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Fiduciary & Governance Engine

PBM Contract Scoring

Score PBM contracts across 45 contractual provisions, identify missing protections and loopholes, and generate redline recommendations for negotiation

The $4.2M Loophole

Your PBM contract says "pass-through pricing" on specialty drugs. Sounds transparent. Then you discover they define "acquisition cost" as "the price we negotiated"—not the actual invoice price. That ambiguity cost you $4.2M over three years because they marked up specialty Rx 28% and called it "pass-through." One word change ("invoice-based" vs. "negotiated") would have prevented it.

Contract Leakage
$2-8M
per 10K lives annually
Loopholes Avg
12-18
per typical PBM contract
Plans Reviewing
<12%
independent contract audit

What Fails Without This Engine

  • Can't score contract quality: no framework to evaluate 200-page agreements
  • Ambiguous definitions: "reasonable", "market-based", "acquisition cost" undefined
  • Missing audit rights: can't validate claims, rebates, or spread pricing
  • No performance guarantees: PBM promises oral "savings", nothing contractual

45-Point Contract Audit

Our PBM Contract Scoring Engine evaluates agreements across 45 critical provisions (pricing definitions, audit rights, guarantee enforceability, rebate pass-through, data transparency), scores each provision 0-100, identifies missing protections, and generates redline recommendations for negotiation.

PBM Contract Scoring Algorithm
// 45-point contract evaluation CONTRACT_SECTIONS = [ pricing_definitions, rebate_pass_through, audit_rights, data_transparency, performance_guarantees, termination_provisions, conflict_disclosures ] FOR each section IN CONTRACT_SECTIONS: // Pricing Definitions (10 provisions) IF section == pricing_definitions: SCORE: - AWP discount clearly defined? (10 pts) - "Acquisition cost" = actual invoice? (15 pts) - MAC defined with update frequency? (10 pts) - Dispensing fee fixed or variable? (10 pts) - Specialty drug markup disclosed? (15 pts) - Brand-generic arbitrage prohibited? (10 pts) - Spread pricing prohibited? (15 pts) - Reasonable and customary defined? (10 pts) - Administrative fees itemized? (5 pts) // Rebate Pass-Through (8 provisions) IF section == rebate_pass_through: SCORE: - 100% of manufacturer rebates passed? (20 pts) - Rebate timing (≤60 days)? (15 pts) - Admin fees < 3% of rebates? (15 pts) - Market check definition objective? (10 pts) - Rebate aggregators disclosed? (15 pts) - Retroactive rebate clawback prohibited? (10 pts) - Rebate reporting quarterly minimum? (10 pts) - Audit rights on rebate calculations? (5 pts) // ... 5 more sections (37 more provisions) ... // Calculate composite score total_score = WEIGHTED_AVERAGE(all provisions) risk_classification = CLASSIFY: IF total_score < 50: "High Risk — major renegotiation required" IF 50-70: "Moderate Risk — targeted improvements needed" IF 70-85: "Low Risk — minor enhancements" IF > 85: "Well-Protected — best-in-class contract" // Generate redline FOR each low_scoring_provision: SUGGEST replacement_language FROM best_practice_library FLAG "Priority: Critical" IF provision_score < 30 OUTPUT: - Overall contract score - Section-by-section breakdown - Redline document with recommended changes - Negotiation priority ranking

Engineering Architecture

Core Components

  • 45-Provision Scorecard: Evaluate pricing, rebates, audits, guarantees, transparency
  • Loophole Detector: Identify ambiguous definitions and missing protections
  • Redline Generator: Suggest replacement language from best-practice library
  • Benchmark Comparison: Compare against top-quartile contract terms

Scoring Metrics

Typical Score
45-62
broker-negotiated contracts
Target Score
85+
best-in-class protection
Leakage Reduction
$1.8-4.2M
per 10K lives annually
Audit Time
<2 hours
complete contract review

Real-World Applications

Specialty Drug Pricing Loophole

  • Contract language: 'Pass-through pricing based on acquisition cost'
  • Engine score on this provision: 15/100 (Critical)
  • Issue: 'Acquisition cost' not defined as actual invoice
  • PBM interpreted as 'our negotiated rate' (28% markup)
  • Redline: Changed to 'invoice-based acquisition cost with 30-day proof'
  • Renegotiated contract, annual savings: $1.9M

Rebate Audit Rights

  • Original contract: No rebate audit rights
  • Engine flagged: 0/100 on audit provisions
  • PBM claimed $42 PMPM in rebates
  • Post-renegotiation: Quarterly rebate reports + independent audit rights
  • First audit discovered: $8 PMPM rebate retention by PBM
  • 3-year recovery: $2.4M + ongoing transparency

Close the Loopholes

Score your PBM contract across 45 provisions. Identify missing protections. Generate redline recommendations. Stop accepting broker boilerplate—demand best-in-class protection.

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