,000
• Describe your target timeline from receiving a transferred prescription to the patient's first doorstep delivery for a 90-day supply.
• Name the single per-prescription cost metric you use to evaluate mail-order versus retail in your budget reviews. Options: Net ingredient cost per fill, Total allowed cost per fill, Employer paid amount per fill, Average cost after rebates, Other

Where the real costs hide in your claims

• How many line items in last quarter's maintenance spend were more than 20% above the corresponding mail-order unit cost? Options: None, 1-10, 11-50, 51-200, >200
• When you model per-prescription savings, which inputs create the biggest swing in projected plan savings? Options: Contracted drug price variance, Dispensing fees at retail, Adherence-driven utilization, Shipping and cold-chain premiums, Return and short-fill rates
• Who in your finance or benefits organization is accountable for the pharmacy budget assumptions we would need to validate? Options: Pharmacy Director, Benefits Director, CFO, Procurement lead, Steering committee
• Estimate the share of your top 50 maintenance medications where 90-day supplies are clinically appropriate without additional clinical review. Options: 0-20%, 21-40%, 41-60%, 61-80%, 81-100%
• If we cannot validate a consistent per-prescription unit cost reduction on your top 50 meds, would that stop this project? Options: Yes, stop the project, No, continue with other goals, Depends on other metrics

Where patient experience and pharmacist relationships create risk

• Who gets the first call when a member is upset about moving from their local pharmacist to home delivery? Options: Member services, Benefits team, Pharmacy director, HR/employee relations, Other
• Tell me a recent example where member loyalty to a retail pharmacist blocked an enrollment effort and what happened next.
• How often do member complaints about mail-order enrollment escalate to leadership or become media issues? Options: Almost every rollout, Occasionally, Rarely, Never
• Which member segments do you expect will resist voluntary enrollment the most? Options: Seniors with complex regimens, Rural members with delivery concerns, Members with strong local pharmacist ties, Unionized workforces, Low digital literacy populations
• If 15% of members impacted by a mail-order shift filed formal complaints during pilot rollout, would you pause a mandatory rollout? Options: Yes, pause, No, proceed, Only for specific cohorts

Clinical complexity that changes fulfillment and eligibility

• Name any high-volume or high-cost medications on your list that require cold-chain or other special handling for delivery.
• Describe the clinical eligibility rules you currently use for 90-day fills, for example controlled substances, dose titration windows, or clinical monitoring requirements.
• Estimate the percentage of members on insulin or specialty injectables who need refrigerated shipment today. Options: 0-10%, 11-25%, 26-50%, 51-75%, 76-100%
• Give an example of a therapeutic substitution or formulary block that historically prevents a 90-day mail-order conversion.
• Is inability to support cold-chain shipment for a defined cohort an immediate deal breaker for your plan? Options: Yes, for those cohorts, No, we can exclude those members, Depends on cost impact

Integration, data readiness, and implementation gates

• Name the single enrollment data extract (for example, member eligibility with Rx IDs) you cannot start without.
• Explain which systems we must integrate with to automate transfers and enrollment, for example your claims system, EHR connectivity, or member portal.
• Which of these integration capabilities does your IT team already expose and can provide in the next 4–6 weeks? Options: Member eligibility feed, E-prescribing connectivity, Claims reconciliation API, Provider directory exports, None of the above
• Do you have a named owner and at least one dedicated FTE to coordinate prescription transfers and prescriber outreach during pilot? Options: Yes, owner and FTE assigned, Owner assigned but no FTE, No assigned owner yet
• Which regulatory or legal approvals could delay launch if they are not completed in the next 6 weeks? Options: Privacy/Data use agreement, Benefit plan amendment, State pharmacy registration, Clinical committee approval, None
• If the member eligibility extract or API is delayed beyond your target start date, would that cancel the pilot within your timelines? Options: Yes, cancel, No, we will adjust timeline, Only for enterprise-wide pilots

