Capital Rx Insights (February 2025)
In March, we've got not one, but TWO amazing webinars teed up for you, and then we're participating in a 3rd! But before we get to them, if you somehow missed the launch announcement for Judi Health?, you'll want to check it out:?Capital Rx Unveils Healthcare's First Unified Pharmacy and Medical Claims Processing Platform. ??
First, on March 5th at 12:30 PM ET, Capital Rx's Chief Commercial Officer, Kristin Begley , PharmD, will join Jeffrey Hogan , President of Upside Health Advisors, and Workplace Intelligence 's Dan Schawbel for an insightful and educational discussion about what's driving costs for employer plan sponsors within their health plans and?how to optimize procurement and plan design to create superior access, experience, and outcomes for all.
Then, on March 14th, at 1:00 PM ET,?Capital Rx's Chief Technology Officer, Ryan Kelly , and SVP of Government Programs, Jason Barretto ???? , will host a live demo to show how modern enterprise health technology ( Judi? ) helps our clients?meet the CMS Medicare Prescription Payment Plan (M3P) Requirements!
And on?Monday, March 17 at 1:00 PM ET,?we'll be exploring the future of pharmacy with specialists from WTW Health, Wealth & Career , Leap Health, and Coriell Life Sciences!
CLICK HERE?to learn more & register.
Related Content on Capital Rx Insights
Astonishing Healthcare
AH053 - Selling Pharmacy Benefits: Relationships, Rebates, GLP-1s, and More, with Bridget Mulvenna
Bridget Mulvenna , VP of Business Development, joined us in the studio again to share highlights of her first full year of selling pharmacy benefit solutions. The discussion covers the evolving healthcare landscape, regulatory pressures, expanding indications for GLP-1s, and the need for transparency in pharmacy benefits. Bridget shares stories from the field, explaining why focusing on drug manufacturer revenue and breaking the industry’s dependence on rebates are so important and how modern technology helps provide real-time data access and actionable insights to plan sponsors.
Bridget also shares insights on the evolving landscape of GLP-1 medications and their growing number of FDA-approved indications beyond diabetes and highlights the challenges plan sponsors face with coverage decisions, balancing short-term costs with potential long-term savings. Discussing Capital Rx’s Never Move Again? offering, Bridget emphasizes its flexibility and appeal to sophisticated plan sponsors. What's the most surprising thing she's seen over the last year?
AH054 - Judi Health?: Going Beyond Pharmacy and into Medical Claims, with AJ Loiacono and Dr. Sunil Budhrani
On Episode 54 of the Astonishing Healthcare podcast, we discussed the transformative potential of Judi Health?, the first unified claims processing platform that integrates medical and pharmacy claim administrative workflows and data to create a seamless experience for stakeholders, including patients, providers, and employers. Guests A. J. Loiacono (Co-Founder & CEO of Capital Rx) and Dr. Sunil Budhrani MD MPH MBA (Chief Innovation & Medical Officer) emphasize the limitations of the traditional fee-for-service model and legacy infrastructure in U.S. healthcare, which incentivizes reactive rather than proactive care and can't handle the evolution and complexities of value-based care, respectively.
Building on Episode 7 (with Sunil) and Episode 9 with Ryan Kelly, CTO, AJ and Sunil discuss how Judi Health’s innovative design can:
AH055 - Pharmacy Benefits 101: Stop-Loss Insurance, with Mike Miele, FSA, MAAA
On episode 55 of Astonishing Healthcare, we discussed stop-loss insurance, with Capital Rx's Mike Miele , FSA, MAAA (SVP, Insured Services). With premiums on the rise due to high-cost claims reaching levels actuaries never thought possible ($4+ million!), self-insured plan sponsors need new options and better tools to monitor their costs.
Mike, who is a healthcare actuary by training, discusses everything from "What is stop-loss?" and who it's for to what's driving high-cost claims to new heights, the rise of a pharmacy-only stop-loss option, and options plan sponsors have to mitigate risk when "it's not a good time to be in a risk-taking business." He also comments on broader cost drivers, using GLP-1s as an example, preliminary book-of-business trends (2024 vs. 2023), the importance of surveillance on emerging claims, and more!
AH056 - Medicare Star Ratings: Updates, How Judi? Helps, and More, with Angela Kalantarova, PharmD
Angela Kalantarova, PharmD , a senior clinical programs manager at Capital Rx, joined us in the studio for a discussion about recent updates to Medicare's star ratings. Angela shares her path to Capital Rx and experience working in managed care and on clinical programs, and she explains what's new for 2025: star measures for polypharmacy and concurrent use of opioids and benzodiazepines.
The conversation highlights the positive impact early interventions can have and how innovative enterprise health technology like Judi? allows for real-time insights. As CMS proposes changes, such as possibly removing the MTM - medication therapy management - measure or others like limiting initial opioid supply, having the flexibility to react quickly helps immensely. Angela also provides some strategic insights into how to navigate the evolving landscape and achieve superior ratings.
Capital Rx Press & Knowledge Exchange
If you know or have ever met Karen Dierker , or if you use or truly understand the power of Judi, then this news is not surprising:?Karen Dierker Ranks Among the Top 50 Women Leaders in Healthcare Technology.?
As AJ said, "Karen truly embraces our company's mission, and her invaluable leadership has helped position Judi as the industry standard for pharmacy and medical claim administration."
At Capital Rx, we are proud to have an award-winning, world-class customer care center that routinely achieves industry-leading Net Promoter Scores (NPS) and leverages Judi to enhance service quality.?How did we set it up? How do you maintain a Customer Satisfaction Score of 96% or better for four years running? William Tafoya (SVP, Customer Care) explains everything?in?Pharmacy Benefits 101: Building an Award-Winning Call Center from Scratch.
Check out the replay of Bridget Mulvenna (VP, Business Innovation) fielding tons of audience questions after outlining?5 ways plan sponsors/fiduciaries, benefits managers, and other industry professionals can improve their PBM procurement process in 2025.
Channel Partners, ?
The longer I work in this business, the more obvious "it" becomes. What am I talking about? As one of my newest colleagues, Hope Nakazato, PharmD, MBA , explains in?Signs it is time to change your PBM vendor, and how to overcome common hesitations?(originally published by Benefits Pro on Feb. 10), "Fear of the unknown is one of the biggest obstacles to progress, but plan sponsors shouldn’t let it block them from seizing opportunities that could help save their plans and members money and improve their members’ pharmacy experiences."
The "it" above is opportunity cost.?The cost of not seizing the opportunity to change has, more times than I can count, cost employer plan sponsors millions upon millions of dollars over the contract term, and it's always obvious with the benefit of hindsight. If you can control spend vs. let it compound for your clients at 10% or worse, especially if they want to cover GLP-1s for weight loss, it makes a world of difference.
At the very least, as Hope says, "Even small steps toward finding a more aligned, transparent partner, such as acknowledging the PBM challenges you face today or putting out a request for proposal can be important progress and a step in the right direction, respectively."?Don't let your clients sit in status quo contracts a minute longer. It's far too costly.
Please reach out if you'd like to run through some math or discuss a potential switch. I'm always available to chat. ???
Brian TenEyck National Director, Consultant Relations || [email protected]
Most Read News at Capital Rx?
We’re hiring! If you are looking or know anyone looking for a new role in the PBM industry, from clinical and client operations to compliance and technology, and everything in between, please visit our careers page to review open positions.
We hope you're enjoying this newsletter. We welcome your feedback, questions, and suggestions for future content. If you'd like to discuss how unbundling with Capital Rx's?Never Move Again??can help future-proof your pharmacy program, we'd love to hear from you!