Reference Pricing Programs Need to Follow Key Guidelines to Ensure That They Don’t Shift Costs to Consumers
Recent news articles have highlighted how some employer-based health plans have started to set dollar caps on what they will pay for certain health care services. If a consumer goes to a provider that charges more than the cap for that type of care, he or she must pay the difference. This strategy is called reference pricing.
Reference pricing is meant to encourage consumers to shop for the best care at the best price, and it even has the potential to pressure some expensive providers to set more competitive prices.