Price comparison only·Not medical advice·Using this site means you accept our Terms & Privacy·Always confirm with your pharmacist·Price comparison only·Not medical advice·Using this site means you accept our Terms & Privacy·Always confirm with your pharmacist·
Pharmacy benefit manager: Express Scripts, Inc. Term September 1, 2021 to December 31, 2024. Contract 00002789.0 v8, signed by DocuSign May 5 and 6, 2022. Initial term September 1, 2021 through December 31, 2024, with renewal options through December 31, 2027. Posted by the A&M System under its Senate Bill 20 contract reporting page.
20Red flagBand 0 to 39 of 100Scored on 75 of 100 weight. 25 excluded as unclear or redacted.
Pages 54 through 106 are fully blacked out as posted by the A&M System. Thirty more pages carry partial redactions, concentrated in the pricing exhibits and network terms. Redaction was measured from the posted PDF (dark pixel ratio per page) and then read page by page. The financial exhibits that would show the actual per claim fees, guaranteed discounts and rebate amounts are inside the redacted range.
The rubric
Clause by clause
Each item quotes the contract and cites the page it came from. Items whose pages are redacted are marked unclear and left out of the score.
Fiduciary duty and loyalty
Weight 7 of 100, model section Section 2.4
Contradicts the model
All five models reached this verdict. Section 4.2 of the scope of services exhibit has the A&M System agree that Express Scripts is not a fiduciary of the plan under ERISA or state law, that it has no discretionary authority over the benefit, and that the financial terms were negotiated at arm's length. The only fiduciary role Express Scripts accepts is for handling an appeal, on page 114. The same page reserves the right to stop serving any plan in a state that requires a pharmacy benefit manager to be a fiduciary, which is the opposite of the duty of loyalty in the model contract published by Mark Cuban and collaborators.
A&M System acknowledges and agrees that, except for the limited purpose set forth in Section 2.3(c) of this Exhibit G, neither it nor the Plan intends for ESI to be a fiduciary (as defined under ERISA or state law) of the Plan
Page 115Model contract says
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.
Model votes: Kimi K3 bad, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro bad
Full disclosure of compensation and conflicts
Weight 6 of 100, model section Sections 2.4, 2.6
Contradicts the model
No verdict won a majority: GPT 5.6 Sol and Grok 4.6 read this as bad, Claude Opus 5 and Kimi K3 as partial, and Gemini 3.1 Pro as missing because there is no officer certification. The reconciliation rule takes the middle vote, which falls on bad, and a re-read of page 115 confirms the text is not merely silent. Section 4.3 points to a Financial Disclosure that lives in the unproduced proposal and that Express Scripts may update on its own, then declares those revenues are not compensation from the plan and that the plan has no interest in them. There is no plan specific accounting of retained revenue and no named officer who certifies quarterly or annually that everything has been disclosed and remitted.
Unlike the Administrative Fees, the revenues described in the Financial Disclosure are not direct or indirect compensation to ESI from A&M System for services rendered to A&M System or the Plan under this Contract.
Page 115Model contract says
All PBM and related-entity compensation, affiliate ownership touching plan claims, and payments to consultants or brokers are disclosed, and a named officer certifies quarterly and annually that everything has been disclosed and remitted.
Hidden revenue streams are the main way plans overpay. Officer certification puts a name on the line.
Model votes: Kimi K3 partial, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 partial, Gemini 3.1 Pro missing
Ownership and affiliate disclosure exhibit
Weight 3 of 100, model section Proposed Exhibit A-5
Not addressed
Three of five models read this as missing; Claude Opus 5 and GPT 5.6 Sol called it partial because page 6 requires advance notice of any merger, acquisition or change of ownership. The exhibit list on page 17 runs from Exhibit A to Exhibit K and contains no ownership or affiliate disclosure exhibit. Accredo Health Group and Express Scripts Specialty Distribution Services are named as specialty pharmacies on page 110 and Medco Containment Life Insurance Company appears as the Medicare plan sponsor on page 116, but only inside operating definitions. Nothing lists owners, parents, group purchasing organizations or rebate aggregators, and nothing requires a refreshed list within 30 days of a change in control.
No verbatim quote is available for this clause.
Model contract says
A signed exhibit lists every owner, parent, subsidiary, affiliate, group purchasing organization, rebate aggregator, mail order pharmacy and specialty pharmacy tied to the PBM, and the PBM must refresh it within 30 days of any change in ownership or control.
The model contract has no ownership exhibit, and the Nautilus Health Institute review of version 3.5 scored conflict of interest 70 of 100 for that gap. A plan cannot police affiliate pricing, steering or GPO pass through if it does not know which companies are affiliates.
Model votes: Kimi K3 missing, Grok 4.6 missing, GPT 5.6 Sol partial, Claude Opus 5 partial, Gemini 3.1 Pro missing
Definitions that close loopholes
Weight 5 of 100, model section Section 1
Weaker than the model
Three of five models read this as partial; GPT 5.6 Sol and Kimi K3 voted unclear because seven numbered definitions on pages 110 to 112, apparently including rebate, manufacturer administrative fee and specialty product, are individually blacked out. The definitions that survive hand the labelling power to Express Scripts: brand versus generic status comes from its proprietary algorithm on page 110, the MAC list on page 111 is whatever it develops or selects, and the specialty product list on page 112 is maintained and updated by it. Those readable terms are addressed but weaker than the model contract, which defines each term by economic function. The redacted definitions keep confidence low because the terms that decide pass through cannot be tested.
