Managing the Exploding Costs of Specialty Drugs | with Jake Velie

"There's no reason why I should be able to do an infusion for 50% of the cost of what it's currently being allowed at. We've seen allowed amounts between $57,000 and $80,000 for Keytruda. I typically can have that in the home at $29,000."My guest this week is Jake Velie, CEO and co-founder of National Integrative Health (NIH). After spending the first half of his career in the clinical "meat grinder" of value-based care on the provider side, Jake realized the only way to truly fix the system was to control the dollars on the commercial plan side. Today, NIH acts as the ultimate watchdog and independent pharmacy solution for self-funded employers, actively managing J-codes, specialty drugs, and clinical coordination.In this episode, we unpack the exorbitant markups hospitals charge for infusions and how NIH has spent years building a 50-state network to redirect patients to safe, comfortable, and massively discounted at-home infusion care. Jake also breaks down the brutal reality of GLP-1 adherence, why his team refuses to fill 90-day prescriptions for weight-loss drugs, how they enforce formularies to switch patients from expensive biologics like Humira to low-cost biosimilars like Yusimry, and the absolute truth about the safety of international drug sourcing.If you want to know how to stop the bleeding on your pharmacy and medical claims while actually improving the white-glove customer service your employees receive, this is a masterclass in specialty cost containment.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Moving Keytruda to the Home Setting (00:01:47) Defining True Value-Based Care (00:03:20) The Genesis of NIH and Leaving the Provider "Meat Grinder" (00:07:01) Building a 50-State Home Infusion Network (00:09:22) Why Specialty Meds Drive 90% of Pharmacy Spend (00:14:53) Demystifying J-Codes and Q-Codes (00:17:01) Exorbitant Hospital Markups and Hidden Fees (00:24:59) The Mechanics of Redirection: Mandatory vs. Voluntary (00:30:27) Coordinating Carve-Outs with Stop-Loss Carriers (00:34:08) Enforcing Formularies: Converting Humira to Yusimry (00:41:12) The Reality of International Sourcing and the FDA (00:47:35) Managing GLP-1s and the Danger of 90-Day Fills (00:51:48) The Ideal Employer Profile for NIH (00:58:04) Overcoming Healthcare's Terrible Customer Service (01:02:05) The Future: Oncology, Cell, and Gene TherapiesKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/