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Transparency Has Lost Its Meaning. The Nautilus Project Is Giving It One.
Every PBM says they’re transparent. Transparent pricing. Transparent rebates. Transparent contracts. After hearing it enough times, the word begins to lose its value.
How Contract X-Ray™ Measures PBM Contract Transparency
That’s exactly why the Nautilus Health Institute launched Contract X-Ray™, the centerpiece of its PBM Procurement, Contracting & Management Project. Rather than recognizing marketing claims, Contract X-Ray™ measures ten fiduciary-aligned contract standards. These standards define what transparency should actually look like in a PBM agreement.
The result is something the industry has long needed: an objective way for employers, consultants, and brokers to evaluate PBMs using contract language — not sales presentations.
Serve You Rx Earns a 93 Fiduciary Alignment Score — an Excellent Rating
In the inaugural CAA 2026 Readiness Report, Serve You Rx earned a Fiduciary Alignment Score of 93 — one of only nine PBMs nationwide to receive an Excellent rating. The score reflects our contract language as written and recognizes explicit pass-through pricing, 100% rebate pass-through, plan sponsor ownership of data, meaningful audit rights, conflict-of-interest protections, and a lowest-net-cost formulary standard.
We developed this CAA-ready contract in collaboration with the Nautilus Health Institute, which clients can elect to adopt.
Why a Transparent PBM Contract Matters for Employers and Brokers
Why does this matter? Because savings only matter if the contract guarantees they remain with the plan.
Every dollar retained through spread pricing or undisclosed revenue is a dollar that never reaches an employer. Fiduciary-aligned contracts help close those gaps by putting key protections in writing.
The Nautilus Project doesn’t score companies; it scores contracts. Scores are based on ten fiduciary provisions, including whether the PBM is obligated to act in the plan’s interest, whether plan dollars stay plan assets (pricing, rebates, fees), and whether the sponsor can verify and enforce the deal (data, audits, exit rights). Each provision is worth 0–100 based on the contract language itself, with a citation behind every score. Then, the Nautilus Project combines the provision scores into a single Fiduciary Alignment Score.
Before this, terms like “transparent” and “pass-through” were marketing claims a PBM could define however it wanted. Now they’re measurable, comparable, and traceable to specific contract clauses — which means a plan sponsor doesn’t have to take a vendor’s word for it. They can read it in the contract.
For brokers and consultants, the ten fiduciary provisions create a common framework for comparing PBMs and documenting prudent decision-making. For employers, they provide greater confidence that the contract aligns with their fiduciary responsibilities and protects plan assets.
Transparency Should Be Measurable, Not Just Marketed
Transparency should never rely on trust alone. It should be measurable. It should be contractual.
We’re proud that independent review confirms what has guided Serve You Rx since 1987: putting clients’ interests first isn’t a marketing message—it’s written into the agreement.
Frequently Asked Questions
What is Contract X-Ray?
Contract X-Ray™ is the Nautilus Health Institute’s independent review of PBM contracts against ten fiduciary-aligned provisions. These provisions include pass-through pricing, rebate pass-through, data ownership, and audit rights.
What is a Fiduciary Alignment Score?
It’s a score out of 100 reflecting how closely a PBM’s actual contract language matches the ten fiduciary standards the Nautilus Project defines. Serve You Rx scored 93, an Excellent rating.
What does CAA 2026 Ready mean?
Being CAA 2026 Ready means that a PBM’s contract meets fiduciary and disclosure expectations under the Consolidated Appropriations Act. Serve You Rx is one of only nine PBMs nationwide named in the inaugural report.
Current and future clients can adopt this CAA-ready contract by request.
How many PBMs received an Excellent rating?
Nine PBMs nationwide received an Excellent rating in the inaugural CAA 2026 Readiness Report, and Serve You Rx is one of them.
In addition to our Excellent rating by the Nautilus Institute, Serve You Rx was also just named to the 2026 Inc. 5000 — recognition of growth we owe entirely to partners like you. Read more about this exciting news.
If you’re ready to partner with us, get in touch with our team today.
About Serve You Rx®
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for nearly 40 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
