RxParadigm

What RxParadigm does

RxParadigm Inc. is a privately-held US healthcare technology company headquartered in Claymont, Delaware, founded by Mesfin Tegenu, a former PBM industry executive who previously scaled a PBM organization into a $3 billion enterprise serving government-funded programs. The company has built and operates Tungsten+PLUS™, a HITRUST r2-certified cloud-based SaaS platform purpose-built to administer the 340B Rebate Model Pilot and the Inflation Reduction Act's Medicare Maximum Fair Price (MFP) for the ten affected Medicare Part D drugs, both of which took effect on January 1, 2026. The platform unifies three distinct stakeholder workflows — pharmaceutical manufacturers, covered entities (community health centers, disproportionate share hospitals), and contract pharmacies — with modules for 340B claim processing, rebate calculation and payment tracking, MFP reconciliation, duplicate discount prevention, automated good-faith dispute initiation with evidence, and state compliance reporting. Its core technical differentiator is a proprietary 340B identification algorithm that removes dependence on unreliable claims modifiers and supports dispute evidence; the platform also connects directly to the CMS Medicare Transaction Facilitator (MTF) as a third-party support partner, enabling federal-system integration for MFP reconciliation and dispute resolution.

RxParadigm generates revenue primarily through recurring SaaS subscription and platform fees from manufacturers, covered entities, and pharmacies for 340B rebate administration, MFP execution, and dispute resolution services, though specific pricing is not publicly disclosed. Go-to-market combines direct enterprise sales to large pharmaceutical manufacturers with a channel-led motion through Primary Care Associations (PCAs), health center associations, and major 340B gateways; notable channel relationships include NACHC Select (national partnership, April 2026), Oregon Primary Care Association, Rhode Island Health Center Association, Southern Atlantic Healthcare Alliance, and state-level health center networks in Virginia, Maryland, and North Carolina. The company operates as a CMS MTF third-party support partner, which functions as both a regulatory credential and a distribution lever into federal drug-pricing workflows. Named customers include PrairieStar Health Center, Central Virginia Health Services, CCI Health Services, Advance Community Health, and Infinity Health, with platform claims of supporting 12,000+ covered entities and 32,000+ contract pharmacies across the United States.

The company's growth strategy is anchored to a narrow but high-stakes regulatory window: the 340B Rebate Model Pilot and IRA Maximum Fair Price, where imperfect identification has caused an estimated 40% of MFP claims to miss the mark. RxParadigm is positioned as a neutral clearinghouse serving all sides of the workflow, with HITRUST r2 certification and CMS MTF status as its principal regulatory and trust assets. Founder-led and privately held with no disclosed institutional investors or funding rounds, the company has assembled a full executive bench (CEO, CSO, COO, CTO, VP Sales, Chief Pharmacy Officer) ahead of national go-live and is currently in an early commercial scaling phase tied directly to the January 2026 regulatory milestone.

Name

RxParadigm

Legal name

RxParadigm Inc.

Website

https://rxparadigm.com

Company type

Private

Founded year

2021

Operating status

Operating

Headcount range

11–50 employees

Short description

RxParadigm operates Tungsten+PLUS™, a HITRUST r2-certified SaaS platform that administers the 340B Rebate Model and Medicare Maximum Fair Price for drug manufacturers, covered entities, and contract pharmacies, with direct integration to the CMS Medicare Transaction Facilitator.

Ownership category

akta.pro rank

Product category

Healthcare Rebate Administration Software

NAICS

Custom Computer Programming Services (541511)

SIC

Surgical & Medical Instruments & Apparatus (3841)

akta.pro primary industry

Government Pricing & Compliance (Medicare/Medicaid/340B/AMP/Best Price) (HLAIAKAE)

Keywords

• 340B rebate administration
• Pharmacy benefit management software
• Drug pricing compliance platform
• Medicare Maximum Fair Price
• Healthcare rebate management

Headquarters

HQ city

Claymont

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Marketing or Sales, Operations

Revenue model

1. Platform/Subscription Revenue: SaaS platform fees for 340B rebate administration, MFP execution, and dispute resolution services for manufacturers, covered entities, and pharmacies.

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Core offering

RxParadigm sells Tungsten+PLUS™, a cloud-based SaaS platform that administers the 340B Rebate Model and Medicare Maximum Fair Price (MFP) for pharmaceutical manufacturers, covered entities (community health centers, disproportionate share hospitals), and contract pharmacies. The platform unifies claims processing, rebate management, duplicate discount prevention, automated dispute resolution with CMS escalation, and state compliance reporting into a single system with HITRUST r2 certified security.

Product overview

RxParadigm offers Tungsten+PLUS™ as a unified platform for managing 340B drug program operations and Medicare Maximum Fair Price (MFP) execution. The platform provides integrated modules addressing 340B Rebate Model management, Maximum Fair Price execution, duplicate discount detection, dispute resolution, reporting, and state compliance requirements across manufacturers, covered entities, and pharmacies.

