Capital Rx's JUDI® Redefines the Role Tech Plays in the Administration of Medicare, Medicaid, and Commercial Pharmacy Programs

NEW YORK, Oct. 6, 2023 /PRNewswire/ -- Capital Rx, the full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) advancing our nation's healthcare infrastructure to improve drug price visibility and patient outcomes, is proud to announce recent enhancements to JUDI®, Capital Rx's proprietary, cloud-native enterprise health platform (EHP). JUDI unifies all backend PBM operations and workflows for managing Medicare, Medicaid, and commercial plans and prescription claims processing within one platform to address the fundamental administration-related inefficiencies contributing to higher costs for members and plan sponsors and improve the member experience.

With every core PBM function in JUDI® and the ability to rapidly deploy enhancements, clients save time and money.

"We built JUDI to be the new standard for healthcare administration and provide unprecedented workflow efficiency to deliver the highest level of service at the lowest price point," said AJ Loiacono, Co-Founder and CEO of Capital Rx. "A modern, scalable platform like JUDI gives a health plan a true competitive advantage on operating expense, while enabling the flexibility and interoperability required in a modern healthcare ecosystem."

Launched in 2021 to improve costs and service levels in the commercial space, JUDI began processing Medicare claims on January 1, 2023. Ryan Kelly, Capital Rx Co-Founder and CTO, said, "Our product and development teams have worked tirelessly to bring new features and functionality to the market so that our account management and operations teams can easily configure and customize plans and benefits." JUDI's flexibility and user-friendly interface allow for same-day turnaround times for most client configuration requests. Ryan added, "No other platform is this intuitively designed or capable of meeting clients' current and future needs, including the potential to integrate medical pharmacy or other patient health data via JUDI's open APIs."

Enhancing Health Plan Executives' and Plan Sponsors' Ability to Control the Pharmacy Program

JUDI is modular, so a health plan, for example, can pick and choose which services Capital Rx's teams will support and what it wants to manage internally. Regardless of whether a client chooses a full-service solution or manages pieces of their program, having every core PBM function in JUDI and the ability to release enhancements, such as a new Prior Authorization Tool (PAT) and "Bulk Actions," helps plans save time, reduce the potential for errors, and boost operating efficiency.

Prior Authorization (PA) Remains an Industry Pain Point

There is plenty of survey data and feedback from healthcare professionals highlighting the frustration with PA as a utilization management tool. Providers of healthcare services generally find PA to be a cumbersome, resource-intensive hurdle that can delay patient care or contribute to adverse outcomes. One recent study - Influence of Prior Authorization Requirements on Provider Clinical Decision-Making - found that prescribers find PA to be "burdensome, both personally and administratively," and they will "alter clinical decisions to avoid PA requirements and related burdens."

Capital Rx's PAT is built into JUDI, so clients do not have to jump between systems to manage processes. Within JUDI, PA is configurable at the line-of-business, client, or group levels. Further, standard features in PAT include automatic formulary integration, a built-in test claim feature leveraging real-time adjudication, the ability to create authorizations directly from a PA case review, and streamlined workflows that save countless hours.

Bulk Actions

The Bulk Action feature was added to JUDI to allow users to configure coverage strategies (plan benefits) from scratch or change the attributes of existing coverage strategies at the highest level (e.g., avoiding PA on a group of physicians or allowing COVID testing coverage across a book of business in minutes), while JUDI is capable of administering benefits at the individual level. This feature saves immense time for plans with hundreds of coverage strategies to create or update. The task can be completed in seconds in JUDI, and plan benefit elections set up for one Coverage Strategy ID (CSID) can even be copied to another.

Additionally, clients with multiple CSIDs may be "batch loaded" directly into JUDI. This is another time-saving workflow enhancement that reduces the potential for errors and alleviates stress for health plan executives.

To learn more about Capital Rx's pharmacy benefit administration capabilities and JUDI, please visit Capital Rx – JUDI®.

About Capital Rx
Capital Rx is a healthcare technology company changing the way prescription drugs are priced and patients are cared for in America. As a Certified B Corp™, Capital Rx is executing its mission through an efficient Single-Ledger Model™ that increases visibility and reduces variability in drug prices. The company's cloud-native enterprise health platform, JUDI®, connects every aspect of the pharmacy ecosystem, servicing over 2.4 million members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare. To learn more, visit capitalrx.com. 

Media Contacts
Michael Passanante, Senior Vice President, Marketing & Communications
Justin Venneri, Director, Communications
marketing@cap-rx.com

‍