Growth Vs. Fixed Mindset: What’s Driving Your PBM Decisions?
Hey, there!
Let’s be real—when it comes to picking a PBM, most decisions aren’t purely analytical. Behind every spreadsheet, rebate guarantee, and network slide lies a quiet, powerful force: mindset.
Some leaders look at a half-full glass and ask how to top it off. Others see a half-empty one and slam on a lid. That’s the fundamental difference between a growth mindset and a fixed mindset—and it shows up loud and clear in PBM decision-making.
What are the hidden costs of this decision? Lost savings, reduced flexibility, growing dissatisfaction, and poor patient outcomes slipping through your fingers every day you choose the status quo.quo?
Let’s Dive In!
On the surface, PBM choices are about savings, discounts, and access. But scratch a little deeper, and the real question comes into focus: “Are we trying to make things better, or just trying not to make them worse?”
Let’s talk about GLP-1s for example. When Prodigy predicted the impact of these meds—Ozempic, Wegovy, Mounjaro—in the Workers’ Comp space, some folks reacted with raised eyebrows: "That’s a stretch," or "Way too expensive." [Read article]. That was classic, instinctive fixed mindset response. But growth-minded leaders? They asked the right questions and saw the possibilities — faster recoveries, fewer complications, and workers getting back on their feet sooner. Same therapy. Different lens. Very different outcome.
When Fixed Mindset Takes the Wheel
A fixed mindset doesn’t just make you cautious—it can lead you straight into confirmation bias. Once you decide “change is risky,” your brain starts ignoring anything that suggests otherwise. You seek out familiar reports, lean on legacy consultants, and choose vendors who’ve always told you what you wanted to hear. We covered this before, if you keep your feedback loop small, don’t expect big breakthroughs.
Firefighting Vs. Future-Proofing
Fixed-minded leaders spend their days reacting—chasing audits, patching leaks, negotiating Band-Aids. Growth-minded leaders shift gears. They design systems that prevent the fires in the first place.
In prior posts we explored how great leaders tune out distractions to focus on what really matters. That applies here too: picking a PBM isn’t just about chasing today’s rebates and discounts. It’s about future-proofing and building a smarter pharmacy strategy that will excel next year—and five years from now. Every month you delay the switch, you risk losing your ability to future-proof your pharmacy program.
Spotting A Growth Mindset in Your PBM Strategy irefighting
So how do you know if your team’s leading with a growth lens? Here are the signs:
You want transparency. Not just a big number—but clarity on how that number works.
You embrace innovation. You’re not afraid of new therapies—you ask what they make possible.
You think beyond the quarter. You make moves today that pay off tomorrow.
You value clinicians . Clinical leadership isn’t just welcome—it’s essential.
Gut Check: Fear or Vision
Every PBM decision is a mirror. It reflects what you truly believe: Are you trying to avoid risk, or create value?
We’ve seen both sides. Fixed mindset thinkers cling to legacy models, even when those models are quietly leaking value. Growth-minded leaders flip the script. They partner with innovators like Prodigy—and unlock data, visibility, and clinical outcomes they never thought possible. It’s not reckless. It’s just bold.
Bottom Line:
Let’s stop pretending PBM selection is just about procurement. It’s about leadership. So ask yourself: Are you playing not to lose? Or are you playing to win?
Because the future belongs to leaders with a growth mindset who don’t just settle for what’s in the glass. They ask for the pitcher.
Are you a growth-minded leader or a fixed mindset thinker?
Let’s chat.
Opportunity Costs
Hey, again!
On my last message, we talked about doing the right math. But doing the math often means facing a decision point that requires a clear analysis of both the benefits of change and the opportunity costs of staying put. It’s easy to focus on potential switching costs —implementation headaches, short-term disruptions, and effort—but what about the cost of inertia? What about the dollars, flexibility, satisfaction and patient outcomes slipping through your fingers every day you choose the status quo?
Let’s Dive In!
Imagine you're standing at a crossroads. One path leads to a modern, optimized pharmacy benefits model (Prodigy)—cost control, transparency, and better outcomes. The other? A well-worn trail of escalating costs, hidden fees, and misaligned incentives. The only problem? Many payers are frozen at the fork, afraid to move. Read article on sunk cost fallacy.
But here’s the reality: Not switching your PBM isn’t a neutral decision—it’s an expensive one. It’s like refusing to upgrade from dial-up internet to high-speed fiber because "the old way still works.” Meanwhile, your competitors are streaming in 4K while you're stuck buffering, losing time, efficiency, and cost savings with every passing moment.
