Solutions
One Managed Care Team. Proven Impact.
What NIH Delivers
National Integrative Health is a Managed Services Organization that administers targeted cost-containment workflows for plans and partners, reducing high-cost, specialty, and infusion medications. Each service is designed to plug into your existing benefit structure — supporting, not replacing, your PBM, TPA, broker, and stop-loss relationships.
Solution Pillars
Twelve coordinated functions. One managed services layer.
Data Analytics
Claims-level review and Repricing Analysis designed to surface high-cost medication outliers. NIH helps identify patterns across specialty, infusion, and traditional drug spend.
Why it matters
You can't contain what you can't see. Data-first review helps focus resources on the claims that drive the most spend.
RX Management
Coordinated oversight across specialty and traditional drug categories — supporting, not replacing, the existing PBM relationship. NIH helps align formulary, utilization, and cost-management strategies where appropriate.
Why it matters
A second layer of pharmacy oversight helps catch high-cost patterns that may fall outside standard PBM reporting.
Lower net-cost pathways
Where clinically appropriate and subject to plan terms, NIH works to secure the lowest net acquisition cost on high-cost medications through direct contracting, proprietary networks, and clinical strategy...without compromising member care.
Why it matters
Specialty and high-cost drugs often carry inflated acquisition costs the plan never sees broken out. NIH surfaces and validates lower net pricing at the claim level.
Therapeutic Alternatives
Clinically equivalent therapy review across specialty and traditional drug categories. NIH evaluates whether members on high-cost regimens could be safely transitioned to lower-cost, guideline-supported therapies and biosimilars, always coordinated with the prescribing provider.
Why it matters
Many high-cost prescriptions have clinically appropriate substitutes that were never considered at the point of prescribing. Provider-led review captures those opportunities.
Infusion Care Coordination
Site-of-care and infusion pathway coordination designed to help reduce per-case cost where clinically appropriate. NIH supports transitions from higher-cost settings to lower-cost, clinically equivalent options.
Why it matters
Infusion is one of the fastest-rising categories in pharmacy spend. Care coordination helps members receive therapy in the right setting.
Actuarial + Underwriting Support
NIH is actuarially certified by the nation's leading stop-loss carriers and MGUs. That certification typically produces renewal discounts of 5–10% on stop-loss premium — and can support the removal or reduction of plan-specific lasers — by translating credible, claims-level pharmacy evidence into underwriting-ready documentation.
Why it matters
Pharmacy is one of the most volatile lines in the renewal cycle. Grounded, certified actuarial input helps plans and partners price coverage, secure premium relief, and remove lasers with confidence.
Clinical Outreach
Direct member and provider engagement to support adherence, prior authorization completion, and clinically appropriate alternatives. Outreach is conducted respectfully and in compliance with plan protocols.
Why it matters
Gaps in adherence and incomplete authorizations drive unnecessary cost. Proactive outreach helps close those gaps.
Prior Authorization
Operational support for complex prior authorization workflows — helping plans, providers, and members navigate requirements, documentation, and appeals where appropriate.
Why it matters
Delays and denials in PA create cost spillover into emergency and inpatient settings. Streamlined PA support helps reduce that leakage.
Ongoing Case Management
Longitudinal, white-glove case management from identification through resolution. Members work directly with a dedicated NIH clinical team to navigate therapy decisions, site-of-care transitions, and prior authorization requirements. Every case is documented, tracked, and reported across the plan year.
Why it matters
High-cost pharmacy is personal. A white-glove experience ensures members feel supported, not processed — which drives better adherence, fewer escalations, and stronger plan satisfaction scores.
Reporting + Savings Validation
Periodic reporting designed to track opportunities identified, actions taken, and outcomes realized. Reporting is designed to validate realized impact subject to claims data and plan terms.
Why it matters
Plan sponsors need credible documentation for finance, leadership, and stop-loss partners. Structured reporting helps provide it.
Plan Design Consulting
Strategic review of plan documents, formulary tiers, and benefit structures to identify design levers that reduce high-cost pharmacy exposure without disrupting member experience.
Why it matters
Many high-cost claims trace back to plan design choices made years earlier. Periodic review surfaces opportunities to modernize coverage language and cost-share structures.
Clinical Trial Coordination
Identification and coordination of clinical trial opportunities for members on high-cost specialty regimens, where appropriate and provider-endorsed, helping connect care teams with manufacturer-sponsored pathways.
Why it matters
Eligible trial enrollment can offer members access to leading-edge therapy while removing significant cost from the plan but only when surfaced and coordinated proactively.
Not Sure Where the Opportunity Is?
Submit a Repricing Request.
Share a few details about your plan. NIH will follow up to scope a free Repricing Analysis designed to surface containment opportunities — without disrupting your existing PBM, TPA, or broker relationships.