Premera's new standard in-network fee schedule delivers automatic medical drug and medical equipment cost protection

Managing total cost of care requires a healthcare partner that proactively and continuously monitors opportunities to address market forces contributing to rising costs.

Effective January 1, 2027, Premera is changing its professional standard in-network fee schedule for provider-administered medical drugs and Durable Medical Equipment (DME) across our entire book of business. This change creates more consistent pricing and stronger total cost of care controls in response to market baseline pricing volatility for medical drugs and DME services. This universal shift fundamentally changes how we protect your plan. Because this cost-control measure is now our professional standard in-network fee schedule level for all lines of business, it naturally becomes the default out-of-network reimbursement rate for provider administered medical drugs and DME services in line with our standard lesser of logic for out of network claim reimbursement.

As a result, Premera is removing medical drugs and DME as separate dynamic pricing categories from the 2027 expansion of the Out-of-Network (OON) Savings Solution. For self-funded groups, this evolution is good news: what was once a targeted, out-of-network repricing mechanism is now a standard feature of their core plan design.

Targeted protections for the remainder of the plan

To safeguard member access and prevent network disruption, the remaining three categories continue under the 2027 OON Savings Solution without modification:

• Ground Ambulance
• Chiropractic Care
• Outpatient Rehabilitation

These services reflect the unique market circumstances of each category. The OON Savings Solution uses service-specific benchmarks informed by Blue contracted-rate evidence to help preserve the value of network participation and avoid creating financial incentives for providers to remain outside the network.