Results & Impact

Turning high-cost drug and infusion visibility into responsible fiduciary action.

National Integrative Health helps plans translate claims-level visibility into coordinated clinical and financial activity — and then validates the outcomes through ongoing reporting.

In the media

Public Impact

Featured appearances and commentary from NIH leadership on the issues shaping pharmacy cost containment and high-cost claims management.

  • Magazine

    PBM Pugilism

    Featuring
    Jake Velie
    Outlet
    The Self-Insurer
    Date
    September 2026
  • Video

    Sneak Peek: HVBA Tampa Fireside Chat

    Featuring
    Jake Velie
    Outlet
    Rachel Strauss, PBM Princess
    Date
    August 5, 2026
  • Video

    The Transparency Hype Word: a Preview of NABIP AC 2026 Panel

    Featuring
    Jake Velie
    Outlet
    Rachel Strauss, PBM Princess
    Date
    June 27, 2026
  • Podcast

    The J-Code Trap: Managing the Exploding Costs of Specialty Drugs

    Featuring
    Jake Velie
    Outlet
    Self-Funded with Spencer
    Date
    June 23, 2026

Client Perspectives

What Our Partners Say

Hear directly from the plans and partners working with NIH to contain high-cost pharmacy spend.

  • Group Benefit Systems, Inc.

    Partnering with NIH has given Group Benefit Systems a powerful advantage in helping our clients address one of the fastest-growing drivers of healthcare costs—prescription drugs. Their innovative approach has enabled us to deliver measurable savings without compromising member access to the medications they need.

    In an environment where traditional carrier and PBM models continue to drive higher costs, NIH has provided a refreshing alternative. Their transparent strategy, combined with their expertise in sourcing high-cost specialty medications, has allowed our clients to significantly reduce pharmacy spend while strengthening the overall financial health of their benefit plans.

    NIH has become an important strategic partner for our organization. Together, we're delivering meaningful cost containment, improving plan performance, and creating better outcomes for employers and their employees.

    Randy HowellPresident, Group Benefit Systems, Inc.
  • Group Administrators

    NIH has been a valuable partner in Group Administrators’ recent success. Through this partnership, we finally have meaningful leverage over one of the BUCAs’ greatest vulnerabilities: rising prescription drug spend.

    As the BUCAs continue to vertically integrate their PBMs and navigate minimum loss ratio requirements, their traditional models are becoming increasingly uncompetitive. By combining NIH’s pharmacy cost-containment strategies with key stop-loss partnerships, we are helping employers achieve something rarely seen in healthcare—reverse cost trends.

    The result is a true win for the plan, the employer, and its members.

    Brett WebbeThird-Party Administrator, Group Administrators

Case studies

Where the Model Becomes Real

Our repricing analyses are built on a simple principle: be transparent with what the plan actually pays. Every outcome is evaluated on a true net basis, with all factors considered and nothing assumed. We take a conservative approach to ensure results are realistic, defensible, and repeatable...not theoretical projections.

Case study — Municipality

Municipality Plan Repricing Analysis

$7,543,118.64

Net plan savings (46.90%)

$417,915.98

Returned to members

120,195
Total claims reviewed
9,150
High-cost claims eligible for intervention (7.61%)
66.31%
Of total plan spend addressed
Situation
Municipal health plan with 120,195 annual pharmacy claims; high-cost specialty claims concentrated in a small share of utilization.
Intervention
NIH Clinical identified 9,150 high-cost claims (7.61% of volume / 66.31% of spend) eligible for MSO sourcing review.
Coordination
NIH Clinical MSO sourcing applied across eligible claims, weighted for rebates and inclusive of all MSO fees.
Plan Impact
$7,543,118.64 net savings (46.90%) on sourced spend after fees and rebate weighting.
Member Experience
$417,915.98 returned to members through reduced out-of-pocket exposure on sourced claims.
Savings Validation
Calculations reconciled against the original 120,195-claim file; sourcing, rebate weighting, and MSO fees included in the net figure.
Caveats
Outcomes specific to this plan's claims profile and contractual arrangements; not a guarantee of future results.