“Brand/Generic Algorithm” or “BGA” means ESI’s standard and proprietary brand/generic algorithm, a copy of which may be made available for review by Sponsor or its Auditor upon request.
Page 110Model contract says
Rebate, manufacturer revenue, affiliate, specialty, generic and pharmacy are defined by economic function, not by label, so value cannot be relabeled (for example as fees) to escape pass-through or guarantees.
Most PBM revenue leakage happens inside definitions. A narrow definition of rebate lets fees, grants and administrative payments stay with the PBM.
Model votes: Kimi K3 unclear, Grok 4.6 partial, GPT 5.6 Sol unclear, Claude Opus 5 partial, Gemini 3.1 Pro partial
100% pass-through of manufacturer revenue
Weight 11 of 100, model section Section 4
Contradicts the model
Three of five models read this as bad; Gemini 3.1 Pro and Kimi K3 voted unclear because the rebate amounts and payment terms in Exhibit C-3 on pages 35 to 37 are blacked out. The readable structure is visible without those numbers. Page 114 says only that Express Scripts will pay the amounts set forth on Exhibit C, and section 4.3 on page 115 says Express Scripts and its affiliates keep the beneficial interest in every other manufacturer and affiliate revenue stream, with the plan owed only what the contract expressly states. That is a guaranteed amount arrangement in which the surplus stays with the vendor, not one hundred percent of manufacturer revenue of every kind. The redacted share keeps confidence moderate.
ESI and ESI’s wholly-owned subsidiaries and affiliates retain all proprietary rights and beneficial interest in such fees and revenues described in the Financial Disclosure and, accordingly, A&M System acknowledges that neither it, any Member, nor the Plan, has a right to receive, or possesses any beneficial interest in, any such fees or revenues; provided, that ESI will pay A&M System amounts equal to the amounts expressly set forth in this Contract.
Page 115Model contract says
One hundred percent of manufacturer revenue of every kind is paid to the plan, quarterly within 30 days of quarter end, with only a closed list of excludable claims.
Rebates and other manufacturer payments are the largest dollar item in most PBM contracts. Anything less than 100% of everything is money left with the PBM.
Model votes: Kimi K3 unclear, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro unclear
Affiliate pharmacy pricing at acquisition cost
Weight 5 of 100, model section Section 3.2
Redacted or unreadable
Four of five models read this as unclear; Grok 4.6 voted bad because the page 24 heading prices ESI Mail Pharmacy on average aggregate annual ingredient cost and dispensing fee guarantees rather than at acquisition cost. Exhibit D, specialty drugs under the mail order pharmacy program, is fully blacked out from page 54 to page 106, and the ESI Mail Pharmacy guarantee section on page 25 survives only as headings. Pages 110 and 111 confirm that the mail and specialty pharmacies are owned by Express Scripts or its affiliates, so the pricing that would settle this item sits entirely under the redaction. The heading Grok 4.6 cited is a real signal, but a heading without its terms is not enough to score the item.
No verbatim quote is available for this clause.
Model contract says
Claims dispensed by PBM-owned or economically related pharmacies (mail, specialty, retail) are invoiced at net acquisition cost plus a stated dispensing fee, with no retained margin and a documentation default if records are not produced.
Owned pharmacies are where PBMs earn the most margin. Pricing them at cost removes the incentive to steer patients into the PBM's own channels.
Model votes: Kimi K3 unclear, Grok 4.6 bad, GPT 5.6 Sol unclear, Claude Opus 5 unclear, Gemini 3.1 Pro unclear
Benchmark ceiling and cheapest lawful option
Weight 3 of 100, model section Section 3.3
Redacted or unreadable
Four of five models read this as unclear; Grok 4.6 voted missing because the readable headings show aggregate guarantees and no ceiling clause appears anywhere in the visible text. A benchmark ceiling would live in the claims reimbursement rates and the general pricing terms of Exhibit C-2, and page 27 says the general pricing terms apply to all pricing in the contract before the text goes black. The surviving heading on page 24 describes average aggregate annual guarantees, which leans against a claim by claim test, but the operative terms cannot be read. Redaction, not silence, is the reason this cannot be decided.
No verbatim quote is available for this clause.
Model contract says
Plan claim cost can never exceed a published benchmark, for example the transparent cash price at a benchmark site, in any channel and for any drug, and the ceiling is checked claim by claim rather than on average.
A ceiling protects the plan from paying more through the contract than the public can pay in cash, and a claim level test stops a favorable average from hiding individual overcharges.
Model votes: Kimi K3 unclear, Grok 4.6 missing, GPT 5.6 Sol unclear, Claude Opus 5 unclear, Gemini 3.1 Pro unclear
Cash price protection and deductible credit
Weight 3 of 100, model section Section 3.4
Redacted or unreadable
Four of five models read this as unclear; Grok 4.6 voted missing because the usual and customary price on page 112 is defined as a pharmacy reported cash amount and nothing readable caps what a member pays or credits a cash purchase to the deductible. The words accumulator and cash price do not appear in the readable text outside that definition. Whether members pay the lesser of the cash price and the plan price would be set in the general pricing terms of Exhibit C-2, which are blacked out on pages 27 to 33. Because the section that would carry the rule is redacted, the item stays unclear rather than missing.
