TGRX Specialty Care Coordination
Make the next step in specialty care clear.
TGRX—Total Governance Rx—is IXB’s specialty-care coordination offering for health plans and PBMs. It is designed to connect the people, information and follow-up needed to help members start and continue specialty treatment.
Bring referrals, prior authorization, medication therapy management, claims information and pharmacy handoffs into a shared view of the member’s care. Give each unresolved barrier an owner and make the next action visible across participating teams.
Connected sources
- Referrals and supporting documents
- Prior authorization status
- MTM referrals and recommendations
- Claims information
- Pharmacy and provider handoffs
One specialty-care episode
The member’s treatment journey from referral through initiation and ongoing follow-up, with each unresolved barrier assigned an owner.
The next action, visible
Who holds the current barrier, what remains to be done and what the evidence establishes, across plan, PBM and pharmacy teams.
Illustrative relationship between connected sources, the episode record and the responsible teams. Not a product screen.
Know what is holding up care—and who can move it forward
A specialty prescription can involve a provider office, a health plan, a PBM, a specialty pharmacy and a clinical care team. Authorization may be approved while treatment is still waiting on missing information, financial assistance, scheduling or a pharmacy handoff.
TGRX is designed to bring those activities together around a specialty-care episode: the member’s treatment journey from referral through initiation and ongoing follow-up.
Organize intake
Connect referrals and supporting information with the appropriate member and treatment context.
Make barriers visible
Identify unresolved coverage questions, missing documents, affordability concerns and partner delays.
Coordinate the handoff
Track which pharmacy or provider has accepted responsibility and what remains to be done.
Support continuity
Bring upcoming authorization renewals, reported treatment gaps and follow-up needs to the responsible team’s attention.
Keep the evidence connected
Distinguish claim activity, dispensing, delivery and reported or documented treatment so teams can see what each source establishes.
Follow through on action
Track the response and supporting evidence when a care team, pharmacy or service partner resolves an issue.
Connected to the IXB PBM suite
TGRX is designed to connect specialty coordination with IXB’s authorization, clinical, claims and issue-management workflows. Each product retains responsibility for its decisions and records, while TGRX helps teams follow the member’s progress across them.
| IXB component | Its role in the connected specialty workflow |
|---|---|
| Prior Authorization | Connect authorization requests, supporting information, decisions and renewal activity to the member’s next treatment step. |
| Medication Therapy Management | Refer members for medication-related review, connect clinical recommendations with coordination tasks, and track follow-up. |
| Claims processing | Bring authorized claim outcomes, reversals and financial information into the specialty-care view through the customer’s selected processor connection. |
| ResolveIT | Link recurring service problems, data discrepancies and unresolved operational issues to an investigation and resolution process. |
Coverage determinations remain with authorized reviewers. Clinical recommendations remain with the responsible clinicians. TGRX connects those decisions with the work needed to support the member.
Keep your choice of claims processor
TGRX’s integration approach supports customers using IXB’s claims processor or another claims processor. Your specialty-coordination strategy can build on your existing processing relationships.
Connections are scoped to your plans, benefits and available data. Implementation includes confirming identifiers, supported information, update frequency and reconciliation so the care team understands both the information available and any gaps.
Partner information can be exchanged through supported APIs, secure files or authenticated partner workflows. The connection method is matched to each organization’s capabilities.
Support both owned and independent specialty pharmacies
For a PBM or health plan that owns a specialty pharmacy, TGRX is designed to work alongside the pharmacy’s existing dispensing system.
The pharmacy continues its prescription, dispensing, inventory, billing and shipping work in that system. TGRX focuses on access coordination, PA and MTM handoffs, patient barriers and follow-up, using information the pharmacy is authorized to share.
The same approach supports independent specialty pharmacies in your network. Both models benefit from clear referral ownership, visible status and a shared understanding of the next action. Access is defined by each organization’s role and responsibilities.
Connect pharmacy and medical benefit information
Specialty treatment can involve pharmacy-dispensed medication, provider-administered therapy, infusion appointments and related services. TGRX is designed to bring the relevant information into the member’s coordination record through customer-authorized connections.
Medical claims and administration information require their own qualified sources. Where available, they help teams connect treatment activity with related services and costs. Reporting should make missing information and data freshness visible alongside the results.
This gives health plans and PBMs a foundation for reviewing access delays, partner responsiveness, treatment continuity and supported episode costs across benefits.
A connected path from referral to follow-up
An illustrative specialty-care journey.
Receive the referral
Organize the requested treatment, member information and supporting documents.
Coordinate access
Track benefit questions, authorization requirements and affordability needs with the appropriate teams.
Confirm the handoff
Establish the receiving pharmacy or provider, acceptance status and next action.
Track treatment progress
Bring together available dispensing, delivery, member-reported or administration evidence.
Connect clinical follow-up
Coordinate an MTM referral when appropriate and follow the resulting recommendations through documented action.
Resolve continuing barriers
Maintain member follow-up while ResolveIT supports investigation of persistent service or operational problems.
A resolved support issue and a resolved member-care barrier are tracked separately, so follow-up remains focused on the member’s situation.
Visibility for the teams responsible for specialty care
Health plans
Build a clearer view of member access, pharmacy and provider handoffs, clinical follow-up and available cost information across participating organizations.
PBMs
Coordinate specialty programs across clients and processing arrangements, with defined responsibilities, consistent work tracking and customer-specific access.
Specialty pharmacy teams
Connect access work with the broader plan and PBM workflow while keeping existing dispensing tools. Make missing information, authorizations, referrals and patient follow-up easier to coordinate.
Questions about TGRX
Is TGRX part of the IXB PBM suite?
Yes. TGRX is IXB’s specialty-care coordination offering within the PBM suite, designed to connect with Prior Authorization, MTM, claims information and ResolveIT.
Can we retain our existing claims processor?
Yes. The product is designed to support your chosen claims processor through a qualified connection. IXB works with you to establish the required data, permissions and exchange method.
Can our owned specialty pharmacy keep its dispensing system?
Yes. TGRX coordinates the member’s specialty-care journey alongside the existing dispensing system. The pharmacy continues its dispensing operations in its current tools.
Does every participating pharmacy need a direct system connection?
Each participating organization needs an agreed way to exchange the required information. Depending on its capabilities, that may be an API, a secure file or an authenticated partner workflow.
How do we determine the right implementation scope?
IXB works with your team to identify the specialty workflows, participating organizations, suite components and data connections needed for your program. Contact us to discuss TGRX availability, supported connections and implementation planning.
Bring your specialty-care workflow to IXB
Tell us where members encounter delays, which pharmacies and providers participate in your program, and how your teams coordinate care today. Let’s discuss how TGRX can fit your PBM suite and specialty-care operations.