Transparency Theatre
For years, the industry treated transparency like theatre—an applause line, not a business model. Some PBMs dimmed the lights, shuffled a few set pieces, and insisted the stage had changed.
But the audience isn’t buying it anymore.
Workers’ comp payers are asking harder questions.
New delivery models are emerging.
Payers are being forced to do more with less, even as cost, complexity, and clinical risk accelerate.
And underneath it all, a truth the industry has tried to outrun is finally catching up:
You can’t retrofit transparency into a PBM business model built on secrecy and opacity.
The economics don’t work. The workflows don’t align. And the technology simply wasn’t designed for the world that now exists.
The Industry’s Strategic Moment
This isn’t a wake-up call. It’s a restructuring of the entire ecosystem.
Employers want pharmacy program designs that actually work for their injured workers—not the illusion of choice inside a locked box.
Workers’ comp payers want treatment pathways that reduce friction, improve return-to-work, and eliminate unnecessary spend.
Meanwhile, incumbents keep trying to repaint the walls of a house sinking into its own foundation.
Gaslighting payers cannot solve this. Transformation can.
We Built Prodigy for This Moment
Prodigy wasn’t built to survive the old world.
Prodigy was built to replace it.
While others built on the status quo, we chased architectural readiness.
While others relied on rebates to fill margin gaps, we built a model where value creation didn’t require hiding the true cost of care behind a curtain.
And while legacy PBMs stitched together siloed workflows to promote opacity, we designed unified process—with real-time visibility that unlocks:
Smarter and faster decision-making
Seamless patient experience
Payer flexibility and customization
True transparency
It’s what employers have needed.
It’s what payers have been waiting for.
And it’s what legacy systems simply cannot retrofit into their DNA.
This isn’t speculation. It’s design. The status quo was never going to carry the industry into its next era.
The Market Has Spoken
The next decade will be defined by leaders who embrace three truths:
Transparency is not a feature—it is a foundation.
You cannot layer it onto a model architected for opacity.
Anything less is a costly delay tactic.Fiduciary responsibility is no longer optional.
Payers can’t outsource judgment to vendors with misaligned economics and incentives.Care only works when the patient is the center of gravity.
The moment the system forgets that, costs rise, outcomes fall, and friction multiplies. Put the patient first, and everything else finally falls into place.
The payers that evolve will succeed. Everyone else will see mediocre outcomes or worse.
If you’re shaping your 2025–2026 strategy, here’s what leaders are doing next:
Rebuilding pharmacy programs around transparency + intelligence
Moving aways from PBMs with business models dependent over-reliant on rebate-driven economics.
Prioritizing systems that lower friction for adjusters, nurses, and members
Partnering with platforms/partners (like Prodigy) designed for transformation—not preservation
If you’re ready to move beyond transparency theater, and would like to explore what this transition looks like for your organization, I’d be happy to help you map it.
The market is moving. The question is who’s moving with it. Let’s schedule time to experience full transparency at scale.
—Del
About P4P
A Strategic Dose of Clarity in a Noisy PBM Market
Written by Prodigy CEO, Del Doherty, 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.