No verbatim quote is available for this clause.
Model contract says
A member never pays more than the pharmacy cash price or the cheapest lawful price, every cash purchase counts toward the deductible and out of pocket maximum, and no accumulator adjustment is applied against member assistance unless the sponsor elects it in writing.
Members routinely pay more through the plan than the cash price on the shelf, and a cash purchase that does not count toward the deductible punishes the member for finding the cheaper price.
Model votes: Kimi K3 unclear, Grok 4.6 missing, GPT 5.6 Sol unclear, Claude Opus 5 unclear, Gemini 3.1 Pro unclear
MAC list governance
Weight 5 of 100, model section Section 3.5
Contradicts the model
Three of five models read this as bad; Gemini 3.1 Pro and Kimi K3 voted unclear because the pricing terms in Exhibit C-2 that might describe how the list is applied are blacked out. The readable definition on page 111 makes the maximum allowable cost list whatever Express Scripts develops or selects. Nothing in the readable text requires one list for what the plan pays and what pharmacies are paid, requires disclosure to the A&M System, sets an update schedule, or gives pharmacies an appeal path with deadlines. A vendor controlled list with none of those safeguards is the mechanism the model clause exists to block.
“MAC List” means a list of prescription drugs or supplies subject to maximum reimbursement payment schedules developed or selected by ESI.
Page 111Model contract says
A single MAC list applies to both what the plan pays and what pharmacies are paid, it is disclosed, updated on a schedule, and pharmacies have an appeals path with defined timelines.
Two MAC lists (one for the plan, one for pharmacies) is the classic spread pricing mechanism.
Model votes: Kimi K3 unclear, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro unclear
No spread pricing
Weight 9 of 100, model section Sections 2.5, 3.1, 3.5
Redacted or unreadable
Four of five models read this as unclear; Claude Opus 5 voted partial because page 4 defines a bona fide dispute as Express Scripts billing the A&M System an amount other than the amount reimbursed to the pharmacy. That definition and the audit protocol on page 127 suggest a pass through arrangement for retail claims exists, but the protocol frames it as something the sponsor might or might not have, and the claims reimbursement rates and general pricing terms on pages 24 to 34 are blacked out, as is every mail and specialty rate in Exhibit D. Whether the plan pays exactly what the pharmacy is paid in every channel cannot be read, so the item is redaction blocked.
No verbatim quote is available for this clause.
Model contract says
The plan pays exactly what the pharmacy is paid plus a disclosed administrative fee. The PBM retains no difference between the two, in any channel.
Spread pricing is an undisclosed markup on every claim. Eliminating it is the single clearest test of a transparent contract.
Model votes: Kimi K3 unclear, Grok 4.6 unclear, GPT 5.6 Sol unclear, Claude Opus 5 partial, Gemini 3.1 Pro unclear
GPO and purchasing entity pass-through
Weight 4 of 100, model section Section 5
Contradicts the model
Three of five models read this as bad; Grok 4.6 voted missing because the words group purchasing organization never appear, and Kimi K3 voted unclear because the rebate exhibit on pages 35 to 37 is blacked out. No clause allocates purchase discounts, volume credits or supplier payments collected by an affiliated purchasing entity to the plan. Section 4.3 on page 115 goes further than silence: Express Scripts and its affiliates negotiate those revenues on their own behalf, not as agents for the plan, and keep them. That is the outcome the model contract's purchasing entity pass through exists to prevent.
act on their own behalf, and not for the benefit of or as agents for A&M System, Members or the Plan.
Page 115Model contract says
Purchase discounts, volume credits and supplier payments received by the PBM or any related purchasing entity (including offshore GPOs) flow to the plan, allocated on disclosed drivers.
PBMs moved much of their manufacturer revenue into affiliated GPOs after rebate scrutiny increased. A contract that only covers rebates misses this.
Model votes: Kimi K3 unclear, Grok 4.6 missing, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro bad
Plan sponsor controls the formulary
Weight 4 of 100, model section Section 6
Weaker than the model
All five models reached this verdict. The formulary is developed by the Express Scripts pharmacy and therapeutics committee and selected or adopted by the sponsor, then changed by Express Scripts over time for reasons that expressly include manufacturer rebate arrangements. Additions and deletions are adopted by the sponsor automatically unless the A&M System elects not to implement them through a set up form on page 111. Page 113 does give the sponsor final say on whether any claim is covered. That is an opt out veto, not the advance approval of every change, lowest net cost analysis and quarterly utilization reporting the model contract requires.
The drugs and supplies included on the Formulary will be modified by ESI from time to time as a result of factors, including, but not limited to, medical appropriateness, manufacturer Rebate arrangements, and patent expirations.
Page 110Model contract says
The plan sponsor approves the formulary and every change, receives lowest-net-cost analysis, and gets utilization management outcomes by drug each quarter.
A PBM-controlled formulary can favor high-list-price, high-rebate drugs that cost the plan more overall.
