Getting Oriented Together

• Who are you representing in this initiative and in one sentence what outcome do you need from a specialty pharmacy partner?
• Which therapeutic areas or product launches are highest priority for this engagement? Options: Oncology, Autoimmune / Rheumatology, Multiple Sclerosis, Rare genetic disorders, HIV / Hepatitis, Other
• Which internal teams will need visibility or integration with our service (pick all that apply)? Options: Pharmacy operations, Clinical pharmacy team, Care management / case managers, IT/integration, Finance / contracting, Legal / compliance, Provider relations, Other
• How have previous specialty pharmacy relationships performed against your expectations—brief example of a win or a failure?
• What is your ideal decision timeframe for selecting a partner? Options: Immediate (0–30 days), Short (1–3 months), Medium (3–6 months), Long (6–12 months), Undetermined

Why Does Prior Authorization Still Add Weeks?

• Why are prior authorizations still adding weeks — not days — to therapy starts at your organization?
• Where in your PA workflow do cases most commonly stall? Options: Benefits investigation, Clinical documentation gathering, Physician signature / response, Payer manual review, Appeals process, Other
• On average, how long does a typical PA take from submission to approval today? Options: <24 hours, 1–3 days, 4–7 days, 8–14 days, >14 days, We don't track
• What percentage of PAs require an appeal or step therapy override? Options: <5%, 5–15%, 16–30%, 31–50%, >50%, Unknown
• When PA delays occur, what internal escalation paths do you use and who gets visibly accountable?

Who's Really Calling the Shots?

• If you map the last 10 specialty approvals, whose decision or influence changed the outcome most often? Options: Health plan medical director, Pharmacy director, Manufacturer access team, Provider specialty pharmacist, Patient / caregiver, Other
• Which decision roles must be aligned before you’ll sign a contract (select all that apply)? Options: Pharmacy director, Medical director, Finance / CFO, Legal / Compliance, Provider lead, Manufacturer liaison, Operations lead, Other
• What timelines and constraints are non-negotiable from your side (e.g., reporting cadence, SLA hours, handling of LDN requirements)?
• Which single metric would make leadership say this partnership was clearly successful? Options: Faster PA turnaround, Improved adherence, Reduced net cost, Higher patient enrollment in assistance, Reliable LDN participation, Other
• Who typically signs off on acceptance criteria for pilots and how many review cycles are normal? Options: Pharmacy director, Clinical lead, Finance, Legal, Cross-functional committee, Other

Where Patients Most Often Fall Off the Rails

• Which single step in the patient pathway is currently losing the most patients to abandonment? Options: Prior authorization delay, Cost / copay at pickup, Complex enrollment forms, Logistics/cold chain failure, Provider scheduling lag, Other
• Which factors drive patient abandonment most in your population (select all that apply)? Options: Out-of-pocket cost, Complex paperwork, Side effects/fear, Transportation/logistics, Lack of clinical support, Long wait times, Other
• What percentage of newly prescribed specialty patients do not receive their first dose within 30 days? Options: 31–50%, <5%, 5–15%, 16–30%, >50%, Unknown
• Tell us about a recent patient who dropped out — what happened and how did it feel to your team?
• How do you currently measure and report adherence and persistence for specialty therapies? Options: MPR/PDC via claims, Patient-reported outcomes, Pharmacy dispensing data, Clinical registry, We don't have consistent measurement, Other

Cold Chain: The Quiet Risk No One Talks About

• How many times in the past 12 months has a cold-chain breach impacted patient therapy or required dose replacement? Options: None, 1–2 times, 3–5 times, 6–10 times, >10 times, Unknown
• Which cold-chain capabilities are must-haves for you (select all that apply)? Options: Real-time temperature telemetry, GPS-enabled tracking, Redundant packaging validation, 24/7 incident response, On-site storage at clinics, Temperature excursion analytics, Other
• Describe a recent logistics failure (if any) and how it affected patient experience or cost?
• What maximum temperature excursion or time-out-of-range is acceptable before a dose is considered compromised? Options: No excursion tolerated, <1 hour, <4 hours, <24 hours, Depends on product, Unknown
• Which vendors or couriers do you currently trust to handle biologics reliably?

