In this episode of Astonishing Healthcare, Judi Health's Sam Custer, who leads the member communications team, shares tips and insights on how to communicate effectively with plan members - around open enrollment and throughout the year. Sam last joined us for Episode 39, which highlighted how the communications and product teams collaborated to ensure we provide clear, compliant communication materials to Medicare members to meet CMS requirements, and this time, we dive into how to educate plan members at open enrollment and throughout the year. After all, as Marsha Perry, our head of benefits and compensation, explained during Episode 72 - The Benefits You Probably Didn't Know You Have, benefits-related education is more than just a once-a-year thing (during open enrollment).

Sam describes how we approach understanding each client's unique needs and the importance of consistent messaging across all channels. We dive into ways to keep members informed throughout the year, the benefits of in-person/on-site events, and much more. If you're a "benefits nerd" like us (and Marsha 😀), this episode is for you.

The Articles that Prompted the Episode

• Employers prepare for disruptive and transformative health plan changes, WTW survey finds
• Benefit managers share their 7 open enrollment best practices

Related Content

• AH050 - PBM Pain Points and Overcoming the Fear of Change, with Hope Nakazato, PharmD
• 12 New Judi® Features Innovating Pharmacy Benefit Administration
• AH082 - Pharmacy Benefit Implementations: Have No Fear, Alignment & Process are Here

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

On Episode 91 of Astonishing Healthcare, we dove into the Workplace Intelligence Forecast for 2026 - The 10 Trends Businesses Need to Focus On! Here at Judi Health, we obviously live in the health benefits world and generally focus on content revolving around the pharmaceutical supply chain (i.e., PBM), health tech, and the administration of employee benefits, more broadly... but there is A LOT more going on our there that impacts America's workforce. Our guest, Dan Schawbel, Managing Partner of Workplace Intelligence (links below), has been tracking and publishing research on workplace trends for well over 15 years, and he unpacks the forces shaping the future of work, today. Aside from rising healthcare costs, how are employers - and their benefits leaders - thinking about remote work vs. returning to the office (and the impact on working mothers), the use of AI and a widening skills gaps, and the shift from white-collar to blue-collar jobs?

Dan paints a picture of a market where employer leverage has returned amidst hiring freezes and layoffs. This newer dynamic intensifies the pressure on benefits teams, who are on the front lines, grappling with the complexities of GLP-1 drug coverage, and the critical need for mental health support, for example. Other highlights of the discussion include:

• AI is widening the skills gap, and many companies are failing to provide adequate training, leaving employees feeling unprepared; this is fundamentally reshaping learning and development needs for 2026.
• The era of the "Great Resignation" is over - employers now have leverage, driving return-to-office mandates and changing the power dynamic.
• Amidst rising costs, a comprehensive and affordable healthcare plan has become a powerful tool for employers - sometimes valued even more than a salary increase.
• Unsustainable healthcare cost increases are reaching a boiling point. Dan predicts 2026 will be the year the system either breaks or fundamentally changes, driven by extreme cost pressures on both employers and employees.
• The gap between what the C-suite thinks about AI and what the workforce says is extraordinarily wide: "We found that 96% of the C-suite expect AI to boost worker productivity... But when we asked employees, 77% of them say that AI has increased their workload. So it's done the exact opposite."

Additional Resources/Links

• Connect with Dan Schawbel on LinkedIn
• Workplace Intelligence Weekly (Free Newsletter - LinkedIn)
• Join Dan Schawbel and Claude Silver, Chief Heart Officer at VaynerX and author of Be Yourself At Work, for an exclusive webinar to look at the Workplace Trends 2026 Forecast: Click Here to Register

Related Content

• AH072 - The Benefits You Probably Didn't Know You Have, with Marsha Perry
• Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive Impact
• AH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia Pettis
• Health Benefits 101: The Importance of a Transparent PBM Model

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

For Episode 90 of Astonishing Healthcare, Jim Winkler, Chief Strategy Officer at Business Group on Health, joins us in the studio for a lively discussion about the results of their 2026 Employer Health Care Strategy Survey! This annual study is packed with qualitative and quantitative information and highlights the top trends in employer-sponsored health care. Jim brings decades of experience to the table and puts helpful context around the headline data and employers' expectation for a ~9% year-over-year health care cost increase. He also shares his perspective on the evolution of the role benefits brokers and consultants play, how employers can navigate the rapidly evolving market and inflationary storm, vendor accountability, and how to position difficult decisions around making big changes.

Discussion Highlights

• Costs are expected to rise 9% in 2026, marking the worst multi-year surge in over a decade; it’s another year of healthcare costs rising by more than benefits teams forecasted.
• Pharmacy's share of the total cost has jumped to 24%, driven by expensive GLP-1 and cancer drugs, and some other new cost drivers include mental health and autoimmune conditions.
• Proactive employers have been reviewing their data and are optimizing their programs, cutting underused solutions, investing where there’s a tangible return, and tightening controls on high-cost treatments.
• Employers are aggressively scrutinizing partners and exploring alternative PBM and health plan models, as they should be (vendor accountability has become increasingly important over the years) - change is imminent (i.e., expect an acceleration of RFP activity).

Additional Resources

• 2025 Employer Well-being Strategy Survey: Executive Summary
• Business Group on Health - Resources (Surveys, Data, etc.)

