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For prescription drugs, a lot of plans now require participants to use the manufacturer coupons and not counting it toward the deductible or out of pocket. Some PBMs offer a program where expensive brand names are sourced from an international pharmacy (which also does not count towards the deductible or out of pocket).
If participants do a lot of out of network claims, reducing what is considered allowed (eg, allowed is up to the Medicare rate, whereas it used to be 200% of Medicare). If you aggregate in network and out of network claims to the same deductible and out of pocket (cross apply), no longer allowing that.
Requiring a lot of review for pre-authorizations. Also, using a cheaper TPA, like Allegiance, HealthGram, Ameriben, Allied (there's a bunch).
You should be using a benefits broker to help you through this process. Choosing the right underlying network is important - for example, for your most frequent claims and providers, UHC may have a lower negotiated rate than Cigna.
I think our PEO is charging us crazy rates and I need to us a broker, which sounds best as we did with my prior employer. Thanks everyone.