Capital Rx
At Capital Rx, our commitment to innovation and excellence never wanes, as demonstrated by our recent accomplishments. Over the last quarter, our team has not only celebrated numerous award wins but also achieved a new security accreditation, launched our Never Move Again™ solution, and secured a U.S. Utility Patent!
Dive into our Q3 highlights to discover how we're continuing to set a new standard for the future of pharmacy benefit administration.
Capital Rx Launched Never Move Again™
If large plan sponsors (10,000+ lives) were given the best administrative services and the flexibility to use any fulfillment or clinical service, all within an ERISA-compliant framework, why would they ever move PBMs again? They wouldn’t. After all, implementing a new PBM is a disruptive and extensive process, and members are the ones who feel that disruption most acutely. They have to change member cards, figure out which portal or website to access, and navigate a new customer care department – and that’s just scratching the surface.
That’s why Capital Rx unveiled Never Move Again™, which unbundles pharmacy benefits, leverages an ERISA-compliant framework, provides large plan sponsors’ members with an industry-leading, multilingual, 24/7 call center that will never change, and enables the usage of any fulfillment or clinical service. Perhaps most important of all, plan sponsors can have peace of mind knowing they’re working with an unbiased administrator that has no conflicts of interest.
Capital Rx Co-Founder and CEO AJ Loiacono and Josh Golden (SVP, Strategy) then hosted a webinar where they dove into the solution’s finer details, along with an explanation of how the pharmacy benefits industry arrived at its current state, with commodity services like mail and specialty pharmacy tied to claims processing. AJ also explained how JUDI®’s modern, interoperable design makes it uniquely suited to underpin and power this solution.
Managed Healthcare Executive Interviewed AJ About Never Move Again™
Shortly after we announced Never Move Again™, Denise Myshko from Managed Healthcare Executive interviewed AJ about the solution – how it works, what its benefits are, and what it means for the future of pharmacy benefit administration.
To explain the “why”, AJ said, “Large employers are essentially mini health plans. They have similar responsibilities and liabilities under ERISA (Employee Retirement Income Security Act), yet they face significant challenges when it comes to managing their health benefits efficiently. With our platform, we’re giving them the flexibility to manage their benefits as health plans do, without the need for constant changes and administrative burdens.”
They also dove into the implications of recent ERISA lawsuits for breach of fiduciary duty and class-action lawsuits that have rocked the pharmacy benefits landscape and how Capital Rx, leveraging JUDI, is uniquely suited to deliver what large plan sponsors need right now – an unbiased administrator with no conflicts of interest that enable them to meet their fiduciary responsibilities.
Most Downloaded Astonishing Healthcare Episodes in Q3
- AH031 - Dissecting Pharmacy Cost Drivers and the Value of PMPM, with Kristin Begley, PharmD, and Mike Miele, FSA, MAAA
- AH032 - Prescription Rebates: Agreements, Guarantees, and More, with NPC's John O'Brien, PharmD, MPH, and Julie Patterson, PharmD, PhD
- AH033 - Never Move Again™, a Paradigm Shift in Pharmacy Benefits, with AJ Loiacono
- AH036 - The Rise of GLP-1s & Partnering to Manage Chronic Diseases, with Vida Health
JUDI Earned HITRUST i1 Certification
It’s no secret that cybersecurity within healthcare has been top of mind, especially with the string of recent ransomware attacks. At Capital Rx, we’ve always prioritized security, especially for our enterprise health platform, JUDI®. At the end of September, we announced that JUDI® earned certified status by HITRUST for information security.
This is a huge accomplishment for our team and further shows how Capital Rx continues to manage data protection and cybersecurity threats in line with industry-leading security practices.
Vice President of IT Security and Compliance, Shane Garoutte, said this about our latest security certification: “The healthcare industry has seen a significant rise in security threats over the past 18 months. Achieving HITRUST i1 Certification is a key milestone in our ongoing mission to deliver secure, reliable, and innovative healthcare solutions. I am incredibly proud of our team and their unwavering dedication to protecting our members' data.”
We Explained Why Capital Rx is a “One-of-One” Organization
Capital Rx is not new to the pharmacy benefits industry. When we came onto the scene in 2018, we had a specific mission: to change the way prescription drugs are priced and patients are cared for. And we solved that problem – but in solving it, we discovered another problem: the platforms that process all pharmacy claims in the country are antiquated and unable to meet modern needs.
Now, in 2024, Capital Rx stands alone as the pharmacy benefit administrator with a future platform – JUDI – designed to deliver the modern capabilities they need. As a result, we are able to unbundle pharmacy benefits for large plan sponsors, implement solutions for complex programs, like the Medicare Prescription Payment Plan (M3P), and pursue unified claims processing, where medical, pharmacy, dental, and vision claims are processed and housed on one platform.
This is what makes Capital Rx a “one of one” organization. No other PBM is prepared to simultaneously tackle existing challenges within pharmacy benefits and innovate for the future. We wrote an article that details all the above and dives even deeper into all the business facets – from our award-winning customer care team to JUDI’s capabilities, to our new and innovative solutions like Never Move Again™ – that are setting a new standard for the future of pharmacy benefit administration.
