The Network Effect That Broke Trust
Most payers don’t stay with a PBM because they’ve re-underwritten the model. They stay because everyone else has. That’s the network effect. And for a long time, it worked.
What It Was Supposed to Do
Simple idea: More users = more value. In pharmacy, that became scale. More reach. More data. More leverage.
So buyers assumed:
If everyone is using the same PBM, pricing improves, access expands, outcomes follow. They didn’t just choose a PBM. They joined a network.
When Scale Became Assumption
Then something changed. The network stopped being evaluated…and started being inherited.
“This is who we’ve always used.”
“This is who everyone else uses.”
“Switching would be disruptive.”
That’s how network effects deepen. Not through proof — through assumption. And assumption creates something dangerous: permission to stop asking questions.
When Trust Became Leverage
Here’s where it breaks. Network effects only work if trust holds. If it doesn’t, scale stops creating value—and starts creating leverage.
That leverage shows up in ways payers don’t always see:
Benchmarks that can be engineered
Discounts applied to inflated prices
Clinical rules that aren’t applied consistently
Revenue tied to complexity
Systems that are hard to verify
None of it is obvious. That’s the point. The same network that created confidence…made it harder to question what was underneath.
The Signal Is Clear
Payers are starting to feel it.
A majority of payers report dissatisfaction
Net Promoter Scores sit in the single digits
Outcomes haven’t kept pace with complexity
That’s not a pricing issue. It’s a trust issue. And when trust breaks, network effects don’t protect you. They expose you.
Why Buyers Stay
Because networks don’t just create value. They create inertia.
Contracts are embedded
Systems are integrated
Teams are trained around the model
Leaving feels like disruption. So payers stay longer than they should. Not because it’s working — but because it’s easier.
The Shift
A different kind of network is forming. Not built on size. Built on alignment. The questions are changing:
Can I see how pricing is built?
Are incentives aligned with outcomes?
Does the model reward cost—or care?
Can I verify this without a translator?
That’s the new network. Built on transparency, trust, and alignment. And it’s growing - on trust, and the network follows.
The Counter-Network
You don’t break a network effect by attacking it. You break it by building a better one. One where:
Transparency replaces complexity
Alignment replaces arbitrage
Patients sit at the center
Pricing reflects reality
Trust is earned—not assumed
That’s where the momentum is shifting. And it gives payers something they haven’t had in a long time: permission to unlearn—and delink from the networks that took your trust for granted. You’re Not Stuck. You’re connected. And connections can change.
The Question That Matters
Stop asking: “Is this market competitive?”
Start asking: “Does this network deserve my trust?”
Because network effects don’t just amplify scale. They amplify intent. And the next network will be built by the buyers who decide to verify again.
If you need to rethink your current network, let’s get started.
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.
