United is not the Plan Administrator of the Plan. Any references in this Agreement to United “administering the Plan” are descriptive only and do not confer upon United any responsibilities or duties beyond the claim administration duties set forth herein.
Why this verdict
Three of five models read this as bad; GPT 5.6 Sol and Gemini 3.1 Pro called it partial because page 10 warrants that services will be performed with the care of a prudent claims administrator or fiduciary and page 34 names United a fiduciary for initial claim determinations and first level appeals. We re-read pages 10, 26 and 34. The fiduciary role is confined to claim decisions, page 26 disclaims any duty beyond claim administration, and nothing requires loyalty to the plan when United sets MAC lists, tiers drugs, or keeps spread, purchase discounts and float interest. There is no conflict disclosure duty and no disgorgement remedy, so the contract permits the self dealing the model clause by Mark Cuban and collaborators exists to prevent. The prudent administrator warranty is a real but narrow counterweight, which is why confidence is moderate.
Compare with the model contract · § Section 2.4
The PBM owes duties of loyalty and care solely to the plan and its members, must disclose all direct and indirect compensation and every economic conflict, and must disgorge anything retained in breach without the plan proving damages.
Without a loyalty duty the PBM is free to put its own affiliates and revenue ahead of the plan when it exercises discretion over formularies, networks and pricing.
Where the council disagreed 5 published readings
Only readings under the score’s rubric version are shown here. Model confidence and agreement do not establish legal correctness.
Claude Opus 5Contradicts the model
The model contract published by Mark Cuban and collaborators makes the pharmacy benefit manager a fiduciary that owes loyalty only to the plan and its members. This contract goes the other way and disclaims duties beyond claim processing. United is named a fiduciary only for initial benefit determinations and first level appeals on page 34, and elsewhere the text lets it keep spread, purchase discounts and interest, which is the opposite of a duty of loyalty. There is no disgorgement remedy anywhere in the document.
United is not the Plan Administrator of the Plan. Any references in this Agreement to United “administering the Plan” are descriptive only and do not confer upon United any responsibilities or duties beyond the claim administration duties set forth herein.
Page 26 · Rubric v2
Gemini 3.1 ProWeaker than the model
The contract appoints the vendor as a named fiduciary for initial benefit determinations and appeals, but does not impose broader duties of loyalty and care solely to the plan for pharmacy benefit pricing, nor does it require disgorgement of retained compensation.
Customer appoints United a named fiduciary under the Plan with respect to (i) performing initial benefit determinations and payment
Page 34 · Rubric v2
GPT 5.6 SolWeaker than the model
The contract supplies a prudent claims administrator standard, and pharmacy claim determinations use the medical attachment's named fiduciary process. It does not impose loyalty solely to the City and members, require full conflict disclosure, or require disgorgement of compensation retained in breach. The duty is therefore materially narrower than the model clause published by Mark Cuban and collaborators.
The Contractor warrants and represents that all services to be provided the City under the Contract will be performed using the care, skill, prudence and diligence under the circumstances then prevailing that a prudent claims administrator/fiduciary acting in a like capacity and familiar with such matters would use under similar circumstances
Page 10 · Rubric v2
Grok 4.6Contradicts the model
United is not the plan administrator. It is a named fiduciary only for initial benefit determinations and first-level appeals. There is no duty of loyalty or care owed solely to the plan for formulary, network, rebate, or pricing decisions. A services warranty uses a prudent claims administrator standard, not a loyalty duty. United may keep spread, affiliate purchase discounts, and other manufacturer revenue, which is the harm the Mark Cuban and collaborators model is meant to stop.
United is not the Plan Administrator of the Plan. Any references in this Agreement to United "administering the Plan" are descriptive only and do not confer upon United any responsibilities or duties beyond the claim administration duties set forth herein.
Page 26 · Rubric v2
Kimi K3Contradicts the model
The only fiduciary role the contract grants United is for claim determinations and first level appeals on the medical side. Everywhere else the contract disclaims the role: Section 5.1 of Exhibit D says United is not the Plan Administrator, and the pharmacy terms let United set MAC lists, classify formulary tiers, and retain spread at its own discretion with no duty of loyalty to the plan. There is no obligation to disclose all direct and indirect compensation, no duty to disclose economic conflicts, and no requirement to give back anything retained in breach. The model contract by Mark Cuban and collaborators makes loyalty, disclosure, and disgorgement the foundation, and this contract permits exactly the self dealing that foundation exists to prevent.
