TIER 2 · SPECIALTY ROUTING · AUDIT WORKSHEET
Five Clauses Decide Where Your Specialty Drugs Fill.
The PBM Owns Four. The Audit Worksheet Surfaces Them.
A 2-page printable worksheet PBS uses across 100s of PBM contract reviews annually. Free download. Sent to your inbox.
Three audit passes on specialty routing
Five clauses that decide where specialty scripts fill
Quantify concentration in the PBM's own specialty pharmacy
Paste-ready broker request to open the network
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A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Match Pattern to Clause
Five contract clauses decide specialty routing: the network definition, the prior-auth pathway, the exclusive-distribution terms, the white-bagging policy, and the site-of-care rules. The PBM wrote most of them.
PASS 01
Pull the Routing Data
Sort your specialty claims by filling pharmacy. The first pass quantifies how much of your specialty spend runs through the PBM's own specialty pharmacy versus everywhere else.
PASS 02
Read the Five Clauses
Five contract clauses decide specialty routing: the network definition, the prior-auth pathway, the exclusive-distribution terms, the white-bagging policy, and the site-of-care rules. The PBM wrote most of them.
ACTION PLAN
This Quarter's Action Plan
Run the three passes, document the owned-pharmacy concentration, and send the paste-ready request to open competitive specialty dispensing before your next renewal.