Capital Rx
2024 was an exciting year for Capital Rx, and Q4 was packed with new award wins, informative thought leadership content, webinars, events, and interviews. Check out our most exciting news from the last few months of the year below!
Capital Rx Earned Full URAC Reaccreditation in Pharmacy Benefit Management
Achieving URAC accreditation is not an easy feat, and it serves as a key component in how PBMs are evaluated by the healthcare industry and policymakers. That’s why we’re so proud to have earned full URAC reaccreditation in pharmacy benefit management.
Sara Izadi, PharmD further explained, “The URAC Pharmacy Benefit Management accreditation touches every department across the organization and is a testament to the quality of care we provide to our patients and the support we provide our plan sponsors, levering both JUDI and our robust operational and performance management infrastructure.”
Multiple Award Wins to Close out 2024
2024 was also a big year for awards at Capital Rx. In the final few months, we added four additional awards to our total, both for individual leaders and the company as a whole.
Firstly, Capital Rx placed on the Deloitte Technology Fast 500 for the third year in a row, improving our ranking by more than 30 spots! Making the list once was a huge accomplishment for our team; making it three years in a row shows how consistent our growth has been.
As Capital Rx’s CEO, AJ Loiacono, put it when the award was announced: “Being listed on the Deloitte Fast 500 for the third year in a row is a testament to our team’s relentless drive, our technology’s peerless capabilities, and the market’s accelerating demand for an independent and transparent company, with the experience and capability to service employers and health plans of any size.”
In addition to that, Ryan Kelly (Chief Technology Officer) and Josh Golden were both named to the Class of 2024 BenefitsPRO Luminaries in the Innovation & Technology and Education & Communication categories, respectively.
Ryan also was named to Crain’s NY Notable Healthcare Leaders list, which recognizes local healthcare leaders whose work is vital to the functioning and advancement of the city’s health care system and the city itself.
Capital Rx Team Members Authored Thought Leadership on Important Topics
There was no shortage of important topics to discuss at the close of 2024. Our team authored three content packages that covered a wide range of topics, from GLP-1s to the importance of the network.
What Plan Sponsors Need to Know About GLP-1s
It’s no secret that Glucagon-like peptide-1 – commonly known as GLP-1s – have been top-of-mind for plan sponsors throughout 2024. In October, Caitlin Munro, PharmD (Senior Manager, Clinical Programs), and Zach Brunko, PharmD (PGY-1 Managed Care Resident) authored three blogs that broke down what plan sponsors need to know about GLP-1s right now, based on questions we received from channel partners.
- Part 1 covers how major pharmaceutical incumbents and reimbursement authorities believe payment and reimbursement for obesity drugs is likely to evolve in the United States.
- Part 2 discusses how and to what extent payers will materially differentiate between patient segments. We also explain what share of the market is expected to be reimbursed versus cash.
- Part 3 explores to what extent increased competition in the market will create downward pressure in pricing and over what time period this is most likely to occur. We also explore what room there is for business model innovation and what innovative pricing/value models are in the market.
Breaking Down the Pharmacy Network and Its Importance
The “network” is something that most people are familiar with, especially in connection with your doctor and your prescription. Yet, at the same time, understanding how the network works and why it is important is more complex.
That’s why Kasi Ortiz (Vice President, Provider Relations) broke down the importance of the network, how it works, and why Capital Rx’s national NADAC-based commercial network is so unique within pharmacy benefits.
We also covered this topic during an episode of our Astonishing Healthcare episode that is well worth a listen!
What is the Difference Between NADAC and AWP?
We talk a lot about the National Average Drug Acquisition Cost (NADAC) price index at Capital Rx – both because it represents a more transparent view into drug prices and because the Capital Rx has a national NADAC-based commercial network. But what is the difference between NADAC and Average Wholesale Price (AWP), the pricing index used by many traditional PBMs?
We wrote an article breaking down the downsides AWP brings (including how it opens the door to gameplay, including spread pricing) and the upside of leveraging a publicly available and consistently deflationary index like NADAC.
