Hedge Your Bet, Don’t Burn the Bridge
April is over and Q2 is now in full swing.
You’re back in rhythm. Revisiting old conversations. Following up on open loops. Asking your team the question you tabled weeks ago: “How’s our PBM doing?”
The answer? It’s not chaos. But it’s not confidence either.
The numbers aren’t glaring. The outcomes aren’t awful. But the updates come with a raised eyebrow, a hesitant “well…”—the kind of feedback that doesn’t ring alarms but still lingers in the gut.
You’re not regretting the decision. But you are re-evaluating the bet.
The Quiet Dilemma
As an executive, you were instrumental in selecting your PBM or ancillary partner. You did the diligence. You saw the deck. And at the time, the hand looked promising.
But leadership isn’t about making the perfect call—it’s about knowing when to adjust before the table turns cold.
That’s where hedging comes in.
Hedging isn’t a panic play. It’s a proactive posture.
It’s not walking away—it’s widening the aperture. Think of it as trimming the hedges while the garden still looks good. You’re not replacing the foundation; you’re reinforcing the fault lines.
At Prodigy, this is our specialty. Clients don’t have to ditch their PBMs—they carve out the riskiest, costliest corners:
Specialty medications that account for 1-2% of scripts but 20%+ of total drug spend
Catastrophic claims where oversight matters most
Challenging geographies with spotty vendor performance
These areas get moved into our clinically-driven model—with real-time reviews, evidence-based protocols, and unmatched specialty insight—while your traditional meds stay right where they are.
You stay in control. You gain visibility.
And most importantly—you stay ahead.
Hedging, Done Right, Does Three Things:
1. Protects Without Provoking
Why gamble on a full transition when you can surgically target the outliers? Specialty carve-outs let you pressure-test smarter models without unnecessary friction.
2. Reveals What’s Really Under the Hood
You know what your PBM reports. But what are they missing? Our team applies 50+ clinical and claims endpoints to identify misaligned drugs, wasteful dosing, off-label drift, and hidden high-cost risks.
3. Keeps You in the Driver’s Seat
Hedging gives you leverage without litigation. It nudges your incumbent to improve while giving you a runway to build a smarter model over time.
So if Q2 has you sensing some slippage—or if your gut says “we can do better”—you’re not alone.
You don’t have to start from scratch.
You just have to start hedging with purpose.
Bottom Line:
Not ready to replace your PBM? No problem. You can hedge your bet by carving out high-risk, high-cost areas—like specialty drugs or catastrophic claims—without disrupting your entire program. Prodigy helps clients layer in clinical precision where it matters most, giving you more control, better oversight, and real savings—without rolling the dice.
Let’s talk. We’ll help you turn second thoughts into first-mover advantage.