Let’s talk about the opportunity cost of staying put.
Hidden Fees (The Slow Leak in the Boat)
Many legacy PBMs operate like old insurance policies—you think you’re covered, but the fine print is bleeding you dry. Spread pricing, rebate traps, and arbitrary markups siphon money out of your plan. Staying with a legacy PBM is like patching up a sinking boat with duct tape while watching competitors sail past with high-performance engines. Every month you delay switching, you’re funding someone gross margin.
The Cost of Inflexibility (The Rusted Lock on the Toolbox)
Innovative PBM models offer dynamic pricing, cost-plus agreements, and real-time data transparency. But if you stick with a rigid, outdated PBM, you’re effectively locking your toolbox and throwing away the key. They limit your ability to adapt to market shifts, new therapies, and employer demands. In the dynamic pharmacy landscape of the future, agility wins. Standing still? That’s just slow-motion failure.
The Patient Experience Cost (The Slow Lane of Healthcare)
Every payer talks about patient outcomes, but an opaque, old school PBM operating model puts profits ahead of patients.That means higher payer costs, restricted access, and unnecessary barriers to care. Imagine running a rideshare company but forcing passengers to take the longest, most expensive route every time. It takes longer and costs more. That’s what sticking with the wrong PBM feels like for patients (and payers alike). A smarter, more aligned PBM puts the patient in the fast lane—with cost-effective, clinically appropriate access to care.
The Fork in the Road
We’ve talked before about fuzzy logic how decisions—or indecisions—can sabotage your program success and how leaders get trapped in the sunk-cost fallacy. This is one of those moments. The cost of switching PBMs may feel daunting, but the cost of inaction is worse. Every day you delay, you’re leaving money, flexibility, and patient trust on the table.
The best leaders know when to pivot. Are you ready to make the right turn?
Bottom Line:
Escaping the status quo isn’t just about making a change—it’s about making a smarter move. If you have any doubts, let’s take five minutes to do the right math on your switching costs vs the opportunity costs of staying keeping your current PBM. As I have said before, if you don’t walk away with valuable insights, the next coffee’s on me. But if I’m right, you’ll be one step closer to cutting through the noise and making a decision that will have your whole team thanking you.
Let’s chat.
Do The (Right) Math
Hey, there!
Most leaders believe they’re making data-driven decisions on PBMs and ancillary programs, but they’re solving the wrong equation. Activity math—rebates, discounts, fancy marketing and flashy dashboards—masks the real impact. True impact means doing the right math: solving for net costs, long-term patient outcomes, and real value. The difference? A system that works for you, not against you. It is time to rethink the PBM equation.
Let’s Dive In!
Let’s be real—you won’t get called out for picking the big-name PBM. The safe bet. The “steady hand.” But is that the whole story?
Nope.
Because playing it safe often comes with a cost. You’re stuck in a contract that looks good on paper but bleeds dollars in the real world. And here’s the kicker—you probably don’t even see it happening.
In the past, we’ve discussed Sunk Cost Fallacy and Switching Costs. These traps exist because you’re solving the wrong math.
The Right Math Problem No One Talks About
You measure activity: rebate dollars, discounts, contract terms that sound great. PBMs love that. They flood you with flashy reports, fancy charts, and savings that look good on paper. All math, right?
Wrong. That’s activity math. What you need is impact math.
Impact math asks:
Are these “savings” actually reducing total spend, or just shifting costs?
Does this ancillary program drive real value, or just add complexity and cause burnout?
What’s my net cost per script—after I factor in patient outcomes?
If you don’t have clear answers, your math is broken.
Consider Journavx, a classic example. Recently approved by the FDA, it comes in at $15 per fill. Some PBMs are balking. Too expensive, they say. Excluded from our formulary, they boast! But hold on—what math are they solving for?
A prudent PBM will say: Opioid dependence. Addiction. Return to work. Risk of overdose.
According to clinical trial data, Journavx eliminates all of those risks. So, what math are we solving for? A short-term cost on a spreadsheet, or the long-term human and financial cost of opioid addiction?
Bottom Line: Leaders who win aren’t the ones who play it safe. They’re the ones who run the right equation. They ask the right questions. They solve for impact, not just activity.
The Big 3 PBMs push their math because they know it solves their value equation—at your cost. The numbers don’t lie.
Let’s rewrite your value equation and build a pharmacy program that works for you. Trash the easy math. Do the right math —choose Prodigy.
