Capital Rx Insights (April 2024)

The benefits of modern enterprise health technology, like JUDI? , really shine when new solutions are needed, especially to meet government requirements that upend existing workflows and processes. To address questions and concerns about the Medicare Prescription Payment Plan - commonly known as “M3P” - Capital Rx hosted a live Q&A featuring Co-Founder and Chief Technology Officer Ryan Kelly and Vice President of Government Program Operations Jason Barretto ???? . The duo discussed program requirements, and Ryan logged on and ran a live demo of the solution, explaining its capabilities and how its functionality stands out.

Read on for the usual roundup of news and insights from the Capital Rx team,?and CLICK HERE for the M3P Forum - A Live Q&A with Capital Rx Replay.

Related Content

?? Capital Rx’s Enterprise Health Platform Enables Healthcare Organizations to Meet the CENTERS for MEDICARE & MEDICAID SERVICES’ M3P Requirements ?

?? AH011 - Navigating CMS' M3P, PDE, and Other Regulatory Changes, with Jason Barretto ?

? M3P Solution Page

Astonishing Healthcare

If you haven’t yet, visit our Astonishing Healthcare Podcast page or subscribe on Apple or Spotify! And if you’d like to watch AH012 - our special episode with Prime CEO Mostafa Kamal & Capital Rx CEO A. J. Loiacono - CLICK HERE .

April 2024 Episodes?

• AH015 - PBM Legislation, Contracting, and More with Lloyd Fiorini (4/26)?
• AH014 - The Rise of Conversational AI: Healthcare Search & Patient Journeys Will Never Be the Same with Christian J. Ward & Carrie Liken (4/19)?
• AH013 - Redefining Virtual Care: A Blueprint for Effective RPM with Robert Longyear (4/12)?
• AH012 - Revolutionizing Healthcare: Prime & Capital Rx's Game-Changing Alliance with Mostafa Kamal & AJ Loiacono (4/5)

Knowledge Exchange

Capital Rx’s Customer Care Team Won 5 Stevie? Awards for Customer Service , including one Gold award for Achievement in Customer Experience. Lisa Ellerhorst and Gismell Abud won 2 Silver awards for Contact Center Leader of the Year and Customer Service Training Professional of the Year, respectively.

Capital Rx’s clinical team published its Drug Pipeline & Clinical Update - March 2024 and Q1 2024 Medication Pipeline Report highlighting key new drug approvals, notable expanded indications, including Wegovy? (semaglutide) for use to reduce the risk of cardiovascular death, heart attack, and stroke in adults, generic approvals, and more.

In April, Capital Rx Earned Accreditation from the National Committee for Quality Assurance (NCQA) in Utilization Management. Our prior authorization tool (PAT) is built into JUDI, integrating formulary and clinical criteria. The ability to test claims and directly create authorizations from a PA case review helps streamline processes.

CONSULTANT CORNER

Channel Partners,

Quite a few broker/consultant partners have requested our team attend onsite meetings over the past 60 days. We’re not only sharing how our PBM model is unique/innovative, but we’re also explaining how things work, including:

1. NADAC, which has been a deflationary price index;?

1. How utilization management programs help with managing cost trend; and?

1. How rebates, drug mix, auto-refills, and other factors impact plan spend.

If such a visit would be beneficial to you or your team, please reach out. We always welcome the opportunity to help!

Let me know if you’d like to chat.

Brian TenEyck , National Director, Consultant Relations || [email protected]

Most Read News at Capital Rx

• The Top Pharmacy Benefit Managers of 2023: Market Share and Trends for the Biggest Companies—And What’s Ahead (4/9; DCI)?
• The GLP -1 Class of Therapeutics is Set to Explode | AMCP 2024 (4/18; Managed Healthcare Executive)?
• A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People with Obesity (4/24, KFF)?
• 2024 compliance checklist: RxDC Is Back! (4/25; Benefits Pro)?
• Walgreens To Launch $24 Billion Business Dedicated To Specialty Pharmacy (4/25; Forbes)

We're Hiring!

If you are looking, or know anyone looking, for a new role in the PBM industry, please click below to visit our careers page.

We hope you’re enjoying this newsletter. We welcome your feedback, questions, and suggestions for future content. And if you’d like to discuss how Capital Rx drives Validated Savings for payers, we’d love to hear from you!

Visit Capital Rx Insights to access the content herein and much, much more. And don't forget to follow us on LinkedIn so you never miss an update.

Thank you for reading, and have a great rest of your day!