Capital Rx Ranked No. 411 on the 2024 Inc. 5000
Ranking on the Inc 5000 isn’t just an exciting accomplishment for our team – it's indicative of our growth and how consistent it’s been. That’s why we were excited to make the Inc 5000 National list for the third year in a row, this time ranking #411 with 1,085% three-year revenue growth. This also marks an increase in ranking from 2023, when we ranked #648.
When we announced the win, AJ shared on LinkedIn, “After almost seven years, Capital Rx remains in the top 10% of the fastest growing companies in the US. I say it all the time, you can't build great companies without great people. I am thankful for all of our incredible colleagues, investors, and partners. However, our MVP (MVAI?) will always be JUDI.”
Capital Rx Earned a US Utility Patent for JUDI’s Tags and Overrides Feature
If you’ve read our content or attended one of our webinars, then you likely have heard us mention JUDI’s “Tags and Overrides” feature. In short, this feature enables users to configure custom rule sets without programming to dictate any desired outcome, thereby eliminating many technological difficulties users often encounter in legacy claims processing systems.
While we’ve been using this feature within JUDI for a while now, we got some exciting news in July: JUDI earned a U.S. Utility Patent for this feature.
This is a huge development for our organization and provides further proof that JUDI is redefining the future of pharmacy benefit administration through future proof, API-driven architecture and efficient workflows that aid plan sponsors.
The Lehigh Valley Business Coalition on Healthcare (LVBCH) Board Endorsed Capital Rx as a Preferred Partner
Transparency is at the core of what we do and it is a central tenet to our pharmacy benefit management (PBM) and pharmacy benefit administration (PBA) solutions. To that end, Capital Rx participated in an extensive review process to earn Lehigh Valley Business Coalition on Healthcare (LVBCH)’s Preferred Partner status – and we did so successfully. The LVBCH Board of Directors endorsed Capital Rx as a Preferred Partner.
“Capital Rx shares the Coalition’s goals for improving quality, patient safety, transparency, and efficient care delivery,” Carl Seitz, President, LVBCH said. “We are extremely pleased to join Capital Rx in bringing value to local employers through exclusive pricing and service options that we expect to yield significant savings for Coalition members.”
CFO Interviewed Antonio Garcia Cueto About His Morning Routine
As we mentioned in our last quarterly round up, Antonio joined Capital Rx back in June as Capital Rx’s new Chief Financial Officer. And back in September, CFO Magazine interviewed Antonio about his morning routine.
There are a ton of fun and interesting insights in this article, including Antonio’s favorite number (12), his favorite leadership mantra and lesson, and how he structures his morning routine.
Sam Custer and Jake Mulkey Broke Down Medicare Part D Transition Benefits and JUDI’s Interoperable Capabilities
If you’ve never heard of “transition benefits” before then you’re not alone. That’s why we worked with Sam Custer (Director, Customer Experience) and Jake Mulkey (Manager, Product) on a blog that breaks down what transition benefits are, what responsibilities plan sponsors have, and how JUDI has enabled better efficiency and reliable compliance through its modern, interoperable, design.
As Sam explained further are a temporary provision for Medicare Part D beneficiaries that helps enrollees or members maintain continued access to their medications when they’re not covered by a Part D prescription drug plan or their Medicare Advantage plan.
Sam further explained during an episode of the Astonishing Healthcare podcast, “Transition benefits will provide [Medicare Part D beneficiaries] a temporary supply of their medication to give them additional time to talk to their doctor about alternatives or what next steps they may have to take.
XO Health Selected Capital Rx as its Exclusive Pharmacy Benefits Administrator
In July, we announced a new strategic partnership with XO Health, a pioneer in innovative health plan solutions, to be their exclusive pharmacy benefit administrator. Through this partnership, XO Health will be able to seamlessly integrate our advanced solutions and leverage advanced analytics and real-time data. This will help lead to more effective and predictable total cost management, enabling the reallocation of resources toward improving client service, care, and outcomes for employers’ employees and their families.
Our Chief Innovation and Medical Officer, Dr. Sunil Budhrani, MD, MPH, MBA, said, “The future of healthcare lies in transparency, real-time data, and the ability to connect the ‘Four Ps:’ Payers, Providers, Patients, and Pharmacy. XO Health selecting us as their exclusive PBA marks another step forward as we show how JUDI powers the workflows necessary to achieve this vision. Together, we will redefine pharmacy benefits administration, making it more efficient, cost-effective, and transparent.”
We're Pulling Back the Curtain on Prior Authorizations
The Prior Authorization (PA) process is one that many view with skepticism. But PAs play an important role within healthcare, and we wanted to clarify what happens during this process and why it’s in place. To answer those questions (and others) we talked with Sara Izadi, PharmD (Chief Clinical Officer), Lorece Shaw, PharmD (Director of Prior Authorization), and Callie Burton-Callegari (Manager, Product) and explored how Capital Rx are working to make the PA process as efficient and painless as possible, leveraging everything from JUDI’s built-in Prior Authorization Tool (PAT) to leveraging AI tools during the fax intake process.
If you want to dive even deeper and learn more about the PA process, you can also check out our Astonishing Healthcare podcast episode with Sara, Lorece, and Callie.
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