Model votes: Kimi K3 partial, Grok 4.6 partial, GPT 5.6 Sol partial, Claude Opus 5 partial, Gemini 3.1 Pro partial
Lowest net cost standard and book of business comparison
Weight 3 of 100, model section Section 6
Not addressed
Four of five models read this as missing; Kimi K3 voted bad because the formulary definition on page 110 names manufacturer rebate arrangements as a reason to move drugs on and off the list. The formulary definition on page 110 and the formulary support clause on page 114 say nothing about net cost to this plan, and no clause promises an annual comparison against the vendor's book of business or requires disclosure when a drug is placed above a cheaper equivalent. The phrase net cost does not appear in the readable text. The rebate factor Kimi K3 flagged is real and is already counted in the formulary verdict, but the lowest net cost standard itself is simply absent.
No verbatim quote is available for this clause.
Model contract says
Formulary decisions must meet a lowest net cost standard for this plan, the PBM delivers an annual comparison against its whole book of business, and any drug placed above a cheaper equivalent is disclosed with the reason.
Rebate driven formularies can favor a high list price drug that returns more rebate but costs the plan more after the rebate. A stated standard and a book of business comparison make that trade visible.
Model votes: Kimi K3 bad, Grok 4.6 missing, GPT 5.6 Sol missing, Claude Opus 5 missing, Gemini 3.1 Pro missing
Pharmacy network protections and anti-steering
Weight 7 of 100, model section Section 7
Contradicts the model
Three of five models read this as bad; Kimi K3 called it partial because page 4 returns pharmacy audit recoveries to the plan, and Gemini 3.1 Pro called it missing because no protective network clause exists. Page 112 authorizes Express Scripts to promote its own mail pharmacy to members and lets it consolidate networks and migrate the plan between networks on its own. Participating pharmacies are defined on page 111 to exclude affiliated mail and specialty pharmacies. Nothing readable gives any willing pharmacy a right to join, bars retroactive clawbacks or bars reimbursement tied to volume, and page 4 lets Express Scripts keep 15% of what it recovers from network pharmacies. Affiliate steering written into the services exhibit is the harm the model clause prevents.
Subject to Applicable Law, ESI will make Members aware of the ability to fill their prescriptions through the ES! Mail Pharmacy, communicate any applicable cost savings, and provide supporting services (e.g. pharmacist consultation) in connection with any prescription dispensed by the ESI Mail Pharmacy.
Page 112Model contract says
Claims are final when adjudicated (no retroactive clawbacks), reimbursement is not conditioned on volume, the PBM may not steer claims into its own pharmacies, and any willing pharmacy may participate at the plan's terms.
Steering and clawbacks push independent pharmacies out and route patients to PBM-owned channels, reducing choice and often raising cost.
Model votes: Kimi K3 partial, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro missing
Most favored pricing and market check
Weight 3 of 100, model section Section 8
Not addressed
Three of five models read this as missing; Gemini 3.1 Pro and Kimi K3 voted unclear because a market check could in principle sit in the blacked out pricing exhibit. The readable text runs the other way: page 2 freezes the Exhibit C pricing terms for the term unless both parties agree in writing or the law requires a change, and page 115 reopens pricing only after a change in law. The words most favored and market check appear nowhere in the readable text, and the Exhibit C headings on pages 21 to 52 show no market check section. The clause is absent from the text that can be read, so the majority verdict of missing stands.
No verbatim quote is available for this clause.
Model contract says
The plan automatically receives pricing at least as good as any comparable client, and can run an annual market check with a meet, credit or release remedy.
Multi-year contracts drift out of market. Without a market check the plan is locked into stale pricing.
Model votes: Kimi K3 unclear, Grok 4.6 missing, GPT 5.6 Sol missing, Claude Opus 5 missing, Gemini 3.1 Pro unclear
Audit rights, data access and reporting
Weight 6 of 100, model section Section 9
Weaker than the model
Three of five models read this as partial; Gemini 3.1 Pro and Kimi K3 called it bad because the auditor must be approved by Express Scripts and may not be a competitor or provide litigation services against it. The audit right is real: page 3 gives one claims audit a year at no cost over a rolling 24 months and acknowledges the Texas State Auditor, and pages 126 and 127 allow rebate and performance guarantee audits. It is also fenced on every side. A rebate audit covers only half of the rebate payments for two quarters, manufacturer contracts may be viewed on site with no copies, Express Scripts may review the auditor's notes, and follow up is capped at 300 claims. Routine delivery of claims level data without asking is not promised. The right exists but is materially weaker than the model contract.
The Sponsor may select an initial number of manufacturer contracts to enable Sponsor to audit fifty percent (50%) of the total Rebate payments due to Sponsor for two (2) calendar quarters during the twenty-four (24) month period immediately preceding the audit
Page 127Model contract says
The plan may audit with its own auditor, receives full claims-level and financial data on a schedule without asking, has pre-adjudication claims access, and no data is withheld as proprietary.
You cannot enforce what you cannot see. Audit and data rights are how every other clause gets verified.
Model votes: Kimi K3 bad, Grok 4.6 partial, GPT 5.6 Sol partial, Claude Opus 5 partial, Gemini 3.1 Pro bad
Plan sponsor owns all plan data
Weight 4 of 100, model section Sections 9.4, 9.5
Weaker than the model
Three of five models read this as partial; GPT 5.6 Sol called it bad because page 8 makes anonymized claims data and mail and specialty pharmacy data the property of Express Scripts, and Gemini 3.1 Pro called it missing because no clause names the sponsor sole owner. Page 4 makes program specific records, reports and data the property of the A&M System with delivery on written request at termination, and page 8 assigns member identifiable health information and eligibility files to the System. The same page 8 clause hands anonymized claims data, mail and specialty pharmacy data, rebate contracts and drug pricing information to Express Scripts, and the business associate agreement on page 130 lets it create and use de identified data. Ownership is addressed but split, with no machine readable delivery duty and no ban on reuse of anonymized plan data.
