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Impact Tool · free, public math
When a payer pushes its specialty pharmacy into your infusion chair, the question isn’t abstract — it’s a number. Pick the drug, enter your acquisition cost, and see the buy-and-bill margin that leaves with the vial: per dose, and per year at your volume. Whether the payer can legally mandate it is the state-law tracker’s job; this is the dollars.
The drug line leaves your books entirely: the payer's designated specialty pharmacy dispenses and bills the drug, so you no longer buy it (no acquisition cost) and no longer bill it (no drug reimbursement). You keep only the administration fee — which you'd bill in either channel. Whatever margin existed between your acquisition and the drug reimbursement is forfeited, dose by dose.
Yes — when the drug is underwater. If your acquisition exceeds the reimbursement, the drug line loses money, and shedding it sheds the loss (the inventory float and denial risk leave too). The calculator's verdict flips automatically when your numbers say so; pair it with the underwater checker to scan whole biosimilar families.
Depends on the state and the plan's funding. Eleven states ban white-bag mandates for state-regulated plans (with scope variations), but self-funded ERISA plans are exempt everywhere — so your real exposure is your payer-and-funding mix, not just your address. The state-law tracker has every statute, cited and dated.
Because they're channel-invariant: you administer the drug and bill the administration codes whether you sourced the vial or the payer's pharmacy shipped it. Including them would pad both sides of the comparison equally and hide the real delta, which is the drug margin.
The CMS July 2026 payment-limit file (public domain), effective July 1, 2026. Your acquisition cost is typed by you and never leaves the browser. Commercial reimbursement — usually the larger share of the forfeited margin — depends on your contracts, which is the practice X-Ray's job.
The full channel comparison (who buys, bills, captures, and bears what): buy-and-bill vs white bagging. Whether your state allows the mandate: the 51-jurisdiction tracker. Whether the drug is worth fighting for: the underwater checker.
Drug economics as of Q3 2026 (Medicare ASP basis)
The practice X-Ray reads your 835s and shows which drugs, payers, and plan types put margin at white-bag risk — and what each mandate would actually cost you, at your real rates.