Let’s chat.
Love at First Call: Prodigy’s Customer Obsession in Action
Valentine’s Day is just around the corner—a perfect time to celebrate love and appreciation. At Prodigy, we’re taking this moment to express our deep devotion to what we do: caring for patients and making your life easier. Your trust means everything to us, and we’re committed to delivering the kind of service that keeps the love alive—every call, every claim, every time.
Some PBMs play hard to get. Not Prodigy. We believe in answering every call, text, and email like it’s a love letter—within minutes, not hours or days. Our commitment to patient care is so strong, we put our service guarantees in writing—so you can hold us accountable. And while the average PBM’s Net Promoter Score (NPS) is heartbreakingly low, ours is 35 points higher than the industry average—but we’re not stopping there. We’re always striving to raise the bar even higher.
What are we solving for?
Nothing kills the mood faster than waiting—especially when it comes to critical medications. Patients shouldn’t be left in limbo and claims professionals shouldn’t have to chase down answers. Unfortunately, most PBMs leave clients feeling ghosted. At Prodigy, we take the opposite approach: immediate, accountable, and compassionate service that keeps everyone feeling valued.
How is Prodigy different?
We don’t play games. Every communication gets a response in minutes—because when patients are in pain, or claims need action, every second counts. And we back it up with performance guarantees.
Don’t just take our word for it—our clients are head over heels:
💖 “I needed my medication approved, and I expected the usual PBM delays. But Prodigy had it done in minutes. No hassle. Truly the best!” — Patient
💖 “I had an urgent claim, and Prodigy responded before I could even follow up. Prodigy is excellent at problem-solving, ensuring patients get their medications without delay. They don’t just promise great service—they deliver it.” — Claims Adjuster
💖 “Prodigy doesn’t make us chase them for answers. They’re always there, always responsive, always dependable.” — Claims Manager
💖 “Partnering with Prodigy helps us navigate the evolving challenges of pharmacy with ease. They provide our clients and claims teams with prompt, transparent, and reliable information.” — Executive
Love is about trust—and in the PBM world, trust is built on service —along with reliability, transparency, and accountability. Prodigy makes your life easier, your patients happier, and your claims process smoother. And unlike others, we don’t need sweet talk to prove it—our performance guarantees and industry-leading NPS speak for themselves.
This Valentine’s Day don’t settle for a PBM that ghosts you. Choose Prodigy—the only PBM that truly has a heart for service.
From All of Us at Prodigy
Happy Valentine’s Day ❤️
PBM Switching Costs: Why Staying Is Costing You Millions
Hey, there!
In my last email we tackled Sunk Cost Fallacy. A closely related concept is Switching Costs. This is particularly important when it comes to switching vendors, specifically PBM vendor.
Let’s cut to the chase: If you think switching PBMs is too expensive, you’re looking at the wrong price tag. The real cost isn’t in making the leap—it’s in staying locked into a system designed to drain your budget, limit your control, and put PBM profits ahead of patient outcomes.
Let’s Dive In!
You know the drill. The Big 3 PBMs (Caremark, Express Scripts, OptumRx) have spent years fine-tuning the art of the illusion of savings—hiding behind rebates, steering patients to their own pharmacies, and keeping pricing so opaque it would make a magician jealous.
And now, thanks to the FTC’s latest damning reports on Generic Markups and Vertically Integrated PBMs, we have the receipts:
$7.3 billion in overcharges on specialty generics—PBMs pocketing billions while payers foot the bill.
Markups of 1,000%+ on cancer drugs, all while PBMs pretend they’re “negotiating savings” for you.
68% of all specialty drugs flowing through PBM-owned pharmacies, ensuring they profit at every step.
A massive rebate shell game that keeps drug prices artificially high—and your costs soaring.
So let’s talk about the real cost of staying in this rigged system:
Every quarter you wait, you’re bleeding money into PBM profit margins.
Every renewal, you’re signing up for another year of opaque pricing and backdoor deals.
Every decision delay, you’re giving up control of your own pharmacy spend.
PBMs love to scare payers with “switching costs.” They warn of disruptions, complexity, and administrative headaches. But what they won’t tell you is that staying put means:
❌ Being locked into rebate schemes that drive up drug prices instead of lowering them.
❌ Watching your injured workers get funneled into PBM-owned pharmacies, where pricing is set to maximize their profit—not your savings.
Enough is enough. You need a PBM that works for you—not the other way around.
Where Do We Begin?