All such records, including any research, reports, studies, data, or other documents that are specifically generated by ESI for the A&M System and are specific to its program under this Contract, shall be the property of the A&M System
Page 4Model contract says
The plan sponsor is the sole owner of claims, eligibility, accumulator, rebate and every derived data set, the PBM delivers it in machine readable form on request, and the PBM may not reuse, license or sell it.
Data ownership decides who can switch vendors, run an audit or check a guarantee. A PBM that owns or licenses plan data can charge for it, withhold it at termination, or resell it.
Model votes: Kimi K3 partial, Grok 4.6 partial, GPT 5.6 Sol bad, Claude Opus 5 partial, Gemini 3.1 Pro missing
Performance guarantees with real remedies
Weight 2 of 100, model section Section 10
Redacted or unreadable
All five models reached this verdict. Performance guarantees exist, because the audit protocol on page 126 lists performance guarantees subsequent to true up as an auditable component and page 3 refers to performance standards obligations. The guarantees themselves, how often they are measured, whether they use plan specific data and whether shortfalls are paid in cash or as capped credits sit in Exhibit C, which is blacked out apart from headings on pages 21 to 53. The surviving headings on page 24 describe average aggregate annual guarantees, but no remedy language can be read.
No verbatim quote is available for this clause.
Model contract says
Guarantees are measured quarterly on plan-specific data, reconciled in cash, and shortfalls are paid dollar for dollar rather than as capped credits.
Guarantees that are capped or measured on book-of-business data rarely pay out.
Model votes: Kimi K3 unclear, Grok 4.6 unclear, GPT 5.6 Sol unclear, Claude Opus 5 unclear, Gemini 3.1 Pro unclear
Self executing enforcement and two strikes exit
Weight 3 of 100, model section Sections 10, 12.5
Weaker than the model
Three of five models read this as partial; Gemini 3.1 Pro and Grok 4.6 called it missing because there are no liquidated damages and no two strikes exit. Remedies here depend on agreement rather than running on their own. Page 127 returns money only after both parties accept the audit results, through credits to a future invoice, and a new audit cannot start until the last one is closed. Page 5 allows termination for material breach after a 45 day cure period, page 6 allows immediate termination on a change of control and page 9 allows termination if Express Scripts knowingly fails its Public Information Act duties. Those are real remedies, which is why the item is weaker than the model rather than absent, but none of them is automatic and none is triggered by a second breach.
To the extent the mutually accepted audit results demonstrate claims errors, ES! will reprocess the claims and make corresponding adjustments to Sponsor through credits to a future invoice(s).
Page 127Model contract says
Missed guarantees and late reports trigger liquidated damages or automatic credits without the plan having to prove damages, and a second material breach or regulatory integrity failure lets the sponsor terminate without penalty.
A right the plan has to litigate to enforce is rarely enforced. Automatic remedies and a defined exit after a repeat failure change the PBM incentives without a lawsuit.
Model votes: Kimi K3 partial, Grok 4.6 missing, GPT 5.6 Sol partial, Claude Opus 5 partial, Gemini 3.1 Pro missing
Amendments only in writing
Weight 2 of 100, model section Section 11
Meets the model
Four of five models read this as good; Claude Opus 5 called it partial because page 117 of the Medicare addendum lets the Express Scripts affiliate equitably modify the program pricing terms on its own if the number of Part D eligible retirees falls materially. Page 5 requires every amendment to be in writing and signed by both parties, and page 2 says Express Scripts will not revise the Exhibit C pricing terms during the term unless required by law or by written agreement. A change in law on page 115 reopens fees and rebates, but if the parties cannot agree either side may terminate rather than Express Scripts rewriting terms by notice. The Medicare carve out Claude Opus 5 found is genuine and keeps confidence below the unanimous level, but the core rule meets the model.
Any amendments to this Contract must be in writing and signed by both parties.
Page 5Model contract says
No amendment is effective unless signed by both parties; the PBM cannot change economic terms by notice, portal update or updated exhibit.
Unilateral amendment rights let a PBM quietly rewrite pricing mid-term.
Model votes: Kimi K3 good, Grok 4.6 good, GPT 5.6 Sol good, Claude Opus 5 partial, Gemini 3.1 Pro good
Termination without penalty
Weight 2 of 100, model section Section 12
Meets the model
Four of five models read this as good; Gemini 3.1 Pro called it partial because the text does not expressly protect earned amounts from forfeiture or name a regulatory integrity event. Page 5 lets the A&M System terminate without cause on ninety days written notice with no fee, penalty or wind down charge stated, and either party may terminate for uncured material breach after 45 days. Page 6 allows immediate termination if Express Scripts is acquired, page 12 covers loss of legislative funding, and page 9 allows termination for a knowing failure of Public Information Act duties. The Medicare addendum on page 125 lets the affiliate delay final rebate and subsidy payments for reconciliation, which is a hold, not a forfeiture.
the A&M System may terminate this Contract without cause by giving ESI ninety (90) days’ written notice.
