How we score
One rubric, published before the scores
Every contract in the Commons is read against the same weighted checklist drawn from the open source model PBM contract published by Mark Cuban and collaborators, version 3.5. Each finding quotes the contract and cites a page, so you can check our reading against the document.
The arithmetic
22 items, 100 weight
Rubric version 2, released September 5, 2026
The scored items carry weights that sum to 100. A score is the credited weight divided by the weight we could actually read, times one hundred. Redacted items are excluded from both sides of that fraction.
One item carries weight zero and is flagged separately as a red flag rather than moving the number.
Method
How a contract becomes a number
Twenty two weighted items, five possible verdicts, one red flag check that never move the score.
Verdicts and credit
- Meets the model, full weight
- The clause is present and at least as protective as the model contract.
- Weaker than the model, half weight
- The subject is addressed, but with carve outs, softer language, or narrower rights than the model.
- Contradicts the model, no weight
- The contract permits the exact harm the model clause exists to prevent.
- Not addressed, no weight
- Nothing in the produced text covers it.
- Redacted or unreadable, excluded from the denominator
- The relevant pages were blacked out. We do not guess, and we do not penalize the buyer for what the vendor hid, so the weight leaves the denominator and is reported separately.
Grade bands
- Excellent85 to 100
- Good70 to 84
- Fair55 to 69
- Concern40 to 54
- Red flag0 to 39
Bands are our editorial judgment, not a legal standard. The item level findings matter more than the band.
The gag clause red flag
A clause that stops a public body from disclosing its own pricing terms carries weight zero, so it can never help or hurt the arithmetic. We flag it on the contract page instead, because a contract that bars the buyer from talking about what it pays deserves its own line rather than a fraction of a score.
Version 2
What changed in v2
Released September 5, 2026. Scores computed under an earlier version keep that label on the contract page until the council re-reads the contract.
Version 2 keeps every version 1 item and adds five scored items so the weights again sum to 100 across 22 scored items plus the gag clause red flag.
Three of the additions are the gaps the Nautilus Health Institute identified in its 92 of 100 review of the version 3.5 model contract:
- OWN, ownership and affiliate disclosure exhibit (weight 3). The model contract has no exhibit that names the PBM owners, affiliates, GPOs, rebate aggregators and owned pharmacies. Nautilus scored conflict of interest 70 of 100 for that omission.
- DATA, plan sponsor owns all plan data (weight 4). Sole ownership of claims, eligibility, accumulator, rebate and derived data, delivered in machine readable form, with no reuse or sale by the PBM.
- LNC, lowest net cost standard and book of business comparison (weight 3). A stated lowest net cost standard for formulary decisions and an annual comparison against the PBM whole book of business.
Two further additions split out protections that version 1 folded into broader items:
- CASH, cash price protection and deductible credit (weight 3). Members never pay more than the cash price, every cash purchase counts toward the deductible and out of pocket maximum, and accumulator adjustments require a sponsor election. Section 3.4 moves here from CEIL, which now covers only the Section 3.3 benchmark ceiling.
- ENF, self executing enforcement and two strikes exit (weight 3). Liquidated damages or automatic credits for missed guarantees and late reports, and termination without penalty after a second material or regulatory integrity failure.
To make room, existing weights were rebalanced: FID 8 to 7, DISC 8 to 6, PASS 12 to 11, NAC 6 to 5, CEIL 4 to 3, MAC 6 to 5, SPRD 10 to 9, GPO 5 to 4, FORM 5 to 4, NET 8 to 7, MFN 4 to 3, AUD 7 to 6, PERF 3 to 2, AMD 3 to 2, SPEC 4 to 3. DEF and TERM are unchanged. GAG stays at weight 0.
Scores computed under version 1 remain current and are labelled with their version until the council re-reads the contract under version 2. No score is ever recomputed by hand.
Earlier versions
Version 1, released September 4, 2026
Version 1 was our original reading of the open source model PBM contract published by Mark Cuban and collaborators, version 3.5. It carried 18 items: 17 scored items with weights summing to 100 and one red flag check, the gag clause, at weight 0. Every contract scored before September 5, 2026 was read under this version.
The rubric
Every item, with its weight
Model sections refer to the open source model contract, version 3.5. Items marked "Added in v2" are new in this version.
- 7weight
FID
Fiduciary duty and loyalty
Model section: Section 2.4
What good looks like
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.
Why it matters
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.
- 6weight
DISC
Full disclosure of compensation and conflicts
Model section: Sections 2.4, 2.6
What good looks like
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.