Capital Rx Held Two Webinars Discussing GLP-1s and Healthcare Costs
Cost is consistently top-of-mind for plan sponsors. Those costs were exacerbated in 2025 by the rise of GLP-1s. How can plan sponsors uncover and manage their costs holistically while also solving the GLP-1 puzzle? Capital Rx held two webinars discussing these topics in-depth.
On October 3rd, Sara Izadi, PharmD (Chief Clinical Officer) joined Vida Health’s Chief Medical Officer, Richard Frank, MD, and Senior Partnership Manager Dom Belmonte to discuss GLP-1 management, key considerations HR leaders should consider, and how to balance both patient care and cost.
Then, a week later, Dr. Sunil Budhrani, MD, MPH, MBA (Chief Medical and Innovation Officer) and Josh Golden (SVP, Strategy) joined Workplace Intelligence's Dan Schawbel to discuss rising healthcare costs, its impact on plan sponsors and their members, and strategies that can be implemented to manage those costs.
You can watch the replay of both webinars on our Insights page!
Interviews with Our Leadership Team
At the end of the year, our leadership team sat for multiple interviews to discuss prevalent issues Capital Rx focuses on every day: drug costs, PBM reform, NADAC, and innovation.
AJ Joined a Panel at HLTH To Discuss Innovation and Resilience
During HLTH 2024 in October, AJ joined a panel alongside Dr. Robert Pearl, MD (Professor at Stanford University Medical and Business School), Randi Seigel (Partner, Manatt, Phelps & Phillips, LLP), Elizabeth Jurinka (Operating Director, Healthcare Policy, VISTRIA PRG), and moderator Seth Joseph (Managing Director and Forbes Contributor, Summit Health Advisors)
They discussed the competitive dynamics within healthcare, how to drive innovation within a consolidated industry like pharmacy benefits, and what innovation opportunities exist to disrupt the status quo.
Lloyd Fiorini Discussed PBM Reform with Modern Healthcare
Michael Mcauliff wrote an article diving into the possibility of certain healthcare reforms – which have been extensively discussed and debated over the last two years – happening during the lame duck period.
Lloyd Fiorini (Chief Compliance Officer and General Counsel) was asked his opinion on whether action was possible given Republicans controlled the house and Democrats the Senate during this period. He said, “I see a possibility, a good possibility if not a probability, that something happens this year, just because there is bipartisan support to do PBM reform.”
While PBM reform provisions were included in the initial draft, it was unfortunately stripped out during negotiations and did not make it into the funding bill that was eventually passed in December. At the same time, president-elect Trump has expressed interested in passing some form of PBM reform, so there is still the possibility of bipartisan reform being passed.
DrugTopics Interviewed AJ about NADAC
AJ has joined the Astonishing Healthcare podcast a few times to discuss NADAC and its importance, and so it only seemed natural when he participated in an interview with Drug Topics to dive even deeper into the subject.
In addition to mentioning how NADAC provides an accurate and transparent view into drug prices, he explains how it sets the stage for the entire pharmaceutical supply chain – on what AJ calls the “distribution” and the “payer” sides.
Antonio Discussed His Morning Routine with CFO Magazine
Antonio Garcia Cueto (Chief Financial Officer) joined CFO magazine for a fun interview discussing his morning routine. During that interview, he broke down how he structures the first few hours of his day, what his favorite leadership quote is, his love for ESPN, and the running medals he’s earned.
HIStalk Interviewed AJ About Capital Rx, Drug Pricing, and Transparent PBMs
AJ also joined HIStalk for a wide-ranging interview that covered everything from Capital Rx’s inception to how to solve the existing vertical integration problem (where PBMs own specialty and mail order pharmacies, creating a conflict of interest).
During this talk, AJ also explained why technology – like JUDI – will be key to solving issues like drug transparency and cost.
Are You Ready for 2025?
With the new year comes new decisions, new considerations, and potential legislative updates. When you have questions, feel free to check out our blog and listen to our podcast for the latest industry news and insights. Plus, our team is always here if you’d like to discuss anything.
And keep an eye out – Bridget Mulvenna (VP of Business Development) will be authoring a blog that explains strategies plan sponsors can leverage to improve their PBM procurement process in 2025.