In The News
Medical Rx and Infusions: The Overlooked Side of High-Cost Rx
As plans build their high-cost Rx strategy for 2027, the drugs paid under the medical benefit are often the part left out. They shouldn’t be. By Jake Velie, CPT | Founder, Chairman & CEO, National Integrative Health Most conversations about high-cost drugs start with the pharmacy benefit, and for good reason. Specialty medications make up […]
DOL Releases Final Compensation Disclosure Regulations for PBMs and Any Entity Providing “Pharmacy Benefit Management Services”
On Thursday, October 29th, the Department of Labor (DOL) finalized regulations requiring any entity providing “pharmacy benefit management services” to a self-insured group health plan to disclose specified compensation streams this entity receives to the plan’s fiduciary. Important Things To Know About These Final Regulations This Final Reg Is Not Just for PBMs Importantly, these final […]
Stop-Loss and Actuarial Partnerships: Why Underwritable Rx Strategy Wins
By Jake Velie, CPTFounder, Chairman & CEO, National Integrative Health Publication date: October 29, 2026 Every self-funded renewal comes down to one question from the stop-loss underwriter: how much of next year’s risk can be seen, measured, and priced? When high-cost drug spend is unmanaged, the honest answer is “not much.” The carrier then protects […]
How to Build a Stable High-Cost Rx Strategy for 2027 and Beyond
Stability, integration, and predictability matter. A durable strategy connects pharmacy and medical claims, clinical review, sourcing, and stop-loss planning. By Jake Velie, CPT | Founder, Chairman & CEO, National Integrative Health Over the past few weeks, brokers, TPAs, and plan sponsors have asked me the same question: will the strategy we rely on today still […]
Three Dragons, One Network
What Stacey Richter and Evan Anderson got right about carrier networks, and what employers can do now to cut costs By Jake Velie, Founder, Chairman & CEO, National Integrative Health I have spent 13 years on the health plan side of this business. I have watched employers pay more each year for the same care […]
Biosimilars Are Not Enough
By Jake Velie, CPT, Founder, Chairman & CEO, National Integrative Health Biosimilars are getting a lot of attention right now. They should. They are changing the economics of the drug channel. Provider-administered biosimilars now account for an estimated 6% of the Big Three wholesalers’ drug distribution revenue, but 23% of their gross profit.1 But employers […]
The Infusion Spend Problem Self-Funded Health Plans Can No Longer Ignore
By Jake Velie, Founder, Chairman & CEO, National Integrative Health Most people around a self-funded health plan already know pharmacy spend matters. What many still miss is where some of the biggest drug costs actually land. They do not always show up in the PBM report. A meaningful share of high-cost drug exposure sits inside […]
The GLP-1 Market Has Changed, Now Plans Need a Strategy
By Jake Velie, CPT, Founder, Chairman & CEO, National Integrative Health The GLP-1 market has already changed. The real question now is not whether these therapies will keep growing. They will. The question is whether plan sponsors have a real strategy for managing them.¹ ² Too much of the conversation is still framed the wrong […]
The Era of Passive Health Plan Oversight Is Ending
By Jake Velie, CPT, Founder, Chairman & CEO, National Integrative Health Employers are getting squeezed from every direction on healthcare costs. That part is not new. What is changing is how they are starting to respond.¹ ² For years, many plan sponsors treated high-cost healthcare as something to review after the fact. They got the […]
Why Brokers Are Asking for Infusion Carve-Outs Now?