Customer appoints United a named fiduciary under the Plan with respect to (i) performing initial benefit determinations and payment and (ii) performing the fair and impartial review of first level internal appeals.
Page 34 · Rubric v2
Finding provenance
Finding ID
5b6128fd-2cb2-4513-807c-bc1f8fae7989
Reviewed
Sep 30, 2026
Reviewer
owner
Recorded confidence
0.65
Model votes
Kimi K3: bad; Grok 4.6: bad; GPT 5.6 Sol: partial; Claude Opus 5: bad; Gemini 3.1 Pro: partial
Published reports 3 write-ups
Published Sep 30, 2026
Good news, bad news: the short version
Good news
The whole deal is visible. All 92 pages are readable, including the fee schedule (page 55) and the pharmacy guarantees (pages 61 to 69). Nothing was scored unclear.
Rebates are shared at a stated 100.0% with per script minimums that rise each year, from $730.25 per retail brand script in 2025 to $1,066.98 in 2027, reconciled annually and paid in dollars when short (page 64).
The discount guarantees are customer specific and measured on the City's own claims: retail brand at AWP less 19.50%, retail generic at AWP less 84.50%, mail brand at 25.50% and mail generic at 86.50%, with dispensing fees of $0.35 and $0.05 (page 64).
Members pay the lesser of the discounted price, the pharmacy's cash charge, or their cost share (page 67).
The City may audit pharmacy claims once a year with access to all of its own claims (page 46).
The City gets one market check during the pricing term against at least four similar customers, with a duty to negotiate if the gap exceeds three percent (page 66).
The consultant fee is on the page: $2.00 per member per month paid to Lockton (page 67). Most contracts hide this.
Bad news
Spread pricing is written in. United may keep the difference between what it pays the pharmacy and what the City pays, for retail, mail and specialty, including dispensing fees (pages 43 and 67). The City never learns what the pharmacy received.
United may run multiple MAC lists and change them in its sole discretion (page 41).
The Rebate definition excludes direct purchase discounts, group purchasing organization money, and payments for services or data tools (page 41). Manufacturer Administrative Fees sit outside the guarantee (page 66). United's own mail and specialty pharmacies keep their purchase discounts and rebates (page 45). The 100.0% share applies to a narrowed pot.
United's specialty pharmacy is in the network and United keeps the spread on every specialty claim (page 69).
Leaving early is expensive. If the City ends pharmacy services before the pricing term ends, United keeps all pending and future rebates and no minimum guarantee reconciliation applies (page 66).
Fees can change on notice, even retroactively, and the City's only remedy is to terminate (page 5), despite a clause elsewhere requiring signed amendments (page 16).
Rebate audits reach only the top five agreements or 75% of rebate revenue, whichever is less, and the auditor may not copy or keep anything (page 46).
Pricing, discounts, reimbursement terms and compensation arrangements are Confidential Information, and on a public records request the City must give notice and cooperate in seeking a protective order (pages 13 and 14).
No fiduciary duty runs to the plan for pricing, formulary or network decisions (page 26), and United may de-identify plan health data and use it for its own purposes (page 50).
The number
The score is 19 out of 100, a Red flag, with all 100 points of weight scored and none excluded for redaction, and the gag clause flag is set. Nothing scored good. The single change that would move the number most is a true pass through: strike the retained spread language on pages 43, 67 and 69 and price every claim at what the pharmacy is paid plus a disclosed fee, which carries 9 points of weight and would pull the MAC, affiliate pricing and specialty items with it. Widening the Rebate definition to every dollar of manufacturer money is the second biggest lever, worth up to 11 points.
Request a signed agreement, later amendments, incorporated proposals or any missing exhibits as needed. A full-contract label does not confirm that the posted copy is signed.
The reference is the open source PBM contract published by Mark Cuban and collaborators, version 3.5. BetterBuy Rx did not write it and is not affiliated with or endorsed by its authors. Read the original model contract.