Limited Distribution & Manufacturer Rules: Where Flexibility Dies

• When manufacturer distribution rules change overnight, how quickly can your patients be re-routed without delay — and what usually breaks when that happens?
• Which manufacturers or products in your portfolio require limited distribution today?
• How long does onboarding into a new LDN typically take for you? Options: <2 weeks, 2–4 weeks, 1–3 months, 3–6 months, >6 months, Unknown
• What documentation, accreditation, or security controls do manufacturers demand from partners in your experience? Options: URAC accreditation, ACHC accreditation, Data security attestation, Insurance/certificate of liability, Cold-chain validation, Other
• Has an LDN restriction ever caused a patient to delay or stop therapy? Tell us what happened.

If We Succeed, What Must Change?

• If your CFO asked for a one-line measurable outcome for this program, what would you give them?
• Which of these success signals will you prioritize (pick up to three)? Options: PA speed (time to approval), First-dose delivery rate, Adherence/persistence (PDC/MPR), Financial assistance enrollment rate, LDN availability, Net cost per treated patient, Patient satisfaction
• For the primary signal you picked, what is your target benchmark and by when?
• How do you prefer to receive outcome reporting (select all that apply)? Options: Weekly dashboard, Monthly executive summary, Real-time alerts, Quarterly business review, Monthly CSV/feeds, EHR integration
• Who will be accountable on your side for monitoring and signing off on these outcomes? Options: Pharmacy director, Clinical lead, Contract manager, Operations manager, Provider lead, Other

If We Move Forward, What Would Kill the Deal?

• What are the top three deal-breakers that would cause you to stop a pilot before completion? Options: Missed SLAs, Data/integration failure, Regulatory non-compliance, Poor patient experience, Unclear ownership, Unexpected cost increases, Other
• What integrations or data access must be in place before launch? Options: Claims feed, EHR/EMR integration, Benefits verification API, Patient portal SSO, Courier telemetry feed, None required, Other
• What accreditation, audit, or compliance evidence will your organization require from a partner prior to go-live? Options: URAC, ACHC, SOC 2, State pharmacy licenses, PCI/DSS, Other
• Realistically, what is the earliest date you could start a small pilot if prerequisites were met? Options: Immediately, In 2–4 weeks, 1–3 months, 3–6 months, Later / TBD
• What support from us would make your stakeholders say yes faster (e.g., short technical demo, sample SLA, reference call)? Options: Technical integration demo, Sample contract and SLA, Reference call with similar client, Pilot playbook, Cost model analysis, Other

Getting Comfortable — Who You Are and What You Carry

• Tell us briefly about your organization and the patient populations you most commonly manage (therapeutic areas / conditions / volume).
• Which stakeholders are typically involved when specialty prescriptions move from prescriber to patient (select all that apply)? Options: Other, Medical director, Pharmacy director, Patient services / HUB, Prior authorization team, Field nurses / case managers, Manufacturer liaisons, Third-party logistics (3PL)
• Roughly how many new specialty patients per month do you handle (or expect to handle) across the therapies we’re discussing? Options: < 10, 10–49, 50–199, 200–499, 500+
• Who is the primary operational contact we should map with for workflow details (role and email or phone)?
• What existing performance metrics do you track today that reflect access and start-of-therapy success (e.g., time-to-first-fill, PA approval rate, abandonment %, enrollment in assistance)?

What If Prior Authorizations Never Pushed Back a Start Date?

• How often do prior authorizations delay therapy initiation in your population—more often than you expect, about as expected, or less frequently? Options: More often than expected, About as expected, Less frequently than expected, Unsure
• When a PA causes a delay or denial, where in your current workflow does it most commonly get stuck (clinician submission, payer review, missing documentation, appeals, patient follow-up)? Options: Clinician submission, Payer review, Missing clinical documentation, Step therapy or formulary issues, Appeals process, Patient financial consent or paperwork, Other
• What are the top three reasons payers are denying or placing barriers on approvals today? Please provide examples or recent denial language if available.
• How long is the average round-trip time from initial prescription to PA decision today (in calendar days)? Options: Same day, 1–3 days, 4–7 days, 8–14 days, 15+ days, Don’t track
• Who owns escalation when a PA is urgent—your team, the prescriber, the manufacturer, or the payer—and how comfortable are you with that handoff? Options: Our team, Prescriber office, Manufacturer support hub, Payer, Shared/depends, Not comfortable with current handoff
• Describe a recent PA that took significantly longer than expected—what happened, and how did it impact the patient and budget?