First Things First: Work with a PBM That Puts You Back in Control. As I’ve mentioned before, Prodigy is that PBM—move fast, think differently, and put patient outcomes ahead of profits.
Your next PBM partner must have these key qualities:
Transparent, pass-through pricing—no spread pricing, no rebate games, no surprises.
You own the data, you set the strategy—they execute your plans.
A focus on patient outcomes—not pharmacy steering, hidden fees, or billion-dollar markups.
While the Big 3 PBMs are defending themselves in court, PBMs like Prodigy are building smarter, more flexible pharmacy solutions that actually deliver results.
Bottom Line: Staying is the Real Risk. Switching is the Smart Play.
The Big 3 PBMs want you to believe switching is too hard, too expensive, too complicated. Why? Because they know that once payers see the truth, they leave.
The numbers don’t lie. The longer you wait, the more you lose.
Let’s rewrite the script. Let’s build a pharmacy program that actually works for you. It’s time to make the smart move. It’s time for Prodigy.
Ready? Let’s chat.
Sunk-Cost Fallacy
Hey, Its Del!
In my last email, we unpacked how fuzzy logic can cause leaders to justify keeping poor-performing partners—often at the expense of the team’s trust and patience. Judging by some of the responses, it seems some of you may have been battling another mental gymnastics move: the sunk-cost fallacy.
Think of it as loyalty to a bad decision just because you’ve already paid the price—whether it’s in time, money, or headaches. When it comes to PBMsand ancillary service providers, this fallacy can trap you into sticking with partners who overpromise, underdeliver, and never fail to invoice on time.
So how do you outsmart this cognitive trap?
Let’s Dive In!
The sunk cost fallacy is the tendency to stick with a failing strategy or partnership simply because of the resources or time already invested.This cognitive bias can have significant financial, operational, and clinical repercussions, particularly when decisions directly impact efficiency and outcomes.
For example:
Inefficient PBMs: Sticking with underperforming contracts can result in higher drug costs, poor patient outcomes, and limited transparency.
Outdated Ancillary Services Technology: Using outdated systems leads to operational inefficiencies, missed savings opportunities, and increased patient dissatisfaction.
Recognizing and addressing this bias is critical to improving performance, reducing costs, and optimizing patient care.
Where Do We Begin?
Here are a few savvy strategies to break free from the sunk cost trap and make sharper, more impactful decisions:
Think like a chess master: Stop making moves based on the board you wish you had. Evaluate your partners for their current performance, not past investments.
Use the “prodigy test”: If a brilliant, unbiased outsider reviewed your PBM and ancillary situation, what would they recommend? Hint: they’d probably suggest cutting your losses and calling Prodigy.
Make it a math problem: Focus on future returns, not sunk costs. If your current partner isn’t delivering value now, they’re unlikely to magically transform later.
Be a talent scout: Look for partners who are hungry, innovative, and aligned with your goals—prodigies who can outplay your current bench.
Recruit your team as your panel of judges: The rank and file often have a clear-eyed view of who’s delivering value and who’s just coasting. Lean on them for their expertise.
Hot tip! Test-Drive a Better Fit: Not ready for a full switch? Try before you buy. Pilot a new vendor on a small scale and let real results show you why change is worth it. If you’d like to test a PBM or ancillary solution before fully committing, try Prodigy.
The brilliance of breaking free from the sunk-cost fallacy is that it creates space for partners who will amplify your success rather than weigh you down. In other words: don’t be afraid to trade up.
Got a story about spotting—or escaping—this trap? Share it with me; I’d love to feature a real-world prodigy move in my next email.
Ready? Let’s chat.
The Trap of Fuzzy Logic
Hey, Its Del Again!
Let’s dive into another head-scratcher: how decisions—or indecisions—can sabotage your success and hit your bottom line. Ever find yourself clinging to a vendor that’s clearly dropping the ball? Maybe you’ve whispered, 'It’s not perfect, but switching feels like a hassle,' or, 'Better the devil you know, right?' Classic fuzzy logic trap!
It’s amazing how far a little fuzzy logic can go when it comes to justifying the unjustifiable—like sticking with vendors everyone knows are terrible. Decision-makers often ignore glaring pain points flagged by their teams, waving them off with excuses like, “It’s not perfect, but it works,” or “Switching would just be too much trouble.” Spoiler: it’s not working, and the trouble is already here.
Let’s Dive In!
