Managed Care · High-Cost Claim Intervention
Guaranteed savings on high-cost drugs.
No upfront or out of pocket fees.
National Integrative Health is a fully integrated fiduciary pharmacy program — data, clinical, sourcing, site of care, actuarial and stop-loss coordination — built to intervene on high-cost, specialty, and infusion medications. You pay only when savings are delivered.
- No implementation fees
- No PEPM or PMPM
- Pay only when savings are delivered
- Start mid-year — or any time
A fully integrated fiduciary pharmacy program
One in-house team. Delivering 40% average savings.
NIH is not a point solution. It is an in-house managed care model that plugs into the plan you already have — handling the high-cost cases that drive the trend, both in pharmacy and for the medications that run through medical benefit.
Learn more about our solutionsData analytics & repricing
RX Management
Clinical outreach
Infusion & site-of-care
Prior authorization as clinical tool
Ongoing case management
Actuarial & underwriting support
Therapeutic alternatives
Clinical trial coordination
Plan design consulting
Lower net-cost pathways
Data analytics & repricing
RX Management
Clinical outreach
Infusion & site-of-care
Prior authorization as clinical tool
Ongoing case management
Actuarial & underwriting support
Therapeutic alternatives
Clinical trial coordination
Plan design consulting
Lower net-cost pathways
Why NIH is different
No Redesign. No Replacement. Just Results.
Zero upfront cost
No implementation fees. No PEPM. No PMPM. You pay only after savings are delivered and validated.
Start immediately
No need to wait for renewal. Implement now to reduce high-cost claim exposure right away and experience a better renewal later.
Minimal disruption
NIH can operate as an in-network managed care provider alongside your PBM, TPA, and stop-loss. Most claims remain unchanged.
Risk sits with us
Clinical, operational, and execution work is in-house...not outsourced. Outcomes are measured and validated case by case.
Impact preview
Measurable outcomes — or you don’t pay.
NIH’s engagement model is built around a repeatable set of activities — from opportunity identification through validated savings and ongoing reporting.
- 1Opportunities identified
- 2Lower net-cost pathways found
- 3Intervention with Members & Providers
- 4Outcomes validated
- 5Ongoing reporting
Activities and outcomes vary based on each plan’s claims profile, contractual arrangements, and applicable plan terms.
Who we serve
Built for the stakeholders shaping plan spend.
NIH supports the full ecosystem around the plan — preserving existing relationships and contractual structures.
Where the spend actually goes
A few claims, an outsized impact.
High-dollar cases like specialty drugs and infusions sit at the intersection of clinical decision-making, sourcing, and plan design. That is where coordinated intervention pays off.
How it worksHigh-cost claim exposure
Just 5-8% of pharmacy claims drive 50-85% of plan spend each year.
Specialty + infusion spend
Biologics, gene and cell therapies, and infusion-administered drugs swing per-case costs by tens of thousands of dollars depending on site of care and billing pathway.
Medical benefit blind spots
Infusion and provider-administered drugs often run through the medical benefit, outside the PBM. Without coordinated oversight, opportunities go unseen.
Stop-loss coordination
Catastrophic claims drive stop-loss renewals. By coordinating high-cost cases with the stop-loss carrier, NIH helps reduce laser risk, curb renewal rate increases, and drive discounts of 5-10%.
Start with a Repricing Analysis
See exactly where your plan is overspending.
Share a few details and NIH will return a free Repricing Analysis showing the high-cost cases where coordinated intervention would change the outcome. No implementation fee. No PEPM. You pay only when savings are delivered.