Differentiator

Problem solved

Functional benefit

Brands

• Tungsten+PLUS™: A next-generation platform for 340B Rebate Model execution, Maximum Fair Price (MFP) identification and reconciliation, duplicate discount prevention, dispute management, and claims processing for manufacturers, covered entities, and pharmacies.

Products and services

• Tungsten+PLUS™ Cloud-based SaaS platform purpose-built to administer the 340B Rebate Model and effectuate Medicare Maximum Fair Price for pharmaceutical manufacturers, covered entities (community health centers, disproportionate share hospitals), and contract pharmacies. Provides unified claims processing, rebate management, duplicate discount prevention, automated dispute resolution with CMS escalation, and state compliance reporting in a single pane-of-glass dashboard, with HITRUST r2 certified security and proprietary 340B identification algorithm.

Quantifiable outcome

• Submit claims once instead of to multiple manufacturer systems
• +1 more outcomes

Named customers5 records

Segments3 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

Eleven partnerships are on record, tiered core and minor.

• NACHC Select (National Association of Community Health Centers)coreGTM or Marketing Partner · 2 April 2026Partnership to enhance 340B drug administration and Medicare MFP execution for Community Health Centers across the United States. RxParadigm's Tungsten+PLUS™ platform provides advanced data validation, transparency, and operational support to reduce administrative burden and improve compliance with evolving federal requirements.
• CMS Medicare Transaction Facilitator (MTF)coreStrategic or Co-development Partner · 1 January 2024Connected to CMS MTF as a third-party support partner for MFP reconciliation and dispute resolution services.
• Southern Atlantic Healthcare Alliance (SAHA)coreGTM or Marketing PartnerPartnership to launch neutral 340B claims clearinghouse for member health centers.
• Oregon Primary Care AssociationcoreGTM or Marketing PartnerPartnered to launch neutral 340B claims clearinghouse for Oregon member health centers.
• Rhode Island Health Center AssociationcoreGTM or Marketing PartnerPartnership to strengthen 340B program compliance for Rhode Island community health centers.
• PrairieStar Health CentercoreGTM or Marketing PartnerLaunched Tungsten+PLUS as neutral 340B clearinghouse solution for PrairieStar Health Center.
• CCI Health ServicescoreGTM or Marketing PartnerPartnership to launch neutral 340B claims clearinghouse in Maryland.
• Advance Community HealthcoreGTM or Marketing PartnerFirst health center in North Carolina to adopt RxParadigm's neutral 340B clearinghouse.
• Infinity HealthminorGTM or Marketing PartnerPartnership to drive transparency in the 340B program.
• Virginia Community Health CenterscoreGTM or Marketing PartnerPartnership to enhance transparency and address duplicate discount challenges for Virginia's community health centers.
• 340BreportminorGTM or Marketing PartnerMedia partnership for sponsored content, podcast appearances, and thought leadership visibility.

Scale indicators4 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• Macro Helix: Established 340B TPA providing split-billing, compliance, and audit software to covered entities and contract pharmacies; competes directly with RxParadigm for 340B administration mandates, particularly in the transition to the rebate model.
• CaptureRx: 340B claims clearinghouse and TPA serving safety-net providers and contract pharmacies; directly competes with Tungsten+PLUS in claims processing, duplicate discount prevention, and CE/pharmacy rebate workflows.
• Sentry Data Systems: 340B management and compliance platform acquired by Henry Schein One; offers split-billing, contract pharmacy administration, and analytics, competing with RxParadigm for the same covered-entity and contract-pharmacy customers.
• Verity Solutions: 340B software and services platform focused on compliance, claims processing, and reporting for covered entities and contract pharmacies; overlaps directly with Tungsten+PLUS's rebate administration and dispute resolution capabilities.
• Kalderos: Drug-discount management platform addressing 340B duplicate discounts and non-compliance between manufacturers, CEs, and payers; operates in the same clearinghouse/dispute-resolution category as RxParadigm.

Broad incumbents

• MedImpact Healthcare Systems (SUNRx): Large PBM with a 340B division (formerly SUNRx); offers a broader portfolio of pharmacy benefit management and 340B services and competes with RxParadigm particularly for manufacturer rebate administration mandates.
• Apexus: HRSA-designated 340B prime vendor and educational/advisory entity; competes in adjacent 340B infrastructure space with Apexus 340B ESP and serves many of the same covered entities RxParadigm targets.

Emerging players

• Equiscript: 340B specialty pharmacy and contract pharmacy solutions company serving covered entities; overlaps with RxParadigm on the contract-pharmacy side of the 340B rebate workflow.
• CERis (formerly 340B Holdings / CERIS): 340B consulting and administration services firm supporting covered entities and manufacturers; competes for the same CE rebate administration engagements as RxParadigm.
• Tessellate: 340B program management and consulting firm for covered entities and contract pharmacies; competes with RxParadigm's CE-facing rebate administration and compliance modules.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/rxparadigm

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about RxParadigm