As a full-service PBM, Native First Health offers claims processing, pharmacy network management, rebate aggregation services, member call center customer service, mail and specialty pharmacy services and clinical and formulary management. We combine state-of-the-art mobile technology, along with unique plan designs to assist our clients with identifying eligible members, converting them to cost-saving networks (340B, Medicare and commercial), and controlling drug spend dollars.

Native First Health has the capabilities to manage a client’s existing pharmacy benefit program or assist clients with establishing a new pharmacy benefit program for its Tribal members.

Pharmacy Network Management

Native First Health has over 69,000 participating pharmacies in its National Pharmacy Network, including all national pharmacy chains, regional pharmacy chains, and independent pharmacy associations. Over 99% of available retail pharmacies are in the Native First Health National Network. Native First Health is also a leader in the structure of custom pharmacy networks. Our effectiveness and experience at custom network design and management ensures patient access to treatment as the critical component of pharmacy benefit management. Additionally, Native First Health routinely consults with its clients to explore custom options aimed at achieving the optimum balance of pharmacy access and cost containment.

Disease Management

Native First Health’s disease management programs are designed to serve people with specific chronic conditions, including asthma, diabetes, congestive heart failure, coronary heart disease, depression, hypertension, hepatitis C and arthritis. Individuals with multiple conditions also benefit from our disease management programs. Our disease management programs help prevent complications caused by adverse drug reactions, poor medication adherence, or other identified therapeutic deficiencies. Our programs promote partnerships among the pharmacist, patient, and health care provider to enhance communication, improve collaboration among all parties, and improve therapeutic outcomes.

Medication Therapy Management (MTM)

Native First Health’s Medication Therapy Management (MTM) program is focused on improving therapeutic outcomes for members. Our program monitors and provides therapeutic mentoring to members taking prescription medications to manage defined or selected disease categories which include Diabetes, Asthma/COPD, Hypertension, Osteoporosis, and Dyslipidemia.

The success of our MTM Program is built upon our proven experience using a wide range of services designed to help members with multiple conditions by:

• Ensuring they take their medications correctly
• Improving medication adherence
• Detecting potentially harmful medication uses or combinations of medications
• Identifying gaps in care
• Educating members and health care providers

Our evidence-based program can integrate both pharmacy and medical data, when available, and is built upon multiple measures that demonstrate positive clinical outcomes for members. Pharmacists, physicians and PhDs develop, manage and evaluate the program for effectiveness.

Native First Health offers a fully integrated “turn-key” pharmacy program through which it can (i) develop, license, manage and operate contract pharmacies; (ii) provide 340B administration and fulfillment to meet client’s needs and objectives; and (iii) provide centralized fill services to supplement the requirements of clients’ pharmacies as volume demands.

Pharmacy Development & Management

In order to create efficiencies for its clients, Native First Health can fully manage the operations of client pharmacies. Such management responsibilities include:

• Site selection and procurement of pharmacy locations;
• Oversight of the build-out of a pharmacy;
• Systems implementation for the pharmacy;
• Recruiting and/or training of pharmacy personnel including, but not limited to, Pharmacist in Charge, Technicians, etc.;
• Assisting with implementation of revenue cycle solutions including third-party billing and collection and overseeing the billing processes and procedures to ensure that optimal charge capture and collection is accomplished;
• Assisting with and negotiating with third-party payer network memberships and managed care / PBM payor contracts;
• Assisting with necessary licensing and registrations;
• Assisting in risk management functions such as reviewing and or obtaining any insurance policies required for operation of the pharmacies;
• Coordinating and maintaining contractual relationship with a pharmaceutical wholesaler(s);
• Developing and implementing pharmacy operational and financial policies and procedures;
• Assisting in the selection and implementation of pharmacy automation hardware and software;
• Managing compliance with respect to Medicaid and Medicare rules for pharmacy operations and any other applicable federal, state or local rules and regulations for pharmacy operations; and
• 340B administration, as discussed below.

340B Administration

In addition to Native First Health’s management of clients’ pharmacy operations, Native First Health has the expertise to include a 340B administration solution that manages the entire 340B cycle from initial patient enrollment, prescription fulfillment, inventory management, and reporting/auditing. These services include:

• Capturing eligible prescriptions through validation of eligibility records and feeds provided by the client;
• Calculating cost and reimbursement for 340B prescriptions;
• Managing virtual inventory and replenishment, replacement and “bill to/ship to” of 340B drugs;
• Providing reporting and reconciliation of dispensing, reimbursement and share-back of 340B savings;
• Maintaining records and providing compliance reporting; and
• Supporting “self-audit” and HRSA audit of compliance.

Centralized Fill

Through its affiliate pharmacy located in Tampa, FL, Native First Health has the capabilities to supplement the inventory and delivery demands of client pharmacies through a centralized fill program. Native First Health can monitor patient demands and inventory levels to determine the most cost-effective channel for maximizing prescription fulfillment.

The Problem with Medical Implant Pricing

• For most employers, healthcare represents the second-highest operating expense category after wages – and one of the biggest drivers of healthcare costs are medical implants such as pacemakers, stents, artificial knees, hips, etc.
• Implants are involved in 70% of surgeries and are one of the thee most expensive components of health insurance costs.
• A key problem is that medical providers significantly overbill for implants.

Native First Health’s Medical Implant Cost Containment Solution

• Native First Health’s medical implant cost containment solution can lower the cost of healthcare and workers’ compensation for an employer’s employees by at least $150 per employee per year without modifying the underlying health plan.
• For an entity with 5,000 employees, Native First Health can save over $750,000 per year.
• Since the vast majority of medium-to-large companies are self-funded, these savings flow directly to the entity’s bottom line.
• Native First Health also offers a “shared savings model” where Native First Health collects 30% of whatever savings it delivers to the client and the employer health plan sponsor keeps the remainder.
• The company’s clients include 2 of the top 5 health insurance companies.

How It Works:

• Providers (hospitals and surgery centers) overbill for medical implants over half the time.
• Native First Health’s proprietary methodology identifies overbilling and works with the Third-Party Administrator (TPA) and the providers to correct the invoice.
• The process is completely automated and only requires a few minutes to set up on the employer side.
• Native First Health’s proprietary methodology is based on a deep pricing dataset of over 50,000 implants, extensive FDA and warranty data, sophisticated algorithms, and expert analysts with decades of knowledge and experience in medical implants.

Native First Health is a Native American-owned, MBE-qualified healthcare company offering pharmacy benefit management (“PBM”) services and medical cost containment solutions. Based in the Milwaukee, Wisconsin area, Native First Health’s full-service PBM provides best-in-class claims processing, access to a national network of over of 67,000 participating pharmacies, formulary management and rebate administration, and mail/specialty pharmacy solutions. Additionally, Native First Health offers a robust suite of standard and customized clinical programming and reporting and analytics.

In addition to its broad PBM capabilities and service offering, Native First Health is uniquely qualified to support the diverse needs of Native American communities and businesses. Native First Health’s tribal market service offering encompasses on-site medical solutions, including pharmacy development and management, and targeted disease state management programs focused on improving health outcomes and reducing healthcare costs for Native American tribes and entities.

Native First Health was founded and is led by Ron Spoerl, a member of the federally-registered tribe of the Little River Band of Ottawa Indians. Ron is a leading entrepreneur and philanthropist in the Native American community.