Page 5Model contract says
The plan may terminate for convenience with reasonable notice and without penalty, earned amounts are never forfeited, and a regulatory integrity event is grounds for termination.
Termination penalties and forfeited rebates are how plans get trapped in bad contracts.
Model votes: Kimi K3 good, Grok 4.6 good, GPT 5.6 Sol good, Claude Opus 5 good, Gemini 3.1 Pro partial
Specialty drug pricing controls
Weight 3 of 100, model section Sections 1.16, 3.2(d)
Redacted or unreadable
All five models reached this verdict. Exhibit D, specialty drugs under the mail order pharmacy program, is blacked out from page 54 through page 106, the specialty product pricing section on page 25 has no surviving text, and the specialty rebate amounts on page 35 are blacked out. The readable text shows on page 110 that the specialty pharmacies are Accredo Health Group and Express Scripts Specialty Distribution Services, both affiliates, and on page 112 that the specialty product list is maintained and updated by Express Scripts. Whether specialty is defined by function, whether drug level rates act as ceilings and whether affiliate specialty claims are priced at acquisition cost cannot be seen.
No verbatim quote is available for this clause.
Model contract says
Specialty is defined by function, drug-level rates act as a ceiling in every channel, and specialty claims at affiliate pharmacies are priced at acquisition cost.
Specialty drugs are a minority of claims but the majority of spend, and most are dispensed by PBM-owned specialty pharmacies.
Model votes: Kimi K3 unclear, Grok 4.6 unclear, GPT 5.6 Sol unclear, Claude Opus 5 unclear, Gemini 3.1 Pro unclear
Gag clause (red flag)
Weight 0 of 100, model section Sections 9, 14
Contradicts the model
All five models reached this verdict. Exhibit F on page 109 designates the contract, Exhibit C program pricing terms, Exhibit D specialty and mail order terms and Exhibit E clarifications as confidential and proprietary and claims they are exempt from the Texas Public Information Act, and page 9 lets Express Scripts designate still more. The confidentiality clause on page 8 treats rebate contracts, manufacturer administrative fee information and drug pricing information as Express Scripts property. The A&M System must still comply with the Act and must notify Express Scripts of requests so it can argue for an exemption, but that is only a right to contest release. The result is visible in this posting: the prices the plan pays are blacked out.
The following is a list of information ESI has designated as confidential and/or proprietary, believing it to be exempt from any requests the A&M System may receive under The Texas Public Information Act.
Page 109Model contract says
Nothing in the contract stops the plan from sharing pricing, rebate or performance data with its own advisors, auditors, members, the public or lawmakers, and nothing stops pharmacies from telling patients about cheaper options.
Confidentiality clauses that treat pricing terms as trade secrets are what keep taxpayers from seeing what their government pays. This is why the A&M contract is partly blacked out.
Model votes: Kimi K3 bad, Grok 4.6 bad, GPT 5.6 Sol bad, Claude Opus 5 bad, Gemini 3.1 Pro bad
The council
Five models, every verdict published
The full independent review from each model, the agreement grid, and the synthesis that reconciles them.
Five models from five providers read the full extracted text independently, without seeing one another, and scored every rubric item. Unanimous verdicts stand. Where the council split, the reconciled verdict and the reasoning behind it are written out in the clause by clause section above, and the split is marked here so nobody has to take the resolution on faith. Items a model could not read because of redaction are unclear and excluded from the score. The council agreed outright on 5 of 23 clauses.
Swipe the grid sideways to see every seat and the published verdict.
Clause by clause verdicts by each council model and the published consensus
Clause
Claude Opus 5
Gemini 3.1 Pro
GPT 5.6 Sol
Grok 4.6
Kimi K3
Published
Fiduciary duty and loyalty
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Full disclosure of compensation and conflictsSplit
Weaker than the model
Not addressed
Contradicts the model
Contradicts the model
Weaker than the model
Contradicts the model
Ownership and affiliate disclosure exhibitSplit
Weaker than the model
Not addressed
Weaker than the model
Not addressed
Not addressed
Not addressed
Definitions that close loopholesSplit
Weaker than the model
Weaker than the model
Redacted or unreadable
Weaker than the model
Redacted or unreadable
Weaker than the model
100% pass-through of manufacturer revenueSplit
Contradicts the model
Redacted or unreadable
Contradicts the model
Contradicts the model
Redacted or unreadable
Contradicts the model
Affiliate pharmacy pricing at acquisition costSplit
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Contradicts the model
Redacted or unreadable
Redacted or unreadable
Benchmark ceiling and cheapest lawful optionSplit
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Not addressed
Redacted or unreadable
Redacted or unreadable
Cash price protection and deductible creditSplit
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Not addressed
Redacted or unreadable
Redacted or unreadable
MAC list governanceSplit
Contradicts the model
Redacted or unreadable
Contradicts the model
Contradicts the model
Redacted or unreadable
Contradicts the model
No spread pricingSplit
Weaker than the model
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
GPO and purchasing entity pass-throughSplit
Contradicts the model
Contradicts the model
Contradicts the model
Not addressed
Redacted or unreadable
Contradicts the model
Plan sponsor controls the formulary
Weaker than the model
Weaker than the model
Weaker than the model
Weaker than the model
Weaker than the model
