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