Results & Impact

Turn 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.

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.

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.

Submit Repricing Request

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.