PBM Toolkit - Pharmacy Network Strategies

Pharmacy network strategies can play an important role in ensuring access to medications while controlling costs
Network Options   What is it? Member Cost Plan Sponsor Costs  Considerations 
Open Network Typically includes the majority of all chain pharmacies and most independent pharmacies  Out-of-pocket costs are the same at participating pharmacies  Network discounts are applied per the PBM contract  Robust geographical coverage is achieved 
Preferred Network with out-of-network pharmacy coverage  Network pharmacies include smaller, preferred list of pharmacies (typically selected chains) Out-of-pocket costs are higher at non-preferred pharmacies than preferred pharmacies  Greater cost savings from higher discounts from participating pharmacies  Tradeoffs between possible member disruption and satisfaction with savings from network strategy 
Narrow Network or Limited Network  Network pharmacies only include a smaller, subset of pharmacies  Covered prescriptions can only be filled through the network  Greater cost savings from higher discounts from participating pharmacies due to the exclusion of competing pharmacies  Tradeoffs between possible member disruption and satisfaction and savings. Ensure appropriate geographic access for members and dependents, emergency access to medications while traveling/family members living in other areas. 
90-day Retail  Network pharmacies allow 90-day supply of maintenance medications to be purchased at retail stores  Out-of-pocket costs are the same to fill a 90-day supply of maintenance medications at retail as through mail order  Discounts are typically between retail and mail order discounts  Can be combined with open networks, preferred networks, and narrow or limited network options