Brand Loyalty or Blind Faith?
Familiar Names. Hidden Risks.
We get it. The big names feel safe. They’ve been around forever. You know the reps. The deck looks good. The reports feel “familiar.”
But let’s be blunt—familiarity is not protection. In the PBM world, it’s often the perfect camouflage.
The big three PBMs? They're not just legacy players—they're legacy liabilities. They’re currently under federal investigation. They’ve been linked to executive orders targeting drug pricing practices. And yet, many payers keep renewing—often on autopilot—because the brand feels easier than the unknown.
That ease comes at a cost.
Behind the brand loyalty, we’ve seen:
Contracts built a decade ago still quietly driving decisions
Formularies bloated with margin-fattening drugs
Spread pricing embedded in layers of complexity
"Custom reports" that show exactly what they want you to see—and nothing more
Here’s the risk no one talks about: sticking with legacy logos can expose you to scrutiny—scrutiny you didn’t invite but may be forced to answer for. When your PBM ends up in the headlines, what’s your defense?
Three ways to test if your “trusted” partner is quietly eroding trust:
Would you pick them again if starting fresh today?
If not, you’re paying the nostalgia tax.Does your pricing model still hold up under scrutiny?
Or is it just a pile of spreadsheets and handshakes?Is your PBM aligned to your goals—or just leveraging your loyalty?
When things go wrong, do they act like a partner or a PR firm?
At Prodigy, we’ve helped payers carve out of these relationships without chaos. No fire, no fury—just a smarter hedge that reduces risk and restores control.
Because in this market, brand loyalty isn’t just expensive—it’s dangerous.
Ask yourself:
Is your PBM implicated—directly or indirectly—in investigations around pricing abuse or their role in the opioid epidemic?
(Hint: If they’re one of the Big Three, the answer may already be yes.)
Are you getting the same level of service, access, and strategic attention as their biggest book of business?
Or are you just a line item behind a firewall of policy?Do you feel like a third wheel—locked in a lopsided relationship you can’t seem to shake?
If so, ask yourself: who’s really benefiting from your loyalty?
📞 Let’s talk. There’s a smarter way forward—and it starts with asking better questions. Call me for a virtual consult. No pressure. Just clarity. I promise—it’ll be worth your while.
About P4P
A Strategic Dose of Clarity in a Noisy PBM Market
Written by Prodigy CEO Del, P4P delivers sharp, consultative insights for decision-makers who are tired of legacy models, hidden costs, and passive vendors. Each piece is a prescription—cutting through the noise to reveal what actually drives performance in pharmacy benefit management.
No fluff. No spin. Just insight that pays off.