Why it matters
Hidden revenue streams are the main way plans overpay. Officer certification puts a name on the line.
- 3weight
OWNAdded in v2
Ownership and affiliate disclosure exhibit
Model section: Proposed Exhibit A-5
What good looks like
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.
Why it matters
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.
- 5weight
DEF
Definitions that close loopholes
Model section: Section 1
What good looks like
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.
Why it matters
Most PBM revenue leakage happens inside definitions. A narrow definition of rebate lets fees, grants and administrative payments stay with the PBM.
- 11weight
PASS
100% pass-through of manufacturer revenue
Model section: Section 4
What good looks like
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.
Why it matters
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.
- 5weight
NAC
Affiliate pharmacy pricing at acquisition cost
Model section: Section 3.2
What good looks like
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.
Why it matters
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.
- 3weight
CEIL
Benchmark ceiling and cheapest lawful option
Model section: Section 3.3
What good looks like
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.
Why it matters
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.
- 3weight
CASHAdded in v2
Cash price protection and deductible credit
Model section: Section 3.4
What good looks like
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.
Why it matters
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.
- 5weight
MAC
MAC list governance
Model section: Section 3.5
What good looks like
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.
Why it matters
Two MAC lists (one for the plan, one for pharmacies) is the classic spread pricing mechanism.
- 9weight
SPRD
No spread pricing
Model section: Sections 2.5, 3.1, 3.5
What good looks like
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.
Why it matters
Spread pricing is an undisclosed markup on every claim. Eliminating it is the single clearest test of a transparent contract.
- 4weight
GPO
GPO and purchasing entity pass-through
Model section: Section 5
What good looks like
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.
Why it matters
PBMs moved much of their manufacturer revenue into affiliated GPOs after rebate scrutiny increased. A contract that only covers rebates misses this.
- 4weight
FORM
Plan sponsor controls the formulary
Model section: Section 6
What good looks like
The plan sponsor approves the formulary and every change, receives lowest-net-cost analysis, and gets utilization management outcomes by drug each quarter.
Why it matters
A PBM-controlled formulary can favor high-list-price, high-rebate drugs that cost the plan more overall.
- 3weight
LNCAdded in v2
Lowest net cost standard and book of business comparison
Model section: Section 6
What good looks like
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.
Why it matters
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.
- 7weight
NET
Pharmacy network protections and anti-steering
Model section: Section 7
What good looks like
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.
Why it matters
Steering and clawbacks push independent pharmacies out and route patients to PBM-owned channels, reducing choice and often raising cost.
- 3weight
MFN
Most favored pricing and market check
Model section: Section 8
What good looks like
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.
Why it matters
Multi-year contracts drift out of market. Without a market check the plan is locked into stale pricing.
- 6weight
AUD
Audit rights, data access and reporting
Model section: Section 9
What good looks like
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.
Why it matters
You cannot enforce what you cannot see. Audit and data rights are how every other clause gets verified.
- 4weight
DATAAdded in v2
Plan sponsor owns all plan data
Model section: Sections 9.4, 9.5
What good looks like
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.
Why it matters
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.
- 2weight
PERF
Performance guarantees with real remedies
Model section: Section 10
What good looks like
Guarantees are measured quarterly on plan-specific data, reconciled in cash, and shortfalls are paid dollar for dollar rather than as capped credits.
Why it matters
Guarantees that are capped or measured on book-of-business data rarely pay out.
- 3weight
ENFAdded in v2
Self executing enforcement and two strikes exit
Model section: Sections 10, 12.5
What good looks like
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.
Why it matters
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.
- 2weight
AMD
Amendments only in writing
Model section: Section 11
What good looks like
No amendment is effective unless signed by both parties; the PBM cannot change economic terms by notice, portal update or updated exhibit.
Why it matters
Unilateral amendment rights let a PBM quietly rewrite pricing mid-term.
- 2weight
TERM
Termination without penalty
Model section: Section 12
What good looks like
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.
Why it matters
Termination penalties and forfeited rebates are how plans get trapped in bad contracts.
- 3weight
SPEC
Specialty drug pricing controls
Model section: Sections 1.16, 3.2(d)
What good looks like
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.
Why it matters
Specialty drugs are a minority of claims but the majority of spend, and most are dispensed by PBM-owned specialty pharmacies.
- 0weight
GAG
Gag clause (red flag)
Model section: Sections 9, 14. Red flag check, reported separately from the score.
What good looks like
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.
Why it matters
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.
See the rubric in use
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.