Case study — Corporation

Plan Sponsor Top 25 Script Repricing

$742,226.23

NET PLAN SAVINGS (35.40%)

$331,049.31

Returned to members

1,677
Top 25 highest-dollar scripts reviewed
20%
Rebate weight applied
35.40%
Net savings on affected claims
Situation
Illinois-based corporate health plan; engaged NIH to review Top 25 highest-dollar scripts, totaling 1,677 scripts.
Intervention
NIH Clinical evaluated lower net-cost options for the Top 25 highest-dollar script set.
Coordination
Analysis incorporated a 20% rebate weight across the reviewed claims.
Plan Impact
$742,226.23 net savings (35.40% of the affected claims) after rebate weighting and sourcing.
Member Experience
$331,049.31 returned to members through reduced out-of-pocket exposure on repriced claims.
Savings Validation
Results reconciled against the supplied Top 25 script set; rebate weighting and sourcing factors included in the net figure.
Caveats
Outcomes specific to this plan's claims profile and contractual arrangements; not a guarantee of future results.

Case study content is published only after activity is documented, reviewed, and approved. NIH does not publish hypothetical scenarios or modeled outcomes as case studies.

Insights & Resources

Ideas and Insights for Better Plan Decisions

Explore NIH research, issue briefs, articles, and perspectives from NIH and our industry partners on the clinical and financial issues affecting employer-sponsored healthcare.

Cover of the NIH employer issue brief, The $58 Billion Question: Why Does the Same Care Cost So Much More?

Employer Issue Brief

The $58 Billion Question: Why Does the Same Care Cost So Much More?

Explore how site-of-care decisions can affect employer and member costs—and where plan sponsors may be able to intervene.

PBM PUGILISM – With the Big Three Pharmacy Benefit Managers Facing greater scrutiny, more independent players are jockeying for position

Industry Article

PBM PUGILISM – With the Big Three Pharmacy Benefit Managers Facing greater scrutiny, more independent players are jockeying for position

David vs. Goliath battle continues to intensify across the pharmacy benefit management landscape as self-insured employers struggle with reining in their Rx spend.

The 2027 Cost Challenge Employers Can Act On: Site of Care, Stop-Loss, and Specialty Drug Sourcing

Industry Article

The 2027 Cost Challenge Employers Can Act On: Site of Care, Stop-Loss, and Specialty Drug Sourcing

The 2027 Segal Health Plan Cost Trend Survey should change the conversation for every self-funded employer.

The Data You Cannot See Is Costing You More Than the Data You Can

Industry Article

The Data You Cannot See Is Costing You More Than the Data You Can

The National Alliance of Healthcare Purchaser Coalitions just released its 2026 Pulse of the Purchaser survey, and if you run a self-funded health plan, you should read it carefully.

Two Sleeping Giants Keep Missing Each Other, and Patients Pay the Price

Industry Article

Two Sleeping Giants Keep Missing Each Other, and Patients Pay the Price

The New England Journal of Medicine just published an article calling self-insured employers “A Sleeping Giant of Health Care Affordability.”

PBMs Keep Putting It in Writing: They Are Not the Fiduciary

Industry Article

PBMs Keep Putting It in Writing: They Are Not the Fiduciary

The most important sentence in some PBM paperwork is not buried in the pricing exhibit.

PBM Transparency Is Coming, and It's About Time

Industry Article

PBM Transparency Is Coming—and It's About Time

The momentum toward pharmacy benefit manager transparency just got a significant boost.

Caribou Systems Is Asking the Right Question, and Plan Sponsors Should Listen

Industry Article

Caribou Systems Is Asking the Right Question, and Plan Sponsors Should Listen

Caribou Systems recently published a piece that every self-funded plan sponsor should read: “You're the Fiduciary. Can You Prove It?”

Repricing Analysis

How much savings will be found in your plan?

A Repricing Analysis is designed to surface where NIH may be able to help — and where it may not. We’ll review the data, discuss next steps, and identify whether further engagement makes sense for your plan.

The analysis is conducted alongside your existing PBM, TPA, broker, or consultant relationships and is not intended to disrupt incumbent arrangements.

Important disclosures

Outcomes vary based on each plan’s claims profile, contractual arrangements, clinical circumstances, and applicable plan terms.

Information presented on this page is for general informational purposes and is not legal, tax, medical, clinical, actuarial, or benefits advice. Case studies are published only after NIH verifies and approves the underlying activity.