Obstacles and contingencies you already anticipate

• Where in your current fulfillment chain do deliveries most often fail or get delayed for maintenance meds? Options: Last-mile delivery, Fulfillment accuracy, Temperatures on transit, Pharmacy review delays, Provider/authorization holds
• In your last rollout or vendor change, what was the single operational failure that caused the most member harm or escalations?
• To what extent do rural ZIP codes or high-weather-risk areas affect your willingness to mandate mail-order? Options: Major constraint, Moderate constraint, Minor constraint, Not a constraint
• Which contingency would you require for temperature-sensitive medications during extreme-weather outages? Options: Alternate hub shipment, Local pharmacy fallback, Delayed shipment with notification, Special courier service
• What single operational risk, if unresolved, would make you abandon a launch plan entirely?

Competitive landscape and internal options

• List the external vendors and any internal solutions you are actively considering as alternatives to a mail-order partnership.
• Which features of the incumbent or an internal build do you view as most defensible and would need to be matched for you to stay with them? Options: Lower unit cost, Local pharmacy access, Cold-chain capability, Faster first-fill turnaround, Member portal experience
• Has anyone inside your organization proposed solving this without an outside partner, and if so, what resource gap prevents that from being fully viable? Options: Yes, implementation headcount, Yes, technology/integration gaps, Yes, lack of cold-chain ops, No internal proposal
• What would have to be true about your current approach for you to keep it instead of switching to an external mail-order partner?
• If an incumbent matched price but could not guarantee cold-chain for specialty injectables, would you still consider them? Options: Yes, No, Only with exceptions

The acceptance criteria that move this from pilot to program

• Identify the specific metric and threshold a pilot must hit for your executive team to approve a broader rollout within 30 days.
• Rate how important each of these pilot outcomes is to your decision: per-prescription cost reduction, on-time delivery rate, fulfillment accuracy, voluntary enrollment rate. Options: Critical, Important, Nice to have, Not important
• List the internal approvals and sign-offs that will still be required even if the pilot meets your targets.
• Which governance cadence do you require after launch to keep the program open and address issues? Options: Weekly during pilot, Biweekly for 3 months, Monthly ongoing, Quarterly
• If the pilot proves the cost and delivery numbers you need, what is the fastest realistic contract execution timeline for your organization? Options: Immediately (1–2 weeks), Within a month, 1–3 months, Longer than 3 months

Next steps, timing, and the decision accelerators

• Share the target launch window you are aiming for if the pilot meets expectations. Options: Start within 4 weeks, Start in 4–8 weeks, Start in 2–3 months, TBD
• Which internal stakeholder group must be present at the kickoff to keep the timeline intact? Options: Pharmacy operations, Benefits leadership, Finance/CFO office, IT/integration team, Legal/compliance
• Would you consider a cohort-based rollout (high-volume medication groups first) to reduce member disruption? Options: Yes, cohort rollout, No, full population, Only voluntary cohorts
• Describe the single next step we should take together that would most reduce timeline risk for your team.
• Finally, are there any hard stop dates—budget reviews, union negotiations, or open enrollment windows—that would force a decision by a set date? Options: Yes, within 4 weeks, Yes, within 1–3 months, No hard stop, Unsure

• Fulfillment & Savings Experience

• Confirm the current state and its cost
• You confirm the demonstrated cost comparison produces the expected per-prescription savings on your top-volume medications.
• Run a bespoke per-prescription savings analysis on the provided top-50 maintenance medications and deliver the comparison before the follow-up session.
• You confirm the cold-chain workflow and SLAs satisfy temperature control and delivery reliability for insulin and specialty injectables.
• Proof: Savings scenario on your top-volume medications
• Provide a de-identified sample of claims or the top-volume medication list and any recent turnaround time reports to enable the scenario runs.
• Share ZIP code samples and any temperature-sensitivity rules for members who require insulin or specialty injectables.
• You confirm the automated refill and adherence workflows eliminate the transfer gaps and membership complaints described in Discovery.
• Proof: Cold-chain fulfillment end-to-end
• Proof: Automated refills and adherence outreach
• You agree on the remaining evidence needed to move toward commercial discussion and a pilot timeline.
• Draft a proposed enrollment cadence and acceptance criteria document for review, including required KPIs for cost, adherence, and delivery SLA acceptance.
• Proof: Rural and exception delivery contingencies
• Validate the future state

