PBM Switching Costs: Why Staying Is Costing You Millions
Hey, there!
In my last email we tackled Sunk Cost Fallacy. A closely related concept is Switching Costs. This is particularly important when it comes to switching vendors, specifically PBM vendor.
Let’s cut to the chase: If you think switching PBMs is too expensive, you’re looking at the wrong price tag. The real cost isn’t in making the leap—it’s in staying locked into a system designed to drain your budget, limit your control, and put PBM profits ahead of patient outcomes.
Let’s Dive In!
You know the drill. The Big 3 PBMs (Caremark, Express Scripts, OptumRx) have spent years fine-tuning the art of the illusion of savings—hiding behind rebates, steering patients to their own pharmacies, and keeping pricing so opaque it would make a magician jealous.
And now, thanks to the FTC’s latest damning reports on Generic Markups and Vertically Integrated PBMs, we have the receipts:
$7.3 billion in overcharges on specialty generics—PBMs pocketing billions while payers foot the bill.
Markups of 1,000%+ on cancer drugs, all while PBMs pretend they’re “negotiating savings” for you.
68% of all specialty drugs flowing through PBM-owned pharmacies, ensuring they profit at every step.
A massive rebate shell game that keeps drug prices artificially high—and your costs soaring.
So let’s talk about the real cost of staying in this rigged system:
Every quarter you wait, you’re bleeding money into PBM profit margins.
Every renewal, you’re signing up for another year of opaque pricing and backdoor deals.
Every decision delay, you’re giving up control of your own pharmacy spend.
PBMs love to scare payers with “switching costs.” They warn of disruptions, complexity, and administrative headaches. But what they won’t tell you is that staying put means:
❌ Being locked into rebate schemes that drive up drug prices instead of lowering them.
❌ Watching your injured workers get funneled into PBM-owned pharmacies, where pricing is set to maximize their profit—not your savings.
Enough is enough. You need a PBM that works for you—not the other way around.
Where Do We Begin?
First Things First: Work with a PBM That Puts You Back in Control. As I’ve mentioned before, Prodigy is that PBM—move fast, think differently, and put patient outcomes ahead of profits.
Your next PBM partner must have these key qualities:
Transparent, pass-through pricing—no spread pricing, no rebate games, no surprises.
You own the data, you set the strategy—they execute your plans.
A focus on patient outcomes—not pharmacy steering, hidden fees, or billion-dollar markups.
While the Big 3 PBMs are defending themselves in court, PBMs like Prodigy are building smarter, more flexible pharmacy solutions that actually deliver results.
Bottom Line: Staying is the Real Risk. Switching is the Smart Play.
The Big 3 PBMs want you to believe switching is too hard, too expensive, too complicated. Why? Because they know that once payers see the truth, they leave.
The numbers don’t lie. The longer you wait, the more you lose.
Let’s rewrite the script. Let’s build a pharmacy program that actually works for you. It’s time to make the smart move. It’s time for Prodigy.
Ready? Let’s chat.
