Regenerative Medicine Benefits Management (RMBM)
At RegenerativeX, the Regenerative Medicine Benefits Manager (RMBM) division serves as a third-party administrator specializing in the management of regenerative medicine benefit programs for various entities, including health insurers, self-insured employers, and organizations providing coverage for advanced therapies in the field of cell therapy and regenerative medicine. This field of application is substantially different when compared to more traditional Pharmacy Benefits Management (PBM). RegenerativeX RMBM facilitates the integration and efficient utilization of regenerative medicine treatments within healthcare systems.
Explore the Services and Functions offered by RegenerativeX RMBM:
Therapeutic Benefit Program Design
RegenerativeX RMBM collaborates with health plans, providers, sponsors and employers to design regenerative medicine benefit programs. This involves defining covered therapies, establishing reimbursement models, and determining criteria for the inclusion of specific regenerative medicine treatments. The goal of a solid program is to balance demand-to-supply ratio, pricing, and outcomes. With this goal in mind, we involve all stakeholders in the design and implementation of a Therapeutic Benefit Program.
Formulary Management
RegenerativeX RMBM develops and maintains formularies specific to cell therapy and regenerative medicine, with registers of approved therapies and treatments. This involves evaluating not only the clinical effectiveness, but also the cost-effectiveness of regenerative medicine options, in alignment with the goals of the Therapeutic Benefit Program.
Treatment Authorizations
RegenerativeX RMBM implements authorization processes for cell therapy and regenerative medicine procedures to ensure that treatments align with established criteria and guidelines, as well as with expected outcomes. Important criteria are considered, such as responder/non-responder profile, matching, and transplant immunology, that are unique to this field of application. The processes help control costs and promote the appropriate use of advanced therapies.
Network Development
We manage a network of healthcare providers and facilities equipped to deliver cell therapy and regenerative medicine treatments. We negotiate agreements with specialized clinics and centers of excellence to ensure accessibility for covered individuals and quality of the services.
Claims Processing and Participant Navigation
We handle the processing of claims related to cell therapy and regenerative medicine treatments. This includes managing the financial aspects of regenerative therapy transactions, such as billing the insurer, employer, or participant, applying cost-sharing measures, and reimbursing healthcare or treatment providers. We guide both providers and participants through every step of the claims process, ensuring a smooth navigation from start to finish.
Pricing and Negotiations
At RegenerativeX RMBM we negotiate pricing agreements with manufacturers, distributors, and providers of regenerative medicine therapies. This includes securing favorable terms, discounts, or rebates to optimize the cost of covered treatments.
Data Management and Analytics
At RegenerativeX RMBM we utilize data analytics to monitor and analyze patterns of regenerative medicine utilization, as well as key outcome parameters. Data analysis inform decisions, enabling the identification of opportunities for cost containment, improvement of treatment outcomes, and abatement of risk - which ultimately enhance overall effectiveness of a program.
Patient Access
We establish patient assistance programs to support individuals in accessing cell therapy and regenerative medicine treatments, particularly those that may be associated with higher costs. In addition, we facilitate patient access to cutting-edge clinical trials for advanced therapies and regenerative treatments - primarily those that have demonstrated safety and that are in later stages of development.