• Fulfillment & Savings Experience
• Solution Experience Deck
• Solution Brief — Fulfillment & Savings Experience

• meeting
• slides
• document

• Fulfill 90-Day Maintenance Prescriptions
• High-Volume Robotic Dispensing and Barcode Verification
• Cold-Chain Shipping for Insulin and Injectables
• Pharmacist Clinical Review and Patient Counseling
• Activate Automated Refill Management
• Medication Synchronization and Combined Shipments
• Proactive Adherence Outreach and Missed-Refill Intervention
• Prescription Transfer Coordination with Prescribers
• Member Enrollment Portal Provisioning and Access
• Provide Per-Prescription 90-Day Price Quotes
• Fulfillment Accuracy and Turnaround Time Reporting
• Formulary Alignment and Therapeutic Substitution Execution

Fulfill 90-Day Maintenance Prescriptions

• Do you intend to convert current retail 30-day fills to voluntary 90-day mail-order enrollment for eligible members? Options: Voluntary only, Voluntary with timed mandate after pilot (e.g., 60-90 days), Hybrid by therapeutic class, Not converting at this time
• How many members do you expect to enroll in month one based on your top 50 maintenance medications? Options: Less than 500, 500-2,000, 2,001-10,000, More than 10,000
• Identify which of your top 50 maintenance medications (provide NDCs or generic names) should be prioritized for the initial 90-day conversion.
• List the member eligibility rules you require for 90-day fills (for example continuous therapy 60 days, exclusion of controlled substances, specific plan carve-outs).
• When should the voluntary enrollment window close before any mandatory mail-order policy is applied (for example 30 days)? Options: No mandate planned, 30 days, 60 days, 90 days
• Who in your benefits or pharmacy team will own enrollment approvals and exceptions (name or role)?

High-Volume Robotic Dispensing and Barcode Verification

• Describe the verification steps you require from automated dispensing (barcode scan, weight check, pharmacist review) for each NDC. Options: Barcode scan at dispense, Weight or dimension check, Pharmacist clinical review before release, Automated image verification
• Specify the per-NDC monthly volume threshold that qualifies a drug for high-volume automated processing. Options: Less than 100 scripts/month, 100-1,000 scripts/month, More than 1,000 scripts/month, No volume threshold
• Are there controlled substances or Risk Evaluation and Mitigation Strategy (REMS) drugs that must be excluded from robotic dispensing? Options: Yes, No
• Select which reconciliation reports you need from the dispensing line and their frequency (pick error log, near-miss, lot recall trace). Options: Daily pick error log, Weekly near-miss summary, Monthly lot traceability report, Real-time exception feed
• Provide the expected integration points with your adjudication or claims system required for dispensing workflows (for example BIN/PCN feed, NCPDP real-time eligibility).
• Estimate the acceptable manual intervention rate for robotic-processed fills expressed as a percentage of total automated fills. Options: Less than 0.1%, 0.1% to 0.5%, 0.6% to 1%, Greater than 1%

