Do The (Right) Math
Hey, there!
Most leaders believe they’re making data-driven decisions on PBMs and ancillary programs, but they’re solving the wrong equation. Activity math—rebates, discounts, fancy marketing and flashy dashboards—masks the real impact. True impact means doing the right math: solving for net costs, long-term patient outcomes, and real value. The difference? A system that works for you, not against you. It is time to rethink the PBM equation.
Let’s Dive In!
Let’s be real—you won’t get called out for picking the big-name PBM. The safe bet. The “steady hand.” But is that the whole story?
Nope.
Because playing it safe often comes with a cost. You’re stuck in a contract that looks good on paper but bleeds dollars in the real world. And here’s the kicker—you probably don’t even see it happening.
In the past, we’ve discussed Sunk Cost Fallacy and Switching Costs. These traps exist because you’re solving the wrong math.
The Right Math Problem No One Talks About
You measure activity: rebate dollars, discounts, contract terms that sound great. PBMs love that. They flood you with flashy reports, fancy charts, and savings that look good on paper. All math, right?
Wrong. That’s activity math. What you need is impact math.
Impact math asks:
Are these “savings” actually reducing total spend, or just shifting costs?
Does this ancillary program drive real value, or just add complexity and cause burnout?
What’s my net cost per script—after I factor in patient outcomes?
If you don’t have clear answers, your math is broken.
Consider Journavx, a classic example. Recently approved by the FDA, it comes in at $15 per fill. Some PBMs are balking. Too expensive, they say. Excluded from our formulary, they boast! But hold on—what math are they solving for?
A prudent PBM will say: Opioid dependence. Addiction. Return to work. Risk of overdose.
According to clinical trial data, Journavx eliminates all of those risks. So, what math are we solving for? A short-term cost on a spreadsheet, or the long-term human and financial cost of opioid addiction?
Bottom Line: Leaders who win aren’t the ones who play it safe. They’re the ones who run the right equation. They ask the right questions. They solve for impact, not just activity.
The Big 3 PBMs push their math because they know it solves their value equation—at your cost. The numbers don’t lie.
Let’s rewrite your value equation and build a pharmacy program that works for you. Trash the easy math. Do the right math —choose Prodigy.
Let’s chat.