Where Patients Drop Out — And Why It Hurts

• When you think about patient abandonment, what feels most unfair or avoidable about how those patients are lost?
• At what point in the patient journey do most abandonments occur for your therapies (prescription not picked up, PA denied, copay sticker shock, waiting for financial assistance, side effects during induction)? Options: Prescription not picked up, PA denied/slow, Copay or out-of-pocket cost, Waiting for financial assistance, Adverse events or side effects, Logistics/cold-chain scheduling, Other
• How do you currently capture why a patient stopped the process—do you have a structured reason code, frontline notes, or mostly anecdotal tracking? Options: Structured reason codes, Free-text notes, Mixed (codes + notes), We don’t systematically capture reasons, Other
• What percentage of patients who receive a prescription never start therapy today (best estimate)? Options: <5%, 5–14%, 15–29%, 30–49%, 50%+, Unsure
• Which of the following interventions have you tried to reduce abandonment, and which felt most effective? Options: Upfront financial counseling, Rapid PA triage, Home nursing support, Proactive shipping/appointment scheduling, Manufacturer PAP enrollment support, Text reminders / digital outreach, Other
• Share a short story of a patient who nearly abandoned therapy but was retained—what changed and who made the difference?

Unseen Coverage Holes That Keep Coming Back

• If a single payer policy could be rewritten to remove your biggest barrier to coverage, what would you change and why?
• Which benefit design features most frequently block access for your therapies (select all that apply)? Options: Prior authorization requirements, Step therapy, Quantity limits, Specialty carve-outs, Medical vs. pharmacy benefit confusion, Formulary exclusions, Site-of-care restrictions, Other
• How consistent are coverage rules across the payers you work with—mostly uniform, some variation, or highly inconsistent? Options: Mostly uniform, Some variation, Highly inconsistent, Don’t know
• Do you receive real-time benefit verification (RTBV) or are you relying on manual eligibility checks? If manual, how often does benefit info prove inaccurate? Options: RTBV integrated, Partial RTBV, Manual checks (inaccurate often), Manual checks (rarely inaccurate), Unsure
• How frequently do patients face retroactive denials or recoupments after therapy has started, and how is that handled operationally? Options: Never, Rarely, Occasionally, Often, Unsure
• Where do coverage exceptions or appeals tend to succeed or fail—who are the people/processes that win exceptions for your patients?

Cold Chain: Is Your Drug Truly Protected End-to-End?

• When a therapy requires cold-chain handling, what keeps you up at night about its journey from dispenser to patient?
• Which elements of your cold-chain are owned internally versus outsourced (select all that apply)? Options: Refrigerated storage at site, Temperature-monitored transport, 3PL/third-party couriers, Dedicated cold-chain packaging vendors, In-house temperature loggers, Patient home pickup/dropoff, Other
• How often do you experience temperature excursions or delivery failures, and what is your current escalation path when that happens? Options: Never, Rarely (annually), Occasionally (quarterly), Monthly, Weekly, Unsure
• Do you require chain-of-custody documentation and temperature proofs for each shipment today, and how is that information stored or shared? Options: Yes, always (integrated), Yes, but manual files, Sometimes, No, Unsure
• Are there geographic areas or patient settings where cold-chain delivery consistently fails (rural addresses, home freezers, LTC facilities)? Please describe.
• What SLA do you currently promise for cold-chain deliveries, and how often do you meet it? Options: Same day, Next day, 2–3 days, Variable by geography, Do not have SLA, Unsure

Systems That Should Talk — But Don’t

• Imagine real-time visibility into every specialty patient’s status—what decisions would that allow you to make that you can’t make today?
• Which systems do you currently use that must integrate with a specialty pharmacy partner (select all that apply)? Options: EPIC / Cerner / other EHR, e-prescribing (Surescripts), Payer portals, Manufacturer HUB systems, CRM / case management, SFTP / batch files, Custom APIs / EDI, Other
• Do you have existing APIs, SFTP feeds, or HL7/FHIR endpoints available for us to connect to, and what is the expected timeline/IT resource availability for integration? Options: APIs available now, SFTP available now, HL7/FHIR available, No endpoints available, Planning to build, Unsure
• Where do handoffs fail between your systems and external partners today (e.g., lost messages, duplicate records, delayed reporting)?
• What reporting cadence and format do you need (real-time dashboard, daily batch, weekly summary, event-driven alerts)? Options: Real-time dashboard, Event-driven alerts, Daily batch CSV, Weekly summary report, Monthly analytics package, Other
• Who is your technical point of contact for integrations and what firewall/whitelisting requirements do they typically require?