Cold-Chain Shipping for Insulin and Injectables

• Confirm the temperature ranges you require for specific product groups and list affected NDCs (for example insulin 2-8 C, some biologics 2-8 C, select injectables 15-25 C).
• Outline the packaging type you require by product group (phase-change gel packs, dry ice, active refrigeration, insulated shippers). Options: Phase-change gel packs, Dry ice with validated shippers, Active refrigerated container, Insulated passive shippers with coolant
• Indicate which shipments must include a tamper-evident temperature logger versus a batch-level temperature summary. Options: All refrigerated shipments, High-cost biologics only, On request for specific NDCs, Batch-level summary only
• Name any rural ZIP codes or delivery zones where you will accept extended transit times for refrigerated products and provide expected delivery tolerances.
• Will you require a per-shipment tamper-evident temperature logger or chain-of-custody report to validate cold-chain compliance at delivery? Options: Yes, per-shipment logger required, Batch-level reporting acceptable, Conditional by NDC and value, No, not required

Pharmacist Clinical Review and Patient Counseling

• For initial dispensing of chronic therapies, which clinical checks must be completed and documented (renal dosing, drug interactions, duplicate therapy)? Options: Renal dosing check, Drug-drug interaction check, Duplicate therapy screening, Therapeutic monitoring requirement
• Where do you want pharmacist counseling notes stored and shared (member profile, clinical dashboard, or sent to prescriber portal)? Options: Member profile, Clinical dashboard, Send to prescriber portal, Secure messaging archive
• Choose the counseling channels you want available to members for initial and follow-up consults. Options: Phone, Video, Secure messaging, In-person by arrangement
• State the maximum time after first dispense when a pharmacist must complete initial counseling outreach (in hours or days). Options: 48 hours, 72 hours, 7 days, 14 days
• Acceptable documentation for pharmacist interventions includes which artifacts (recorded call logs, signed counseling summary, message thread)? Options: Recorded call log, Signed counseling summary, Secure message thread, Clinical note in member file
• Detail your clinical escalation criteria that require prescriber notification (for example dose change, serious drug interaction, lab monitoring required).

Activate Automated Refill Management

• Explain whether you want automatic refill enrollment by default or opt-in for eligible members and which cohorts qualify. Options: Auto-enroll by default, Opt-in only, Auto-enroll with easy opt-out, Phased opt-in by cohort
• Measure the refill reminder cadence you prefer before the medication is due (for example 7 days, 14 days, 30 days) and indicate per therapy tier if different. Options: 7 days before, 14 days before, 30 days before, Custom per therapy tier
• Set the channels we should use for refill reminders for your population. Options: SMS, Automated call, Email, Mobile app notification
• Assign which medication edits should flag a refill for pharmacist review (dose change, new prescriber, DAW code). Options: Dose change, New prescriber, DAW present, Early refill request
• Determine the integration method for your eligibility and claims adjudication required for automated refills (SFTP file feed, API eligibility check, daily batch). Options: SFTP file feed, Real-time API, Daily batch upload, No integration needed
• Report which adherence thresholds should trigger outreach (for example proportion of days covered under 80 percent or two missed refills). Options: PDC < 80%, Two missed refills, MPR < 80%, Custom threshold

Medication Synchronization and Combined Shipments

• Authorize which patient segments are eligible for medication synchronization (for example polypharmacy defined as 5+ meds, chronic disease cohorts, high-cost drug users). Options: Polypharmacy (5+ meds), High-cost drug users, Specific chronic disease cohorts, All eligible maintenance members
• Require a synchronization window that aligns refill dates; which window do you prefer for the first phase? Options: 7 days, 14 days, 30 days, Custom
• Allow combined shipments for multiple therapies; are there medications you want excluded from combined shipping (controlled substances, refrigerated items)? Options: Exclude controlled substances, Exclude refrigerated items, No exclusions, Other
• Include your desired packaging consolidation rules such as maximum items per box and labeling requirements for multi-med shipments.
• Map how returns, early fills, and partial fills should adjust the synchronized refill dates for a member.
• Upload a sample member medication list to validate synchronization logic for the initial pilot (CSV with NDC, days supply, last fill date) or indicate if you need assistance producing it. Options: I will upload a sample CSV, I need assistance producing the file, Not available at this time

