TransactRx Launches SpecialtyXB, a better way to manage buy-and-bill medical benefit specialty drugs
MIAMI, Aug. 11, 2021 /PRNewswire/ -- TransactRx announces the launch of SpecialtyXB an innovative solution for payers to move the coverage of medical provider administered specialty drugs from the medical benefit to the pharmacy benefit. TransactRx provides an integrated set of consulting services, provider network management and technology to enable medical providers across all places of service to submit claims and receive payments for provider purchased specialty drugs administered to patients. SpecialtyXB is the newest of the TransactRx cross benefit solutions that manage drug spend across medical and pharmacy benefits.
Specialty medications represent nearly half of the drug spend in the US and are expected to increase by more than 11% this year. Just under 50% of the specialty drugs are administered by hospital outpatient clinics, infusion centers and medical providers that purchase the drugs and are billed under the medical benefit (a model called buy-and-bill). Over the past 10 years the PMPM dollars spent on commercial lives for these medical benefit specialty drugs is up almost 90%. The increases in medical drug spend create several challenges for payers as the utilization data is captured from batch medical claims and adjudicated on platforms that don't have the same utilization management tools available on PBM platforms used to adjudicate pharmacy claims.
"To respond to these rising costs and management challenges some payers have started to move medical specialty drugs to a white-bagging model or a home infusion model which has decreased costs but has introduced issues with providers and with patients", said Jack Guinan, CEO, TransactRx. "Our SpecialtyXB service provides an alternative solution that has proven to reduce costs, provide transparency to data, maintains provider relationships and supports the highest level of patient quality of care."
SpecialtyXB is implemented on the TransactRx Cross-Benefit platform which seamlessly integrates medical and pharmacy systems to enable provider administered specialty drugs to be billed and reimbursed as standard pharmacy (NCPDP) claims. The solution includes the implementation of a medical provider pharmacy network managed by TransactRx which contracts with the payer's PBM. The experienced TransactRx team, with over a decade of managing medical provider administered drug reimbursement, works with the payer, providers and pharmacy benefit manager to implement and operate the solution.
TransactRx successfully implemented SpecialtyXB with a regional Blue Cross and Blue Shield payer contracting with over 2700 medical providers that support their 640K commercial lives. The implementation resulted in moving 100% of specialty medications for the payer's commercial lives from the medical benefit to the pharmacy benefit while retaining the providers' buy-and-bill drug acquisition model and maintaining all sites of care for their patients. TransactRx is in discussions to launch SpecialtyXB with several other payers
For more information how TransactRx can help manage medical provider administered specialty drugs please visit our website www.transactrx.com/specialtyxb.
About TransactRx
TransactRx provides Cross Benefit Drug Reimbursement Solutions where everyone wins; payers, providers and patients. TransactRx has developed and operates its patented Cross Benefit Clearinghouse platform, operates national scale provider networks and provides consulting services that enable medical providers to be reimbursed for products and services covered under pharmacy benefits and enables pharmacy providers to be reimbursed for products and services covered under medical benefits.
TransactRx Contact
Andrea Seratte, EVP
[email protected]
800-971-3890
SOURCE TransactRx
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