Capital Rx Insights (July 2024)
If you've been reading our newsletter and following our story, you know we're proud of our independence, aligned business model, and proprietary enterprise health platform, JUDI? .
While we remain laser-focused on advancing our nation's electronic healthcare infrastructure and bringing much-needed change to the pharmacy benefits industry, the news wires have been ablaze with criticism of the traditional PBM model.
In July, we were in the news for good reasons: the receipt of a U.S. Patent for JUDI's novel data tagging system, and two new partnerships, which you can read more about below!
"Smart tags and overrides" are among our favorite features in JUDI. As A. J. Loiacono ?explained on LinkedIn, "Claim tags are an elegant system for managing specific functions for patients, providers, payers, and claims." The use cases are nearly limitless!
CLICK HERE to read more about how Tags and Overrides work!
Related Content
?? Replay – The Future of Pharmacy Claims Processing: A Deep Dive into a Modern Adjudication System?
Did you see U.S. Rep. Jake Auchincloss (D, MA-04) highlight NADAC prices vs. traditional PBM prices during the House Committee on Oversight and Government Reform Hearing on July 23 - The Role of Pharmacy Benefit Managers in Prescription Drug Markets Part III: Transparency and Accountability? If not, check out his comments HERE.
Read on for the usual roundup of news and insights from the Capital Rx team, including?a collection?of the company’s accomplishments in?Q2, our most recent Astonishing Healthcare episodes, the Lehigh Valley Business Coalition on Healthcare (LVBCH) announcement, and much more.
The Astonishing Healthcare Podcast
If you haven’t yet, visit our Astonishing Healthcare Podcast page or subscribe on Apple or Spotify!
July 2024 Episodes?
Executive Vice President and CEO of the National Alliance of State Pharmacy Associations (NASPA), Krystalyn Weaver , PharmD, JD, discusses pharmacists and expanding their scope of practice. She shares her insights on the role pharmacists can play in the healthcare system and highlights several positive developments recently, including Iowa changing the scope of practice to be a standard of care model and Tennessee passing a law that allows pharmacists to prescribe in a "slew of categories" without requiring additional regulations.
Additionally, Krystalyn shares her thoughts on the importance of making progress at the federal level to allow pharmacists to be reimbursed by Medicare (ECAPS), the AMA's stance against the expansion of pharmacists' responsibilities, how to relieve the pressure on the pharmacy business model, what some pharmacies are doing to diversify their businesses and succeed, and much more.
Alfonso Martinez , Director of Product Management at Capital Rx, discusses the transformative role APIs - application programming interfaces - play in the healthcare industry and the flexibility they offer plan sponsors and benefits administrators to be imaginative. He explains how APIs facilitate seamless integration, automate critical workflows, and empower real-time data access and exchange, significantly enhancing user experiences.
Alfonso reviews several practical use cases and explains how an open platform like JUDI? is revolutionizing pharmacy benefits management without being too "salesy." Additionally, he touches upon the future potential of APIs in achieving value-based care by breaking down data silos and enabling integrated analytics, processing payments, and much more.
Jillian Lonson, PMP? , Sr. Director, Benefits Administration & Operations, and Jean Beman , Manager, Benefits Operations & Administration, join host Justin Venneri for part one of a two-part discussion about what pharmacy benefit management (PBM) entails. They describe the basics and then peel back the layers of what PBMs do to ensure that a prescription processes correctly - per your pharmacy benefit - so you can pay the correct amount at the pharmacy counter or receive your medication in the mail. They highlight how their roles and teams are central to configuring and testing plan benefits so that formularies, the network, and clinical programs are set up correctly. This informative episode sets the table for a deeper dive into the configuration and testing that go on behind the scenes!
Jillian Lonson, PMP?, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration, dive deeper into the weeds and geek out on topics including benefit configuration, enhancements, and testing to be sure everything is set up correctly! They also explain how JUDI? is different and makes several aspects of the process far simpler than they've experienced in the past with legacy software solutions.
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Jillian and Jean also share their perspectives on the common challenges employers, for example, face when configuring and implementing a new PBM. They offer advice to ensure things go smoothly, emphasizing the importance of considering member experience. Last, Jean explains how JUDI's design enables the deployment of enhancements such as a new Medicare Prescription Payment Plan (M3P) solution with relative ease.
Media Highlights & Thought Leadership?
XO Health Inc. selected Capital Rx and JUDI to help revolutionize how pharmacy costs are managed in advanced payment models (APMs), directly addressing and reducing employer healthcare expenses.
The Lehigh Valley Business Coalition on Healthcare (LVBCH) Board announced they chose Capital Rx as a preferred PBM partner! This came after Capital Rx participated in an extensive review process to earn the Coalition’s Preferred Partner status.
Now that it’s almost August, we wanted to take a moment and reflect on all the wins the organization achieved between March and June -- including award wins, an NCQA accreditation, and two popular webinars. We compiled all those accomplishments in our blog, Quarterly Round-Up: Capital Rx in the News - Q2 2024.
In an updated version of Pharmacy Benefits 101: What is a Formulary?, we explained everything you need to know about formularies and touched on other important topics, like specialty drugs and prior authorizations.?
Capital Rx’s clinical team published its Drug Pipeline & Clinical Update – June 2024 and Q2 2024 Medication Pipeline Report highlighting three key new drug approvals, eight notable expanded indications, four biosimilar approvals (alternatives to Eylea? and Soliris?) and one generic launch.
Channel Partners,
My colleagues and I often discuss the complexities of running a fair and accurate request for proposal (RFP) process. The "spreadsheet analysis" is a mystery to most plan sponsors, and generating truly comparable results that show the PBMs being considered on an apples-to-apples basis is, in my opinion, critical. As we wrote in?Pharmacy Benefit Procurement: How to Ensure That Savings Materialize, initially published in the International Foundation's?March/April 2024 Benefits Magazine?(Vol. 61, No. 2), this is easier said than done.??
As you likely know, PBMs almost always have more information than the other parties involved in the RFP – plan sponsors and consultants alike. This asymmetry and the allure of guarantees (discounts and rebates) tend to tilt the playing field out of your – and plan sponsors' – favor.
However, you can:?
Just those few things should help you run a fairer process, which should result in more accurate plan spend forecasts in the coming year. Let me know if you have questions or would like to chat.
Brian || [email protected]
Most Read News at Capital Rx
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