By Jake Velie, Chairman & CEO, National Integrative Health When brokers start raising infusion carve-outs in renewal conversations, it is a sign that the old approach to medical-benefit drug spend is under pressure. This is not a labeling exercise. It is about cost, accountability, and control. In one recent NIH case, a broker managing over […]
PBM PUGILISM – With the Big Three Pharmacy Benefit Managers Facing greater scrutiny, more independent players are jockeying for position
Written by Bruce Shutan David vs. Goliath battle continues to intensify across the pharmacy benefit management landscape as self-insured employers struggle with reining in their Rx spend. In one corner lie the so-called Big Three PBMs, which are vertically integrated with the nation’s largest health insurance companies and control about 80% of U.S. prescription drug […]
The 2027 Cost Challenge Employers Can Act On: Site of Care, Stop-Loss, and Specialty Drug Sourcing
By Jake Velie, Chairman & CEO, National Integrative Health The 2027 Segal Health Plan Cost Trend Survey should change the conversation for every self-funded employer. The issue is not simply whether costs will rise. It is whether the same high-cost claim will become more expensive because of its site of care, its sourcing pathway, and its lack […]
The Data You Cannot See Is Costing You More Than the Data You Can
By Jake Velie, Chairman & CEO, National Integrative Health 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.¹ Not because it says anything surprising about costs. Costs are up. Everyone knows that. The average employer expects a 7.7% […]
HVBA Innovation Summit Tampa Brings Industry Leaders Together for Education, Connection and an Unforgettable Casino Night
The Health & Voluntary Benefits Association® (HVBA) brought together brokers, consultants, industry leaders, innovators and strategic partners in Tampa for the 2026 HVBA Innovation Summit, delivering two days filled with meaningful conversations, timely education, relationship-building and plenty of fun. The experience began Wednesday evening with an exclusive VIP Dinner for HVBA Board Members and invited guests, […]
HVBA Innovation Summit Returns to Tampa August 20 with Cutting-Edge Healthcare Sessions and Upscale Casino-Themed Networking Reception
TAMPA, FL — August 19, 2026 — The Health & Voluntary Benefits Association® (HVBA) will bring benefits professionals, brokers, consultants, healthcare innovators and industry leaders together at the 2026 HVBA Innovation Summit – Tampa on Thursday, August 20, 2026, at Hotel Alba Tampa. Designed to be more than a traditional industry conference, the HVBA Innovation Summit combines timely education […]
Two Sleeping Giants Keep Missing Each Other, and Patients Pay the Price
By Jake Velie, Chairman & CEO, National Integrative Health The New England Journal of Medicine just published an article calling self-insured employers “A Sleeping Giant of Health Care Affordability.”¹ The authors, Dr. Suhas Gondi and Dr. Zirui Song, wrote it because most physicians do not know that a self-insured employer sits behind that carrier card their patient […]
PBMs Keep Putting It in Writing: They Are Not the Fiduciary
By Jake Velie, Chairman & CEO, National Integrative Health The most important sentence in some PBM paperwork is not buried in the pricing exhibit. It is not in the rebate schedule. It is not in the reporting package. It is the disclaimer. In one PBM pharmacy service agreement reviewed by our team, the language is direct: […]
PBM Transparency Is Coming, and It’s About Time
By Jake Velie, Chairman & CEO, National Integrative Health The momentum toward pharmacy benefit manager transparency just got a significant boost. As reported by Allison Bell in BenefitsPro on July 17, 2026, DOL Secretary nominee Keith Sonderling told the Senate Health, Education, Labor and Pensions (HELP) Committee that drafting new PBM transparency regulations is a priority for […]
Caribou Systems Is Asking the Right Question, and Plan Sponsors Should Listen
By Jake Velie, CEO & President, National Integrative Health Caribou Systems recently published a piece that every self-funded plan sponsor should read: “You’re the Fiduciary. Can You Prove It?” It’s a direct, uncomfortable question, and that’s exactly why it matters.¹ Their argument is simple and correct: ERISA fiduciary compliance isn’t about outcomes. It’s about process. Specifically, can […]
Case Study: Seamlessly Reducing High-Cost Pharmacy Spend Without Disrupting Member Care
Client Snapshot: The Illinois Plan Sponsor Top 25 Reprice An Illinois Plan Sponsor was facing a growing challenge with high-cost pharmacy claims. A small group of prescriptions was driving significant plan spend, and the company needed a clearer way to identify savings without disrupting employees who depended on these medications. NIH analyzed 1,677 claims of […]