If You Could Snap Your Fingers — The One Fix That Changes Everything

• If one single operational change could cut time‑to‑therapy in half tomorrow, what would it be and why would it matter most to your stakeholders?
• Which of the following outcomes would signal success to you in the first 90 days of a new partnership (select top 2)? Options: Reduced time-to-first-fill, Higher PA approval rate, Lower abandonment %, Fewer cold-chain incidents, Faster financial assistance enrollments, Real-time patient visibility
• What constraints must we respect if we were to implement that change (limited distribution rules, budget caps, contract terms, accreditation requirements)? Options: Manufacturer LDN restrictions, Budget/contract limits, Regulatory controls, Staffing capacity, IT/integration timelines, None
• How would you prioritize trade-offs between speed, cost, and patient experience for this therapy—put them in order (1 = most important)
• Who needs to sign off internally for us to pilot a focused improvement (roles and ideal timeline)?
• What would success look like at 30, 90, and 180 days—please list one measurable metric for each timeframe.

Quick Grounding — Who Are We Launching With?

• Tell us your role and the best contact for launch coordination (name, title, email/phone).
• Which type of organization are you representing today? Options: Health plan / payer, Pharmaceutical manufacturer, Health system / hospital, Integrated delivery network, Other
• Roughly how many specialty prescriptions per month would touch this partnership at steady state? Options: <50, 50–199, 200–499, 500–999, 1000+
• What is your target go-live window for initial patients? Options: Within 30 days, 30–60 days, 60–90 days, 90–180 days, Undetermined
• Which therapeutic areas will be in scope for launch (select all that apply)? Options: Oncology, Autoimmune / Rheumatology, Neurology / MS, Infectious disease / HIV / Hep C, Rare disease / gene therapy, Other
• What single outcome matters most to you in the first 90 days (e.g., faster PA approvals, baseline adherence, zero cold-chain failures)?

If Launching Today Felt Risky, Where Would You Blame?

• What is the single biggest launch risk you worry will stop patients from getting therapy on time? Options: Prior authorization delays, Incomplete benefits info, Cold-chain delivery failure, Limited distribution access denial, Lack of trained staff, Data/integration failure, Other
• Tell a recent story where a similar risk actually happened—what went wrong and who felt the impact?
• How do you typically detect these failures today—manual checks, exception reports, or frontline patient complaints? Options: Automated alerts/reports, Manual reconciliation, Clinician or case manager flags, Manufacturer notification, Patient-reported issues, Other
• Who in your organization is ultimately accountable for resolving that type of issue (title/department)?
• When that risk occurs, how quickly do you need it resolved to avoid patient harm or financial exposure? Options: Within hours, Same business day, 48 hours, 1 week, Longer

Are Your Systems Actually Ready to Talk to Ours?

• Which integrations must be fully functional before we can launch (pick all that apply)? Options: Patient portal / CRM, EHR / EMR (Epic/Cerner/etc.), Payer eligibility APIs, Claims adjudication interfaces, Manufacturer LDN portals, Cold-chain telemetry feeds, Other
• Which EHR / EMR systems and versions are in scope for prescriptions and clinical status feeds? Options: Epic (specify version), Cerner / Oracle, Allscripts, MEDITECH, Other
• How will we exchange protected data—what technical methods are allowed on your side? Options: FHIR APIs, HL7v2 messages, SFTP / batch files, Secure VPN, Proprietary vendor API, Other
• Are there specific security or penetration-testing requirements we must pass before data connections are approved? If so, list them and target dates.
• Do you have a technical sandbox or test environment we can use, and when can we access it? Options: Yes—available now, Yes—available in 2–4 weeks, Planned but not scheduled, No test environment available

Where Do Real-World Workflows Tend to Break Down?

