A Simple RFI Separates Transparent From Entrenched
Executive Brief
Still working with a Big 3 PBM—or a copycat that mimics their model?
Then it’s time for a Contract Compliance RFI.
It’s fast. It’s simple. And it reveals everything you need to know.
Ask your PBM to adopt 10 contract terms aligned with ERISA, the CAA, and fiduciary best practices.
If they resist, stall, or hedge—you’ve got your answer.
Every “No”: from an incumbent gives you justification to move on.
Every “Yes”: from a challenger builds your business case for change.
A better PBM is just one RFI away.
The Top 10 Terms To Demand
As part of the Nautilus PBM Project we’ve identified 28 model contract clauses every transparent, fiduciary-aligned PBM should be able to accept.
But some employers need to start the ball rolling with one step first: issuing a Contract Compliance RFI to their incumbent PBM and asking them to accept the Top 10 terms. What you’ll find:
A Contract Compliance RFI tests your PBM’s willingness to meet legal and fiduciary standards
Resistance is a red flag—especially if they hide behind vague language or delay tactics
Every term they reject gives you a reason to move on (and build internal support to do so)
To eliminate wiggle room we’ve crafted binary (Yes or No) questions. These aren’t radical asks—they’re the minimum bar for fiduciary compliance. Each one maps directly to legal risk and financial waste.
The strategy is simple. Ask hard questions. Demand clear answers. No vague language. No delay tactics. Just a simple Yes or No.
Truly transparent PBMs will readily agree to all 10 terms. And usually offer 20–30% savings compared to those who don’t.
Top 10 Questions For A Contract Compliance RFI
Nautilus PBM Project Contract Terms
Want the full list of 28 terms + plug-and-play contract language? Visit the Nautilus PBM Project to download the complete toolkit.
Case Study: What Happened When One Employer Asked
A mid-sized employer issued an RFI to their incumbent PBM. The response?
Stall tactics. Vague replies. Flat refusals.
Resistance tells you everything you need to know.
Then they sent the same RFI to 5 transparent PBMs:
All 5 agreed to all 10 terms
4 offered 20–30% lower pricing
2 could implement in under 90 days
The RFI became the turning point.
Take Action This Week
Send the RFI to your current PBM
Ask them to agree to these 10 core terms
Log their responses—Yes or No
Explore challengers who are ready to perform, not just promise
Use their response to build your case for change
Show your leadership team there’s a better alternative
Stop making excuses and start making savings.
Launch Bonus: 1-on-1 Help — Free for Subscribers
Need a jumpstart? As a newsletter subscriber, you get free access to the tools—and our help using them. We’ll:
Send the Contract Compliance RFI
Review the PBM’s responses with you
Help frame next steps for your team
No sales pitch. No pressure. Just results.
Just hit reply with one sentence: “I’m ready to issue the RFI.”
We’ll handle the rest.
A Note of Thanks
Thanks to Paul Holmes, Partner at Williams Barber Morel for his contribution to the Nautilus PBM Project. Paul is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul has extensive and unique experience in representing large employers and Taft-Hartley welfare funds in their selection, contracting, auditing and litigation with large PBMs.
Also, deep gratitude to everyone who built this toolkit: Nautilus and Health Rosetta leadership, expert advisers, and PBMs committed to transparency.
Explore the model PBM contract language and apply for early access to the Nautilus PBM Configurator at: 🔗nautilushealth.org/pbm
💸 SPECIAL OFFER: Newsletter subscribers receive 10% off any Validation Institute service. Use code FIDUCIARY10 at checkout.
validationinstitute.com
📬 PAY IT FORWARD: Feel free to forward this offer to your broker, PBM, or other vendors. Don’t hesitate to tell them you will favor validated vendors as part of your modernized procurement processes. Strong compliance and better benefits begin with validation.
Don’t be a bystander. Change the status quo and reap the benefits of The Health Plan Compliance Advantage.
