Your Contract Has No Exit Ramp 67 agreements. 27 PBMs. Zero extension clauses. Executive Brief I spent Friday at a conference talking with PBMs. They’re still receiving RFPs for January 1 starts. Several said the same thing: to implement on time, they need a signed contract in two weeks. That’s a tighter deadline than most plan sponsors think they’re working against, and the vendors know it better than the buyers do. Here’s what happens when a sponsor arrives at signature with two weeks of...
14 days ago • 6 min read
6 Weeks To Set The Next 3 Years The 90 Standard. Any size. Any sector. Executive Brief Most January 1 pharmacy contracts get signed in the next six weeks. The term will likely run three years. That's forty-two days of attention governing more than a thousand days of spend. For a 5,000-life employer at roughly $1,200 per member per year, the commitment can easily clear $20 million. The most valuable thing you can do with it takes one sentence and costs nothing. We call it "The 90 Standard."...
20 days ago • 6 min read
We Scored Mark Cuban's Contract Full Negotiation Report and Book Foreword, Both Free Executive Brief Something changed in the PBM market this year, and many plan sponsors haven't realized it yet. Ten PBMs have rewritten their standard contracts to score 90 or better on Contract X-Ray. Not one started there. All but one began in Red Flag, the lowest tier we score. The average improvement is 39 points. Nobody made them do it. No regulation requires a contract score, no enforcement action sits...
26 days ago • 8 min read
What Does It Cost You To Leave? Contracts either let you leave clean or clean you out Executive Brief A plan sponsor's leverage comes down to three things in sequence. You need your data. You need to be able to verify it. And if what you find is bad enough, you need to be able to leave. Break the last link and the first two stop mattering. An audit that proves you're being overcharged is a document, not a remedy, if leaving costs more than the overcharge. So we looked at what typical PBM...
28 days ago • 7 min read
Mutually Acceptable Audit Rights Sounds like agreement. Functions like a veto. Executive Brief An audit is how a promise becomes collectible. Everything you negotiated, every guarantee, every pricing term, is an assertion until someone independent checks it. Here's a sentence from a PBM contract we scored earlier this year. Under no circumstances can the specific individual auditor(s) have testified previously as a witness in litigation against [PBM] or any other pharmacy benefit managers....
about 1 month ago • 9 min read
It Means Just What I Choose It to Mean Lewis Carroll wrote that in 1871. Your PBM contract says it in Article 1. “The question is,” said Alice, “whether you can make words mean so many different things.” “The question is,” said Humpty Dumpty, “which is to be master — that’s all.” Lewis Carroll, Through the Looking-Glass, 1871 Executive Brief Lewis Carroll wasn't predicting anything. He was describing a permanent feature of language: meaning is shared, and any party with enough leverage can...
about 1 month ago • 6 min read
Stop Signing Stupid Contracts And definitely don’t sign silent ones. Executive Brief Last week at RosettaFest, Cristy Gupton told me our motto should be “stop signing stupid contracts.” The line gave me a real chuckle. She's been a Health Rosetta advisor for a long time and has seen her fair share of stupid PBM contracts come across her desk. She's right. But the expensive risk is quieter than that. Across the 67 contracts in our reference database, 78% fall below 60. Score enough of them and...
about 2 months ago • 8 min read
Special Announcement Same Newsletter. New Name. Eighteen months ago this newsletter started as The Health Plan Compliance Advantage, and compliance was the right frame for the moment. The job was defensive and it was your responsibility alone to know your obligations, document your process, protect your plan. The frame got too small. What we've been writing about for a year is the money moving between an employer and the middlemen standing between you and your benefits. Middlemen exist...
about 2 months ago • 5 min read
Short Note. Big Week. The full issue arrives Thursday, with announcements attached. Executive Brief We've been working toward this week for a while. Lots of Nautilus announcements coming out at RosettaFest in Nashville. Contract X-RayFull Assessment launc and demos CAA 2026 Readiness report with 9 PBMs scoring Excellent The Middleman's Cut now available in hardcover & paperback So today is short on purpose. The next issue comes out on Thursday with the announcements, the findings, and the...
2 months ago • 1 min read