• Which step in the patient journey currently causes the most delay or drop-off for your patients? Options: Benefits investigation, Prior authorization submission, PA approvals/appeals, Patient financial assistance enrollment, Medication dispensing logistics, Cold-chain delivery, Patient onboarding/adherence outreach
• What is your current median time from prescription to first fill for these therapies (choose range)? Options: <48 hours, 48–72 hours, 3–7 days, 8–14 days, 15+ days, Don't track
• Where do handoffs between your teams and external partners most often create friction (describe role-to-role handoff and frequency)?
• What percentage of patients abandon therapy before first fill, and do you track top reasons? Options: <5%, 5–10%, 11–20%, 21–30%, 30%+
• If you had to rank the top three operational chokepoints for this launch, what would they be (ranked list)?

Who’s on the Launch Team — and Are They Empowered?

• Do you already have a named launch lead and cross-functional core team for this program? Options: Named launch lead and team, Named launch lead only, Team identified but no lead, No formal team yet
• List the primary internal stakeholders who will need training or access (roles only: e.g., pharmacy ops manager, payer clinical lead).
• How much dedicated FTE (or percent of FTE) can your organization commit to launch activities over the first 90 days? Options: <0.25 FTE, 0.25–0.5 FTE, 0.5–1.0 FTE, 1.0–2.0 FTE, 2.0+ FTE
• Which training formats work best for your teams (select all that apply)? Options: Live virtual workshops, Onsite training, Recorded modules, Train-the-trainer, Job aids / playbooks, Shadowing in production
• What common organizational barriers have blocked past launches—political, budgetary, operational, or otherwise?

Show Me the Evidence — How Will We Measure Early Wins?

• Which success signals must we demonstrate in the first 30–90 days to call the launch a success? Options: PA turnaround time improvement, PA approval rate, Time-to-first-fill, First-fill adherence, Patient enrollment in assistance, Cold-chain delivery success rate, Real-time status reporting accuracy
• Please provide or summarize current baseline metrics for the top 3 signals you selected above (numbers, timeframes).
• How often do you want operational performance reports during ramp—daily, weekly, monthly? Options: Daily, Twice weekly, Weekly, Biweekly, Monthly
• Who will be the formal acceptance authority for launch KPI signoff (title/role)?
• Are there financial or contract milestones tied to these metrics (bonuses, penalties, holdbacks)? If so, summarize. Options: Yes—financially tied, Yes—operational gating only, No formal ties, Not sure

What Could Stop Us at the Threshold — Regulatory, Privacy, Credentials?

• Are there any non-negotiable regulatory or accreditation requirements we must show before launch? Options: URAC accreditation required, ACHC accreditation required, State pharmacy permits needed, Manufacturer-specific audits, No additional requirements, Other
• Do you require vendor background checks, SSAE/SOC reports, or other formal attestations before data sharing? Options: SSAE/SOC reports, Background checks, Pen-testing report, Business continuity plan, None required, Other
• What is the current status of Data Use Agreements or Business Associate Agreements (BAAs) with our organization? Options: Fully executed, Drafted and under legal review, Not started, We have an approved master agreement
• Are there patient consent or authorization workflows we must support differently (e.g., special consent for cold-chain monitoring or text messages)? Describe.
• What is your expected timeline to complete all credentialing and compliance checks required for go-live? Options: <2 weeks, 2–4 weeks, 4–8 weeks, 8+ weeks, Undetermined

I’m Imagining Launch Day — What Keeps You Up at Night?

• On day one, what single failure scenario would be most damaging—what exactly would happen and to whom? Options: PA backlog > X days, Patient receives wrong-storage medication, LDN denial for shipment, Data feed outage, Massive enrollment confusion, Other
• What contingency plans do you already have in place for that scenario? Options: Alternate dispensing partner, Manual overrides, Redundant data feeds, Standby courier/cold-chain vendor, None, Other
• Who will be the 24/7 escalation contact from your side and what is their preferred communication channel?
• What acceptance test must pass on day zero (describe one critical end-to-end scenario we should run together)?
• On a scale from 1–10, how confident are you that the program is operationally ready for launch today? (1 = not ready, 10 = fully ready) Options: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10

Agreeing Next Steps — Who Does What, When?

• What are the top three actions you want our team to take in the next 7 days to move readiness forward?
• Which deliverables do you need from us to unblock legal, technical, or operational approval (pick all that apply)? Options: SOW / statement of work, Technical integration spec, Security documentation (SSAE/SOC), Training schedule and materials, Playbook for day-one operations, Other
• Who on your side will own each of these items—please list name, role, and target completion date.
• When should we schedule the next checkpoint meeting to review readiness (select preferred cadence)? Options: Daily stand-up, Twice weekly, Weekly, Biweekly, Ad hoc by milestone
• What would a reasonable minimum-viable launch look like for you (scope/features we must include vs. what can come later)?