Here’s the thing: ignoring the grumbles from the rank and file doesn’t make the problems go away. It just kicks the can down the road while costs quietly pile up—operational headaches, missed savings, and lost time you'll never get back. But instead of facing reality, fuzzy logic swoops in, convincing you that the devil you know is somehow safer than making a change.
Let’s get real—this is less about risk aversion and more about comfort with mediocrity. And mediocrity comes with a price tag. Every day you stick with a subpar vendor or partner, you’re leaving better results (and money) or personal growth on the table.
Where Do We Begin?
Enough talk—here are three smart ways to ditch the fuzzy logic and make sharper decisions:
1) Prioritize Numbers Over Nostalgia
Forget the warm fuzzies about "the devil you know." Look at the cold, hard facts. Missed deadlines? Rising costs? Let the data guide you, not your comfort zone.
2) Calculate the Cost of Inaction
Think staying put is easier? Think again. Add up the inefficiencies, missed savings, and wasted time. Spoiler: the real hassle is doing nothing while the costs pile up.
3) Test-Drive a Better Fit
Not ready for a full switch? Try before you buy. Pilot a new vendor on a small scale and let real results show you why change is worth it. If you’d like to test a PBM or ancillary solution before fully committing, Prodigy is here to help
Escaping fuzzy logic isn’t just about clarity—it’s about leveling up your game. If you have any doubts, give me five minutes to challenge your thinking about your current PBM or ancillary vendors. If you don’t walk away with valuable insights, I’ll buy you a coffee. But if I’m right, you’ll be one step closer to ditching the fuzzy logic and making a decision your whole team will thank you for.
Ready? Let’s chat.
New Year, New Focus: Refine Your Resolutions and Thrive in 2025
As 2024 winds down—what a ride—it’s time to shift gears and set our sights on 2025. Personally, I can’t wait. Like 38% of Americans, I’m all in on New Year’s resolutions. According to MarketWatch, the usual suspects are financial goals and self-improvement. But as a business leader, I can’t help but extend that ambition to my organization too.
And I’m not alone. Constant Contact reveals that 53% of business leaders make annual resolutions aimed at boosting revenue, streamlining operations, and expanding customer reach. The real question is: how do you turn those lofty goals into tangible results while keeping up with the daily grind?
Let’s Get Into It!
The conundrum leaders face is cutting through the noise to stay focused on the big picture. This isn’t just challenging—it’s part of the job. Too often, leaders get stuck in the “now,” avoiding key strategic decisions, like regularly reevaluating pharmacy, post acute care, and other ancillary programs. While this may seem convenient in the short term, it can lead to costly consequences down the road.
Here’s the reality: the long-term payoff of smart decisions always beats the comfort of avoiding a little inconvenience. The trick is knowing where to begin. Here are three practical steps to help you escape the daily grind and refocus on what really matters.
Untangle Yourself from the Day to Day:
Back to basics, folks—this is Leadership 101. Give your team the reins with clear roles and decision-making power so you can zero in on the big picture. Set aside time for strategy sessions, track those long-term KPIs, and keep yourself accountable. After all, you can’t lead from the weeds!
Drown Out the Noise
Great leaders know the secret: focus on what moves the needle. Zero in on your core objectives—growth, strategy, and long-term wins—and let the rest fade into the background. Hand off the small stuff, lean on data for decisions, and stay laser-focused by asking, “Does a pharmacy vendor evaluation get us closer to our goals?” Clarity isn’t just a buzzword; it’s your team’s alignment and your path to maximum impact.
Get Back in Traffic
It’s time to shake off the cobwebs and revisit those resolutions gathering dust. Whether it’s fine-tuning your pharmacy program or tackling another lingering priority, the moment to act is now. Start small—shoot me a message, ask a question, connect with an partner like Prodigy. You don’t have to solve it all overnight; just take that first step and watch the momentum build.
Building Inertia: Where Do We Begin?
Let’s achieve your pharmacy and ancillary program goals together. Every plan deserves action, and every challenge is a chance to level up. If you’re ready to reset and make 2025 the year of meaningful change in your pharmacy or ancillary programs, I’m here to help. Together, we’ll craft strategies that stick and tackle the tough stuff with clear, actionable steps.
Don’t let the noise drown you out. Let’s cut through it and create real solutions. Reach out today, and let’s start turning those ideas into results. Your success is my priority—and it’s time to get moving.
Before Signing Off:
As we look ahead to 2025, we’re filled with optimism and excitement for what we can accomplish together in the new year.
From all of us at Prodigy, we wish you and your loved ones a joyful holiday season and a bright, successful year ahead.