Weaker than the model
Lowest net cost standard and book of business comparisonSplit
Not addressed
Not addressed
Not addressed
Not addressed
Contradicts the model
Not addressed
Pharmacy network protections and anti-steeringSplit
Contradicts the model
Not addressed
Contradicts the model
Contradicts the model
Weaker than the model
Contradicts the model
Most favored pricing and market checkSplit
Not addressed
Redacted or unreadable
Not addressed
Not addressed
Redacted or unreadable
Not addressed
Audit rights, data access and reportingSplit
Weaker than the model
Contradicts the model
Weaker than the model
Weaker than the model
Contradicts the model
Weaker than the model
Plan sponsor owns all plan dataSplit
Weaker than the model
Not addressed
Contradicts the model
Weaker than the model
Weaker than the model
Weaker than the model
Performance guarantees with real remedies
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Self executing enforcement and two strikes exitSplit
Weaker than the model
Not addressed
Weaker than the model
Not addressed
Weaker than the model
Weaker than the model
Amendments only in writingSplit
Weaker than the model
Meets the model
Meets the model
Meets the model
Meets the model
Meets the model
Termination without penaltySplit
Meets the model
Weaker than the model
Meets the model
Meets the model
Meets the model
Meets the model
Specialty drug pricing controls
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Redacted or unreadable
Gag clause (red flag)
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Contradicts the model
Council synthesis: where the five models agreed and where they split
How the council worked
Five frontier models read the same 140 page text: contract 00002789.0 v8 between The Texas A&M University System and Express Scripts, Inc., signed on May 6, 2022 (page 16), effective September 1, 2021, with an initial term through December 31, 2024 and renewals possible to December 31, 2027 (page 4). The models were Claude Opus 5 (Anthropic), GPT 5.6 Sol (OpenAI), Gemini 3.1 Pro (Google), Grok 4.6 (xAI) and Kimi K3 (Moonshot AI). Each read independently against the same 23 item rubric, derived from the open source model PBM contract published by Mark Cuban and collaborators. We reconciled under a fixed rule: three or more seats agreeing settles a verdict; with no majority the middle vote is taken after re-reading the cited pages; unclear is allowed only where the page is actually blacked out. Every seat's vote is published on the contract page, including the votes that lost.
Redaction shaped every read. Pages 54 to 106, the whole of Exhibit D on specialty and mail order pricing, are blacked out, and pages 21 to 53, the Exhibit C pricing terms, survive only as headings.
Where the five models agreed
Loyalty and secrecy. All five voted bad on fiduciary duty: the A&M System agrees that Express Scripts is not a fiduciary, and the vendor may stop serving any plan in a state that requires one (page 115). All five raised the gag flag: Exhibit F designates the pricing, specialty and clarification exhibits as confidential and exempt from the Texas Public Information Act (page 109).
Formulary control. All five voted partial: the vendor modifies the formulary for reasons that include manufacturer rebate arrangements, and changes take effect unless the System opts out (page 110).
Behind the black bars. All five voted unclear on performance guarantees, which exist (page 126) but sit in the redacted Exhibit C, and on specialty pricing, which lives in the redacted Exhibit D (pages 54 to 106).
Where they split, and how it was resolved
Eighteen items were not unanimous. Seventeen had a majority; one did not.
Disclosure of compensation, the item without a majority. GPT 5.6 Sol and Grok 4.6 voted bad, Claude Opus 5 and Kimi K3 partial, Gemini 3.1 Pro missing. The middle vote is bad, and page 115 is not silent: it points to a Financial Disclosure in the unproduced proposal, lets Express Scripts update it alone, and declares those revenues are not compensation from the plan. Confidence 0.5.
Pass through of manufacturer revenue. Three voted bad; Gemini 3.1 Pro and Kimi K3 voted unclear because the rebate percentages on pages 35 to 37 are redacted. The structure is readable without the numbers: page 114 promises only the amounts on Exhibit C, and page 115 leaves every other revenue stream with the vendor.
MAC governance, GPO pass through and network protections. Each drew a three vote bad majority. The MAC list is whatever Express Scripts develops or selects (page 111); the vendor negotiates affiliate revenue on its own behalf, not as the plan's agent (page 115); and the services exhibit has Express Scripts promote its own mail pharmacy and migrate the plan between networks (page 112).
Definitions, audit, data and enforcement. Each drew a three vote partial majority. GPT 5.6 Sol and Kimi K3 voted unclear on definitions because seven of them on pages 110 to 112 are blacked out. Gemini 3.1 Pro and Kimi K3 called the audit right bad because the vendor approves the auditor (page 3) and a rebate audit reaches only fifty percent (50%) of payments for two quarters (page 127). GPT 5.6 Sol called data ownership bad because anonymized claims data and drug pricing information are vendor property (page 8).
Ownership exhibit, lowest net cost and most favored pricing. Each drew a missing majority. A change of ownership notice (page 6) is not an affiliate inventory, and page 2 freezes pricing for the term with nothing readable hinting at a market check, so those clauses are absent rather than redacted.
Affiliate pricing, benchmark ceiling, cash price protection and spread. Four voted unclear on each. Grok 4.6 alone read the page 24 heading that prices ESI Mail Pharmacy on aggregate annual guarantees as decisive; Claude Opus 5 alone voted partial on spread from the page 4 bona fide dispute definition. The operative terms are under redaction, so unclear stands.