Tell Us About Your World

• How many patients on specialty therapies does your organization manage each year? Options: <500, 500–2,499, 2,500–9,999, 10,000–49,999, 50,000+
• Which therapeutic areas currently drive the majority of your specialty spend? Options: Oncology, Autoimmune/Inflammatory, Multiple Sclerosis, Rare genetic disorders, HIV/Hepatitis, Other
• Who owns specialty pharmacy strategy and vendor relationships inside your organization? Options: Pharmacy Director, Clinical Operations Lead, Population Health/Value-Based Care, Manufacturer Partnerships Lead, Other
• Briefly describe your current relationship(s) with specialty pharmacy vendors—what works well and what doesn’t.
• What is the primary objective you are trying to achieve with specialty pharmacy partners right now? Options: Reduce specialty spend, Speed time to therapy, Improve clinical outcomes/adherence, Expand patient access (LDN), Operational consolidation, Other
• Tell us about a recent initiative related to specialty care you’re proud of or that changed how you work.

Are You Losing Patients Before Therapy Starts?

• How often do patients never start a prescribed specialty therapy—and why does that still happen in your experience?
• What is your estimated patient abandonment rate between prescription and first fill? Options: <5%, 5–15%, 16–30%, 31–50%, >50%, Unsure / Data gap
• Which of the following most commonly causes patients to abandon therapy before first dose? Options: Cost or high copay, Prior authorization delay/denial, Side‑effect concerns, Logistics/cold-chain delivery issues, Clinical complexity/confusion, Other
• Share a recent patient story where abandonment occurred—what were the key moments and decisions?
• How do you currently measure the downstream cost or clinical impact of patients who fail to start therapy? Options: Reported readmissions, Increased medical spend, No formal measurement, Ad hoc case reviews, Other
• Who on your team is responsible for initiatives to reduce abandonment and what resources do they have? Options: Care management, Pharmacy team, Patient services, Manufacturer liaisons, Other

When Prior Authorization Becomes the Bottleneck

• If prior authorization approval times were cut in half tomorrow, what would be different for patients and your organization?
• What is your average time from prescription to PA approval today? Options: <24 hours, 1–3 days, 4–7 days, 8–14 days, >14 days, Unsure
• Approximately what percentage of PAs are approved on the first submission? Options: <30%, 30–50%, 51–70%, 71–90%, >90%, Unsure
• Which teams or vendors submit and manage PAs for your patients? Options: Prescriber office, Internal pharmacy team, Third-party PA vendor, Manufacturer support, Other
• What are the top three reasons submissions get kicked back, delayed, or denied?
• Do you currently use electronic prior authorization (ePA), rules engines, or payer portals; if so, which and how reliable are they? Options: No ePA, Basic ePA integration, Advanced ePA with rules engine, Partial automation with human follow-up, Unsure

If Limited Distribution Rules Could Be Different…

• How have limited distribution network (LDN) policies forced compromises in care or access for your patients?
• About how many products that matter to your population are in LDN today? Options: None, 1–5, 6–15, 16–30, 30+
• Which manufacturer requirements create the biggest operational burden (select all that apply)? Options: Special credentials/accreditations, On-site audits or site visits, Specific shipping/packaging rules, Custom enrollment paperwork, Restricted dispensing channels
• How often does LDN availability or manufacturer routing change unexpectedly and disrupt patients? Options: Never, Rarely, Occasionally, Often, Unsure
• Describe a specific instance where LDN constraints led to delayed therapy or administrative escalation.
• If a partner could guarantee manufacturer acceptance and LDN compliance, would you consider consolidating LDN management? Options: Yes, immediately, Yes, after a pilot, Maybe, depends on terms, No

What Would Success Feel Like for Patients and Your Team?

