Employers
have a choice.
You choose who you do business with.
You choose the terms you’re willing to accept.
And you have more leverage than you think.
The problem isn’t that employers lack leverage.
It’s that they rarely use all of it.
Employers control the money. With the right information, stronger contract terms, and a clear standard for what good looks like, they can get better results for their people and their business.
You can choose.
You choose your advisors, health plans, PBMs, and the terms you’re willing to accept.
The contract is the point of control.
It defines your rights, your economics, and your leverage. Better terms lead to better outcomes.
Good has a standard.
Strong contracts share common characteristics. They can be measured, compared, and improved.
Better contracts are measurable.
improvement after negotiation
Source: Contract X-Ray, Nautilus Health Institute. As of October 2026.
STRONG PBM CONTRACTS.
Good shouldn’t be
a matter of opinion.
Contract X-Ray turns PBM contract terms into a measurable standard.
Don’t sign anything scoring less than 90.
The Middleman’s Cut
A leadership playbook for the people who sign the deals.
See where the money goes. Understand the terms that control the deal. Know what good looks like — and what to do next.
Once you see it, you can change it.
EXPLORE THE BOOK →Clearer questions. Stronger contracts. Better outcomes.
Because employees deserve better.
What readers are saying
Mr. Ditto has provided a practical roadmap for fiduciary conduct while at the same time placing that conduct in the greater context of corporate governance.
Alden J. Bianchi
ERISA Attorney | Co-Chair, ABA/JCEB Health and Welfare Plans National Institute
You can do better than the deal you were handed.
See where the money goes. Understand the terms that matter. Know what good looks like. Then use your leverage.
Because employees deserve better.