Amendments and termination. Four voted good on each against one partial dissent.
What only one model caught
Claude Opus 5 found that the Medicare addendum lets the Express Scripts affiliate equitably modify the program pricing terms on its own if the number of Part D eligible retirees falls materially (page 117), a real exception to the signed amendment rule.
Grok 4.6 noticed that the owned mail channel is priced on aggregate annual guarantees rather than acquisition cost (page 24) and that audit follow up is capped at 300 claims (page 127).
Kimi K3 flagged that at termination the Medicare affiliate may delay final rebate and subsidy payments pending reconciliation (page 125).
The bottom line
The reconciled score is 20 out of 100, a Red flag grade, with a scored weight of 75 and an unclear weight of 25 that the redactions removed from the denominator. The gag flag is raised. Two items earned full credit, worth 4 points, and five partial items added 11, so the arithmetic is (4 + 11) divided by 75, which is 20. The five seats' own scores ran from 13.4 (Gemini 3.1 Pro), 15.7 (Grok 4.6) and 17.1 (GPT 5.6 Sol) to 27.4 (Claude Opus 5) and 34 (Kimi K3). The spread comes mostly from how much weight each seat sent to unclear: Kimi K3 excluded 53 weight points and Gemini 3.1 Pro 44, while Grok 4.6 excluded only 14.
The same contract written up for different readers: the people who negotiate these agreements and the people who pay for them.
Good news, bad news: the short version
Good news
The A&M System can walk away without cause on ninety (90) days written notice, and no termination fee appears in the readable text (page 5).
Every amendment must be in writing and signed by both parties (page 5), and Express Scripts agrees not to revise the Exhibit C pricing terms during the term unless the law requires it or both sides agree in writing (page 2).
The Texas State Auditor may audit the contract, and the System gets one claims audit a year at no additional cost over a rolling 24 months (page 3).
Records, reports and data generated specifically for the A&M System belong to the System and must be delivered on request when the contract ends (page 4).
Express Scripts may not sell or take anything of value for personally identifiable member data (page 12), and the sponsor keeps final say over whether any claim is covered (page 113).
If Express Scripts is acquired or merges, the System may terminate immediately (page 6).
Bad news
The System agrees that Express Scripts is not a fiduciary of the plan, and the vendor may stop serving any plan in a state that requires a pharmacy benefit manager to be one (page 115).
Express Scripts and its affiliates keep all beneficial interest in the manufacturer and affiliate revenue described in a Financial Disclosure that sits in the unproduced proposal; the plan is owed only what the contract expressly states, and the vendor negotiates that revenue on its own behalf (page 115).
The services exhibit has Express Scripts promote its own mail pharmacy to members and lets it migrate the plan between networks (page 112).
The MAC list is whatever Express Scripts develops or selects (page 111), brand versus generic status comes from its proprietary algorithm (page 110), and the specialty product list is maintained by the vendor (page 112).
The formulary can be changed by the vendor for reasons that include manufacturer rebate arrangements, with changes adopted unless the System opts out (page 110).
The auditor must be approved by Express Scripts and may not be a competitor or provide litigation services against it (page 3). A rebate audit reaches only fifty percent (50%) of rebate payments for two quarters, contracts are viewed on site with no copies, and the vendor may review the auditor's notes (page 127).
Express Scripts keeps 15% of overpayments it recovers from network pharmacies on the plan's claims (page 4).
Anonymized claims data, rebate contracts and drug pricing information are treated as vendor property (page 8).
Vaccine claims are excluded from every pricing and rebate guarantee (page 29).
Exhibit F designates the pricing exhibit, the specialty exhibit and the clarifications as confidential and exempt from the Texas Public Information Act (page 109).
What we could not see
Exhibit D, specialty drugs under the mail order pharmacy program, is blacked out in full from page 54 to page 106. Exhibit C, the program pricing terms on pages 21 to 53, survives only as headings, so every discount, dispensing fee, rebate amount, administrative fee and performance guarantee is hidden. Seven definitions on pages 110 to 112 are individually blacked out, as are page 107, page 136 and the insurance limits on pages 14 and 15. The proposal and clarifications are on file with the System and not produced (page 1). Six rubric items worth 25 weight points could not be scored.
The number
The reconciled score is 20 out of 100, a Red flag grade, on a scored weight of 75 with 25 excluded as unclear, and the gag flag is raised. Two items earned full credit worth 4 points and five partial items added 11, so (4 + 11) divided by 75 gives 20. The change that would move the number most is the pass through item, worth 11 points: a promise that one hundred percent of manufacturer revenue reaches the plan would lift the numerator to 26 and the score to 26 divided by 75, about 34.7. The redactions are the other lever: releasing Exhibits C and D would bring 25 more weight points into the score and show whether the hidden terms help or hurt.
Check our work
Read a page
Pull the text of any page we extracted and compare it with the original.
We already have this document, so you do not need to request it. What is still missing is whatever the posting withheld: redacted pricing exhibits, fee schedules, rebate terms and the incorporated proposal. Generate a Texas Public Information Act letter for The Texas A&M University System that names those pieces, send it in your own name, and log what comes back.
The model contract we score against 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 its authors. Read the original on LinkedIn.