Proactive Adherence Outreach and Missed-Refill Intervention

• Do you want automated adherence outreach channels prioritized for cohorts identified by PDC or MPR? Options: Yes, prioritize high-risk cohorts, No, standard outreach only, Prioritize by cost and risk
• How should missed-refill events be defined for outreach (number of days past expected refill or number of missed refills)? Options: Number of days past expected refill (e.g., 7 days), Count of missed refills (e.g., 1 or more), PDC or MPR threshold
• Identify which member personas should receive pharmacist phone outreach versus automated messaging. Options: High-cost medication users, Multiple chronic conditions, Elderly members, All members
• List the escalation steps after unsuccessful outreach attempts (for example number of attempts, prescriber notification, case management referral). Options: 3 outreach attempts then prescriber, 2 attempts then case management, Immediate prescriber notification, Custom escalation
• When should clinical case management be engaged for adherence failures (for example after 2 missed refills or PDC under 50 percent)? Options: After 1 missed refill, After 2 missed refills, PDC under 50%, Case-by-case
• Who will be the point of contact on your side for reviewing adherence outreach scripts and consent language?

Prescription Transfer Coordination with Prescribers

• Describe the preferred transfer request workflow to prescribers for existing maintenance meds (e-prescribe transfer, secure fax with signed consent, phone call). Options: E-prescribe transfer, Secure fax with signed consent, Phone follow-up, Direct EHR message
• Specify documentation you require from prescriber offices to accept transfer requests (signed patient consent, original prescription, prescriber NPI). Options: Signed patient consent, Original Rx copy, Prescriber NPI and contact, Authorizing form
• Are there prescriber offices or EHRs you know will not accept electronic transfer that require manual workflows? Options: Yes, No, Unknown, will provide list
• Select the SLA target for completing prescription transfers from request to active Rx in the pharmacy system. Options: 24 hours, 48 hours, 72 hours, Custom
• Provide any templates or authorization forms you require to be used when requesting transfers from prescribers.
• What evidence will confirm prescription transfer completeness at enrollment (for example transferred Rx in system with correct NDC and days supply and prescriber authorization on file)? Options: Transferred Rx in system with matching NDC and days supply, Scanned prescriber authorization, Confirmation from prescriber office, Other

Member Enrollment Portal Provisioning and Access

• Confirm which authentication methods you require for member portal access (single sign on, date of birth plus last four, mobile one time passcode). Options: Single sign on (SSO), DOB plus last 4, Mobile one time passcode (OTP), Two factor authentication
• Outline the enrollment fields mandatory for benefit verification (member ID, BIN, PCN, group number, primary diagnosis or medication list).
• Indicate which enrollment channels you will use for the pilot and provide estimated volumes per channel (self-service portal, benefits admin CSV upload, phone enrollment). Options: Self-service portal, Benefits admin CSV upload, Phone enrollment, In-person HR enrollment
• Name the administrative users who should receive portal admin access and their required permission levels.
• Which data privacy or consent documents must be displayed during enrollment and retained in the member profile? Options: HIPAA consent, Medication transfer authorization, Terms of service, Other
• Will you require SSO integration with your current identity provider for employee members? Options: Yes, SSO required, No, SSO not required, SSO optional

Provide Per-Prescription 90-Day Price Quotes

• For price comparisons, which baseline should be used (your current retail claims average, a specific retail chain average, or a public benchmark)? Options: Current retail claims average, Specific retail chain average, Public AWP benchmark, Custom comparator
• Where should per-prescription 90-day price quote files be delivered (secure SFTP, API endpoint, encrypted email)? Options: Secure SFTP, API endpoint, Encrypted email, Secure file portal
• Choose the level of detail required in quotes (NDC-line pricing, ingredient plus dispensing fee breakdown, projected member cost share). Options: NDC-line pricing, Ingredient + dispensing fee breakdown, Projected member cost share, All of the above
• State the minimum savings threshold per prescription or percent over retail that will trigger executive approval to proceed.
• Acceptable supporting artifacts for quotes include which items (run-of-service sample, current claims extract, formulary crosswalk)? Options: Run-of-service sample, Current claims extract, Formulary crosswalk, Other
• Detail any rebate pass-through or warranty assumptions that must be reflected in the per-prescription quote.

