VENDOR agrees to be a fiduciary solely for the purpose of initial Claim adjudication and appeals relating to the coverage of prescription drug benefits.
Why this verdict
All five models reached this verdict. Section 2.5(B) on page 11 has the vendor accept a fiduciary role only for initial claim adjudication and appeals, and then states that for everything else it is not the plan administrator, not a named fiduciary, has no discretionary authority and is not deemed a fiduciary under ERISA or state law. Formulary placement, MAC pricing and manufacturer money therefore sit outside any duty of loyalty to the city. The model contract published by Mark Cuban and collaborators requires loyalty and care owed solely to the plan across the whole relationship, and page 10 confirms the vendor keeps manufacturer fees, so this is the opposite of the model.
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.
Independent council readings 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 vendor agrees to act as a fiduciary only for the narrow job of deciding claims and appeals, and then disclaims fiduciary status and discretionary authority for everything else. That leaves formulary placement, pricing lists and manufacturer money outside any duty of loyalty to the city. The model contract published by Mark Cuban and collaborators requires loyalty and care owed solely to the plan and its members across the whole relationship. Read together with the clause on page 10 that lets the vendor keep manufacturer fees, this is the opposite of the model.
VENDOR and CITY acknowledge and agree that, except with respect to its fiduciary obligations as specifically delegated and accepted by VENDOR pursuant to this CONTRACT, VENDOR shall not be (i) the administrator of the Plan for any purpose; (ii) a named fiduciary with respect to the Plan for purposes of ERISA or any applicable state law;
Page 11 · Rubric v2
Gemini 3.1 ProContradicts the model
The contract explicitly limits the PBM's fiduciary duties solely to initial claim adjudication and appeals, denying a broader duty of loyalty or care.
VENDOR agrees to be a fiduciary solely for the purpose of initial Claim adjudication and appeals relating to the coverage of prescription drug benefits.
Page 11 · Rubric v2
GPT 5.6 SolContradicts the model
The fiduciary role is expressly limited to initial claim adjudication and appeals. The contract then disclaims fiduciary status for the rest of plan administration, so it does not impose loyalty and care across formulary, network, rebate, and pricing decisions as the model requires.
VENDOR agrees to be a fiduciary solely for the purpose of initial Claim adjudication and appeals relating to the coverage of prescription drug benefits.
Page 11 · Rubric v2
Grok 4.6Contradicts the model
The vendor agrees to be a fiduciary only for initial claim adjudication and appeals. The same section says it is not the plan administrator, not a named fiduciary, and has no discretionary authority over the plan. That contradicts the loyalty and care duty in the model contract published by Mark Cuban and collaborators. The vendor can still put mail, specialty, and manufacturer revenue ahead of the City and its members.
VENDOR agrees to be a fiduciary solely for the
purpose of initial Claim adjudication and appeals relating to the coverage of
prescription drug benefits.
Page 11 · Rubric v2
Kimi K3Contradicts the model
The contract limits any fiduciary role to initial claim adjudication and appeals, and the same paragraph expressly states the vendor is not a named fiduciary, has no discretionary authority over the plan, and is not deemed a fiduciary under ERISA or any applicable state law. There is no duty of loyalty to the plan and its members, no requirement to disclose all direct and indirect compensation, and no disgorgement obligation. This is the opposite of what the model contract published by Mark Cuban and collaborators calls for.
VENDOR agrees to be a fiduciary solely for the purpose of initial Claim adjudication and appeals relating to the coverage of prescription drug benefits.
Page 11 · Rubric v2
Finding provenance
Finding ID
15b67596-127e-453a-9e11-760541d6d074
Reviewed
Sep 30, 2026
Reviewer
owner
Recorded confidence
0.98
Model votes
Kimi K3: bad; Grok 4.6: bad; GPT 5.6 Sol: bad; Claude Opus 5: bad; Gemini 3.1 Pro: bad
Published reports 3 write-ups
Published Sep 30, 2026
Good news, bad news: the short version
Good news
Amendments must be in writing, dated after the contract and signed by both parties (page 20).
The city may cancel without cause on 90 to 120 days notice (page 29), and may stop if funds are not appropriated (page 19).
The city owns information produced solely for it (page 19), and all files are city property at termination (page 29).
Every retail claim is priced at the lowest of the discounted rate, the pharmacy's usual and customary price and the MAC rate, and members pay the lowest of those or the copayment (page 4).
The city gets annual claims and rebate audits (page 15), a post termination audit (page 30), SOC 1 reports and audited financials (page 17), and portal access to claims data (page 7).
Performance penalties come off the vendor's invoice within sixty days (page 14), and only city claims are used to measure claims operations (page 13).
Bad news
The vendor is a fiduciary only for claim adjudication and appeals and disclaims fiduciary status for everything else (page 11).
Rebates means formulary rebates only (page 2); manufacturer administrative fees of one to four percent of wholesale acquisition cost, plus purchase discounts earned by the vendor's own pharmacies, belong exclusively to the vendor (page 10).
The city may not negotiate rebates or discounts with any drug maker on its own, and doing so is a material breach (page 10).
The formulary is the vendor's own CVS Health drug list, changed on thirty days notice with no city approval (page 8).
The MAC list is set and amended by the vendor on a list specific to the city, with no schedule and no appeal path (page 2).
The city may not audit the vendor's agreements with pharmacies or drug makers (page 15), so any spread stays invisible.
The rebate audit covers at most ten manufacturer contracts, and what the auditor sees may not be revealed to anyone, including the city (page 15).
The vendor may use, adapt and sell deidentified claims and eligibility data (page 19).
Performance dollars at risk are the city's exclusive financial remedy, settle once a year, and total $175,000 (page 13).
The vendor may suspend all services if the city is five days late on a payment (page 18).
Costs and pricing data are confidential, and Public Information Act requests route through the vendor, which the city agrees not to oppose (pages 34 and 36).
What we could not see
The contract incorporates Exhibits A through F (page 32), and none is posted. Exhibit A holds the performance guarantees (page 13); Exhibit B holds the administrative fees (page 17), discounts, dispensing fees, the implementation credit (page 3) and rebate remittance terms (page 9). Without them the guarantees, fees and rebate share cannot be read. The ordinance's estimate of $124,000 a year (Ordinance, page 1) is the only price figure in the posting.
The number
The reconciled score is 17 out of 100, a Red flag, with the gag clause flag set. Nothing scored good; ten items worth 34 points scored partial, and half of 34 is 17. Nothing was excluded as unclear, because the readable body decides every item. The change that would move the number most is pass through, worth 11 points: redefine Rebates to cover every dollar of manufacturer money on page 10 and pay all of it to the city. A no spread covenant, worth 9 points, would be next. The term ended in 2021 and no successor is posted, so the first step is a Public Information Act request for the current agreement and its exhibits.
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.