Reference Pricing and Network Adequacy Standards: Conflict or Concord?

By: Joel S. Ario | Michael S. Kolber
– Health Affairs

With benefit designs and enrollee cost-sharing increasingly standardized across health plans under the Affordable Care Act (ACA), one of the remaining levers plans have to differentiate themselves - and to control premiums - is the size of their provider networks. Regulators have been caught in a crossfire between advocates of narrow networks who say they promote quality and keep prices down, and those who feel narrow networks could constrain access to necessary services.

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