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.
Cost Containment
Self-funded and level-funded plans can use levers a fully insured plan can’t to lower claims. These FAQs cover reference-based pricing, pharmacy strategies, networks, and care navigation.