Fulfillment Accuracy and Turnaround Time Reporting

• Explain the SLA fulfillment accuracy target you expect for go-live (for example 99.9 percent dispense accuracy and 100 percent cold-chain integrity). Options: >= 99.9% accuracy, >= 99.5% accuracy, Custom target

• Master Services Agreement (MSA)
• Statement of Work (SOW)
• Service Level Agreement (SLA)
• Commercial Terms & Order Form
• Enrollment & Acceptance Criteria
• Operational Governance & Escalation Matrix
• HIPAA Business Associate Addendum (BAA) — conditionally required
• Cold-Chain Shipping Addendum
• Reporting & Performance Review Schedule

• Go-live health check (weeks 1-4)
• First outcomes measurement (weeks 4-10)
• Acceptance gate review (around day 90)
• Ongoing quarterly success review

• Confirm the escalation contact list and publish the operating cadence for the next quarter.
• Restate acceptance criteria and targets
• Produce a documented acceptance decision referencing each Mutual Commit criterion as pass, fail, or conditional and capture the buyer's designated acceptance owner.
• If any criteria are conditional or failed, agree a remediation plan with measurable targets and resolution dates.
• Establish the verification process and timeline for confirming remediation items are closed.
• Publish the formal acceptance record showing pass/fail/conditional status for each Mutual Commit criterion.
• Document remediation tasks for conditional items with required evidence and final verification date.
• Schedule a follow-up verification session if any conditional items require additional validation.
• Review quarterly outcomes
• Confirm that realized savings per-prescription and adherence rate remain at or above Mutual Commit thresholds or document corrective actions if they do not.
• Close or re-prioritize the top operational issues from the shared channel with clear next steps and timelines.
• Ensure governance roles and escalation paths are current and understood by both parties.
• Update the shared issues and enhancement channel with agreed prioritization and target delivery quarters.
• Deliver a remediation status report for any metric trending below Mutual Commit targets before the next quarterly review.
• Reconfirm acceptance criteria and owners
• Confirm the deployment completed against the Mutual Commit milestones and that owners for each acceptance criterion are named and reachable.
• Identify top 3 early blockers with remediation actions and target resolution dates.
• Agree the data sources and reporting cadence to be used for the first measurement meeting.
• Publish the deployment validation checklist and evidence of initial dispensing and shipments.
• Record the top 3 blockers with required remediation steps and target resolution dates for tracking.
• Deliver the data extract and methodology to be used for KPI measurement at the next meeting.
• Present first-period outcomes
• Establish whether realized savings per-prescription and enrollment rate are tracking toward Mutual Commit targets and document variance drivers.
• Agree a prioritized remediation plan with clear tasks and dates to address the biggest shortfalls before the acceptance gate.
• Confirm the dataset and acceptance evidence package required for the day-90 decision.
• Produce a variance analysis for each metric missing its Mutual Commit target, including root-cause evidence.
• Implement the agreed corrective actions and publish progress updates twice weekly until the acceptance gate.
• Assemble the acceptance evidence package with data extracts and process logs for day 90.
• Deployment validation
• Operational exceptions and root causes
• Diagnose gaps versus targets
• Present outcome data against each criterion
• Agree corrective actions and timelines
• Document pass/fail per criterion
• Enhancement and issue backlog review
• Early adoption and usage signals
• Confirm readiness for acceptance gate
• Open issues and blockers
• Agree remediation plan for any failed or conditional items
• Governance and escalation check
• Close next steps and evidence submission
• Agree immediate remediation actions