Creating a consumer friendly reference pricing program

Reference pricing is a strategy in which insurers and/or other purchasers set a cap – or “reference price” – to limit the amount they will pay for a certain procedure. When combined with quality thresholds, this strategy is a way to guide consumers toward choosing more reasonably priced providers and to encourage providers to meet set pricing.  This paper provides a set of consumer protection principles intended to ensure that insurers and others maintain consumers’ access to affordable, quality care and an adequate network of providers when implementing a reference pricing program.