Fiduciary-aligned contracts, ready for CAA 2026.

There has never been a clear fiduciary standard for PBM contracts. ERISA and CAA 2021 set the obligations — loyalty, prudence, diligence — but those are principles, not specifications. CAA 2026 and the DOL rule that implements it codify more of the framework. Specific requirements around rebate pass-through, spread pricing, audit independence, and fee disclosure are now law. But the fiduciary judgment about what is in the best interest of participants stays where it has always been: with the plan sponsor.

Plan sponsors have the latitude to do business with whomever they choose, under whatever terms they choose. There is no reason to wait for staggered effective dates, and no reason to contract only to what the statute requires. The law is the floor. A fiduciary-grade contract is the ceiling, and it includes statutory requirements, regulatory requirements, fiduciary safeguards that protect against identifiable risks, and best practices that make the work more achievable.

Most PBM contracts in force today were written by PBMs, lightly reviewed, lightly negotiated. They fall short of this standard because they were never built to it. PBMs adapting to CAA 2026 will work to preserve the economics the new rules curtail. The contract is where that adaptation either succeeds or fails, and the plan sponsor is the only party with the standing to draw that line.

Contract X-Ray sets the bar at fiduciary-aligned standards now. Statutory, regulatory, fiduciary safeguard, and best practice — all four together, applied today, ahead of the staggered effective dates that run through 2029. Plan sponsors are asking for contracts built to that standard. PBMs that recognize where the market is moving are adopting model language to meet it. The first public benchmark of which PBMs have done so publishes at RosettaFest in July.

A CAA-2026-ready contract holds up at four specific provisions where the contract determines what the plan sponsor can actually do. Four of the ten Contract X-Ray provisions intersect directly with the standards CAA 2026 codifies.

A Contract X-Ray analysis returns a score and citation for each of the four CAA-relevant provisions plus the other six. The output identifies where contract language meets the standard, where it falls short, and where the contract is silent.

For plan sponsors at renewal, the analysis becomes the input to a CAA-2026 readiness negotiation: specific provisions ranked, specific language proposed, and specific evidence on how the current contract compares to a reference set drawn from 20+ distinct PBMs.

The plan sponsor view of CAA 2026 readiness is one side of the conversation. The PBM view is the other. PBMs that recognize the market is moving toward fiduciary-aligned contracts are using the Contract X-Ray framework to build forward rather than defend backward. Five to ten PBMs will be working actively with the methodology by mid-2026.

The market signal is about to become public.

If you are a PBM and want to participate in the first published list, learn more on the PBMs page or get in touch.

Waiting for an effective date is not a strategy. The law is the floor a contract has to clear eventually. The fiduciary-aligned standard is the ceiling a contract should clear now. Most plan sponsors are at one of three moments where the conversation is easier to start than to defer.