Why Transparent Pricing Still Feels So Rare in Workers’ Comp
Transparent pricing in workers’ comp is widely praised—almost universally, in fact. Yet when it comes time to choose it, most buyers hesitate.
Not because transparency is unproven.
Not because it doesn’t work.
But because the system has trained smart, rational leaders to be careful in ways that quietly preserve the status quo.
Opacity didn’t win in workers’ comp by being superior.
It won by being familiar.
The Comfort of “Good Enough”
Most pricing models persist because they function. Claims get paid. Networks stay intact. Reports get delivered. No alarms go off.
That absence of friction becomes its own form of validation.
Over time, “working” is confused with “working well.” And when no single stakeholder owns the full economic picture—drug cost, clinical impact, administrative drag—there’s little pressure to interrogate the model beneath the surface.
Complacency doesn’t announce itself. It blends in as professionalism.
Prudence, or Fear Wearing a Suit?
Buyers are trained to manage risk. And from that vantage point, sticking with a known PBM model can feel like the responsible choice.
Switching introduces questions:
Will this disrupt claims flow?
Will providers push back?
Will something break—and land on my desk?
These are reasonable concerns. But prudence becomes counterproductive when it only evaluates what could go wrong—and not what is already quietly going wrong.
Fear of change in workers’ comp rarely looks emotional. It looks analytical. It shows up as spreadsheets that model transition costs but ignore structural leakage.
The Switching Cost Mirage
One of the most powerful forces keeping opaque pricing in place is the belief that switching is expensive and disruptive. Sometimes it is.
But more often, buyers overestimate the one-time cost of change and underestimate the recurring cost of staying put.
What rarely gets quantified:
Time spent reconciling unclear invoices
Clinical decisions made without full cost visibility
Savings narratives that can’t be independently verified
These costs don’t arrive as a single invoice. They compound quietly—spread across departments, renewals, and years.
Opacity is not free. It’s just well-disguised.
The Benefits We Discount
Transparent pricing doesn’t just clarify what you pay. It clarifies how decisions get made.
When pricing is explicit:
Clinical conversations sharpen
Accountability increases
Reporting becomes usable, not ceremonial
But these downstream benefits don’t always show up in year-one ROI calculations. They show up in governance, trust, and speed of decision-making.
Systems built to minimize disruption tend to discount benefits that arrive later—even when those benefits fundamentally change how the organization operates.
Why Transparency Feels Risky (and Why It Isn’t)
Transparency feels disruptive because it removes ambiguity—and ambiguity has been doing a lot of quiet work.
It cushions difficult conversations.
It spreads responsibility thin enough that no one feels fully exposed.
It allows “net savings” to substitute for verifiable math.
But when pricing is truly transparent, something unexpected happens: complexity decreases.
Fewer explanations are needed.
Fewer exceptions are negotiated.
Fewer assumptions are carried forward unchallenged.
Organizations that move toward transparent PBM models don’t experience chaos—they experience compression. Decisions get faster because the facts are visible.
This is where solutions like Prodigy differentiate quietly but meaningfully—not by promising perfection, but by removing the fog that forces buyers to operate on trust alone.
Ask Yourself
If transparent pricing is so clearly aligned with fiduciary responsibility, the real question isn’t why it’s rare.
It’s this:
Which risks are you actively managing—and which ones have you simply grown used to?
Are you protecting your organization from disruption, or from clarity?
And if you had full visibility tomorrow, which decisions would you make differently?
Transparent pricing doesn’t demand recklessness. It demands honesty.
And in workers’ comp, honesty isn’t radical—it’s overdue.
The prescription for performance isn’t bravado. It’s the discipline to see clearly—and the prudence to act on it. Get in touch, let’s talk.
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.
