What cost-containment strategies do self-funded plans use?

June 16, 2026June 16, 2026

Short answer: Self-funded plans can use levers a fully insured plan can’t easily access: reference-based pricing, PBM carve-outs with transparent pharmacy contracts, narrow or high-performance networks, care navigation and advocacy, centers of excellence, and direct provider contracting.

Because a self-funded employer keeps the savings, it has a direct incentive to lower the claims trend. Common levers include:

Pharmacy: carving the PBM out of the medical carrier and using a transparent, pass-through contract; managing specialty and GLP-1 drugs with clinical criteria. Facility pricing: reference-based pricing (paying a multiple of Medicare) or steering to centers of excellence for high-cost procedures. Networks: narrow or high-performance networks that reward efficient providers. Member support: care navigation and advocacy that guide employees to the right, cost-effective care.

Each lever trades some member convenience or choice for savings, so the art is combining them in a way the workforce will accept.

Sources

TABA Self-Funded knowledge base (Cost Containment, PBMs, Networks & RBP). Verify specifics before CE use.

Content history
Originally published: June 16, 2026
Last reviewed: June 16, 2026

Strategies Cost Containment

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