Nautilus Contract X-Ray

Contract X-Ray / For Plan Sponsors

Your PBM contract is a fiduciary document. Read it that way.

Contract X-Ray gives plan sponsors an independent, defensible analysis of whether the contract supports the fiduciary obligations the law assigns to you.

01 · The question on the table

ERISA names the plan sponsor as the fiduciary. Not the PBM. Not the broker.

The fiduciary obligation belongs to the plan sponsor. It does not transfer through a service agreement, and it does not pause between renewals. CAA 2026 sharpens the obligation by codifying disclosure and oversight requirements that the plan sponsor is responsible for verifying.

The question on the table is simple. When the auditor, the board, or a participant asks “can you show this contract supports your fiduciary obligations?”, there is an answer you can defend or there isn’t. Contract X-Ray gives you the artifact that answers the question.

The contract is the document the auditor will read. Read it before they do.

02 · What you’ll learn

Concrete findings about your specific contract.

A Quick Look surfaces findings most plan sponsors have never seen written down. Each finding is grounded in specific contract language, or in the absence of it.

  • Where is the contract silent on rebate flow?

    Many contracts speak in generalities about rebates without committing the PBM to pass them through. The analysis identifies the specific language gaps and what they mean for plan economics.

  • Are your audit rights real, or theatrical?

    Audit clauses commonly contain restrictions that make the right unusable: pre-approved firms only, narrow scopes, blackout windows, no extrapolation, single look per year. The analysis names each restriction.

  • Is the contract silent or restrictive on spread pricing?

    A pass-through commitment without a spread-pricing prohibition is not a pass-through commitment. The analysis distinguishes contracts that prevent spread from contracts that merely describe a preferred pricing model.

  • Do you own your own claims data?

    Data ownership clauses range from clean (the plan sponsor owns all data, can extract it at any time, in standard format) to hostile (the PBM owns the data, releases summaries at its discretion). The analysis tells you which end of the spectrum you sit at.

  • How constrained is your carve-out flexibility?

    Specialty, mail, and biosimilar carve-out rights are often hedged with repricing triggers, exclusivity clauses, and termination penalties. The analysis identifies what flexibility the contract actually preserves.

03 · What you receive

A board-presentable analysis. Free Quick Look. PDF in your inbox.

The Quick Look is the starting point. It is free, fast, and delivered as a PDF you can share with your fiduciary committee, your board, or your ERISA counsel.

Headline number

Fiduciary Alignment Score

A 0 to 100 score for the contract overall, mapped to a five-tier scale from Red Flag to Excellent.

Provision detail

Ten-provision breakdown

Each of the ten provisions scored individually, with the specific contract language or absence cited.

Market context

Reference set placement

Where your contract sits relative to a reference set drawn from 20+ distinct PBMs.

Top findings

Three to five priority items

The findings the analysis ranks as most consequential for fiduciary posture, in plain language.

Ready to see your contract?

Analyze your contract →

For plan sponsors preparing for renewal negotiation, fiduciary committee review, or formal counsel engagement, a Full Assessment is available. It adds redline language for each finding, an executive brief, and additional analytical reports. Start with the free Quick Look; the upgrade path is in the delivery.

04 · Who this is for

Self-funded employers, public and private, of any size.

The framework is designed for any plan sponsor with a written PBM agreement. It does not require a minimum plan size, a particular industry, or a specific PBM relationship.

  • Private-sector self-funded employers governed by ERISA. The framework speaks directly to ERISA fiduciary duties of loyalty, prudence, and reasonable cost.
  • Public-sector and government plan sponsors operating under applicable state and federal law rather than ERISA. The underlying contract questions are the same, and the framework adapts to the applicable-law framing.
  • Plan sponsors with a fiduciary committee or board oversight structure who need a defensible artifact to support governance.
  • Plan sponsors approaching renewal or RFP who want a baseline analysis before opening the negotiation.

If you serve plan sponsors as a consultant, advisor, ERISA attorney, or coalition staffer rather than holding the fiduciary role yourself, the Advisors page is the better starting point.

05 · What this is not

An independent analysis. Not a vendor pitch, not a verdict, not a substitute for counsel.

Nautilus Health Institute is a 501(c)(3) nonprofit. The framework exists to advance fiduciary-aligned PBM contract standards. A few things it deliberately does not do.

  • Not a vendor pitch. Nautilus does not sell PBM services, does not take referral fees, and does not recommend specific PBMs. The analysis evaluates the contract, not the vendor.
  • Not a verdict on the PBM. A score answers whether the contract supports your fiduciary obligations. Whether to remain, renegotiate, or transition is a decision for the plan sponsor, advised by counsel.
  • Not a substitute for legal advice. The report is an input to your fiduciary process. Use it with your ERISA attorney and your fiduciary committee.

Read your contract before the auditor does.

Free Quick Look. PDF in your inbox within minutes.

Analyze your contract →