• If the end-to-end journey (PA → first dose → active adherence at 6 months) were consistently reliable, what new opportunities would that create for your organization?
• Which metrics matter most to you right now? Pick up to three. Options: PA speed (time to approval), PA approval rate on first submission, Time-to-first-dose, 6‑month adherence rates, Financial assistance enrollment rate, Cold-chain delivery success, Total specialty spend
• What target thresholds would you set for your top metrics (give specific numbers or ranges)?
• How often do you need reports or live dashboards to feel confident in performance? Options: Real‑time, Daily, Weekly, Monthly, Quarterly
• Who needs view or edit access to patient status and outcomes dashboards (roles, not names)? Options: Pharmacy Director, Care Managers, Population Health Leads, Manufacturer Liaisons, Prescriber/Clinic Staff, Other

Where the Logistics Break Down (And Who Bears the Fallout)

• When a temperature excursion or failed cold-chain delivery happens, how long does it typically take to resolve and what are the consequences?
• How many cold-chain shipments do you coordinate monthly for your specialty population? Options: None, 1–50, 51–200, 201–1,000, 1,001+
• Have you experienced product loss, delayed dosing, or clinical compromise due to cold-chain failure in the last 24 months? Options: Yes — product loss, Yes — delayed dosing, Yes — clinical impact, No, Unsure
• Which partners or vendors currently manage last-mile delivery and temperature telemetry for you? Options: Internal logistics, Third-party courier, Manufacturer logistics, Specialized cold-chain provider, Other
• What visibility and controls would you require on chain-of-custody, telemetry data, and exception alerts before go-live?
• List the acceptance tests (for example: temp excursion simulation, chain-of-custody audit, KPI thresholds) you'd want completed in a pilot.

Money, Incentives, and Access—What Keeps You Up at Night?

• Which single financial barrier—benefit design, copay burden, or administrative delay—causes the largest drop-off in access, and why hasn’t it been solved?
• Approximately what share of patients require financial assistance to initiate therapy? Options: <10%, 10–25%, 26–50%, 51–75%, >75%, Unsure
• Do you operate an in‑house financial assistance team, rely on manufacturer PAPs, or partner with third-party foundations? Options: In-house team, Manufacturer PAPs, Third-party foundations, Hybrid model, Other
• On average, how long does it take from referral to confirmed patient financial clearance? Options: <48 hours, 3–7 days, 8–14 days, >14 days, Varies widely
• What documentation or controls do payers and manufacturers require to verify financial assistance and how burdensome is that process?
• Would shortened financial clearance change prescribing patterns or formulary decisions in your organization? Options: Yes — significantly, Yes — modestly, No, Unsure

If We Took This On—What Would You Need From Us First?

• What's the one thing a specialty pharmacy partner must deliver on day one to earn your trust?
• What is your decision timeline for selecting a dispensing and clinical partner? Options: Immediately / in progress, Within 30 days, 30–90 days, 3–6 months, No current timeline
• Which contractual or procurement constraints will most shape any agreement (pick all that apply)? Options: Budget caps, Data sharing/privacy requirements, Accreditation requirements (URAC/ACHC), Liability/indemnity terms, Limited distribution compliance, Other
• Would you require a time‑bound pilot before broad deployment, and if so, how long would be acceptable? Options: No pilot—direct onboarding, 30 days, 60–90 days, 3–6 months, Depends on scope
• Which technical integrations are must-haves (EMR, claims, lab results, HIE, manufacturer portals)? Options: EMR (Epic/Cerner), Claims system, Lab interfaces, Manufacturer portals, HIE, Other
• Who are the internal signatories or decision roles for commercial terms and clinical acceptance? Options: Pharmacy Director, Chief Medical Officer, Finance/Procurement, Legal/Compliance, Other

Commitments, Risks, and Small Wins to Start

• What is the smallest, clearly measurable pilot that would reduce your biggest operational risk within 90 days?
• What acceptance criteria and KPIs would you require the pilot to meet to consider a full roll‑out? Please be specific.
• Which internal teams must be actively engaged during a pilot to make it successful? Options: Pharmacy Operations, Care Management, IT/Integration, Legal/Compliance, Finance, Manufacturer Liaisons
• What reporting cadence and level of detail do you expect during a pilot (examples: real‑time exceptions, weekly KPI scorecard, root cause analysis)? Options: Real‑time exceptions, Daily operational huddles, Weekly KPI scorecard, Monthly executive review, Ad hoc deep dives
• If the pilot succeeds, what would be the earliest acceptable timeline to transition to a broader contract or operational handoff? Options: Immediately, Within 30 days, 30–90 days, Depends on outcomes
• Is there anything else—hidden constraints, political dynamics, or stakeholder sensitivities—we should know before proposing next steps?