Related Content

• How employers can take back control of unnecessary pharmacy spending
• Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive Impact
• Signs it is time to change your PBM vendor, and how to overcome common hesitations
• Health Benefits 101: The Importance of a Transparent PBM Model

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

On Episode 89 of Astonishing Healthcare, we are talking about some "visual treats," as the title suggests! Our guest, Andrew Tsang, has been posting some very cool things on LinkedIn of late, including Sankey and other dynamic charts highlighting where the money flows in healthcare (from the premium dollars to the care plan members receive), and which stakeholders win or lose in different scenarios via a 5-Way Seesaw he developed using AI! If you're a [healthcare] data nerd, this episode is definitely for you, and you'll want to check out:

• How many layers are between your employer's healthcare dollars and care? on LinkedIn (you can see where every $100 an employer spends goes!)
• What would happen if power actually shifted in healthcare? on LinkedIn (5-Way Seesaw)

Andrew discussed how and why:

• A significant portion of the healthcare premium is consumed by administrative layers and middlemen before ever funding patient care.
• Employers can combat wasteful spending by demanding full access to their claims data, then identifying and eliminating things that extract value from their plans (or don't work for their populations).
• Integrated care models (like Kaiser Permanente) and direct primary care help eliminate friction by aligning provider and payer incentives, allowing doctors to focus on practicing medicine (vs. revenue cycle management).
• New technologies like AI-powered prior authorizations may reduce administrative costs for payers but risk creating new burdens for providers and patients, if we're not careful.
• Hospitals face a fundamental conflict: core, life-saving services like ICU and emergency care are often unprofitable and must be cross-subsidized by higher-margin procedures.

Related Content

• How to obtain Rx data and what to do with it
• AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan
• Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform
• Pharmacy Benefits 101: Prior Authorizations
• AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

On Episode 88 of Astonishing Healthcare, we're celebrating Women Pharmacist Day (#WPD2025) and sharing stories from four of our amazing team members: Allison Gallant, PharmD (Sr. Strategic Account Executive), Cindy Strassner, RPh (Customer Success Pharmacist), Lorece Shaw, PharmD (Sr. Director of Prior Authorization and Clinical Care), and Hope Nakazato, PharmD (VP of National Business Development). These women aren't just talking about improving healthcare or celebrating one day - they're actively promoting and implementing change, mentoring the next generation of pharmacists, and building systems to improve clinical workflows and member care.

Lorece, Allison, Hope, and Cindy highlight their career journeys, insights on leadership, and the importance of mentorship to their personal and professional development throughout the discussion. They offer unfiltered advice on career growth, overcoming obstacles, staying resilient and expressing confidence in yourself, and how to work together to fix what's broken in pharmacy and health benefits. Whether you're interested in "non-traditional" career paths for pharmacists, curious about how pharmacists work in managed care, or just need some motivation to go for the next big opportunity and a reminder that you've got to be prepared and show up with confidence, per Allison and Lorece, respectively, this episode is for you!

Related Content

• Signs it is time to change your PBM vendor, and how to overcome common hesitations (by Hope Nakazato, PharmD, MBA)
• AH018 - What's the Right Path? Post-grad Options for Pharmacists
• Pharmacy Benefits 101: Prior Authorizations
• Health Benefits 101: The Importance of Clinical Programs
• AH040 - Celebrating Women Pharmacist Day 2024

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

In this episode of Astonishing Healthcare, return guest Libbi Green, PharmD (Manager, Formulary Operations) joins Justin Venneri for a discussion about the 2025 flu season, including the latest vaccine-related updates that employer plan sponsors and plan members need to know. We discuss the effectiveness of last year's flu vaccines, factors influencing the rates, vaccination timing, and how there can be differences in state vs. federal guidelines, among other topics!

Highlights

• Larger employers may need to tailor flu programs across different states due to varying regulations.
• Federal agencies - ACIP and the CDC - are recommending the annual flu vaccine but are emphasizing single dose formulations that are free of preservatives.
• For people who regularly get or would like to get the flu vaccine, the timing is good now, before the end of October. For other vaccines - COVID, etc. - it's important to discuss timing and need with providers to reach a "shared decision."
• For plan sponsors, working with a PBM partner "to ensure patients have the access that they need and that you're meeting all regulatory compliance" is crucial.
• Judi®'s flexibility helps allow plan sponsors to react quickly and ensure vaccine-related claims are appropriately processed for their populations.

Related Content

• What employers need to know about federal vaccine policy changes (Mercer)
• AH072 - The Benefits You Probably Didn't Know You Have, with Marsha Perry
• AH071 - A Look at What's Really Driving Drug Spend, and How it Impacts Us, with IQVIA's Michael Kleinrock
• 12 New Judi® Features Innovating Pharmacy Benefit Administration

Reference Materials

• Interim Estimates of 2024–2025 Seasonal Influenza Vaccine Effectiveness — Four Vaccine Effectiveness Networks, United States, October 2024–February 2025
• RSV monoclonal antibody nirsevimab 83% effective in babies, data reveal
• BEYFORTUS® reduced hospital and doctor visits for RSV disease in babies by 87%, according to largest US real-world study

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.

Episode 86 of the Astonishing Healthcare podcast focuses on several pharmacy and health plan member service-related topics with Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations)! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up. Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors can ask during the RFP process (Episode 84), we discuss:

• Several of the most frequent reasons plan members call and how those questions are handled, including switching a prescription from retail to mail and vice versa, prior authorizations for GLP-1s, and more.
• How to navigate transitions and focus on quality care (over speed).
• What it takes to maintain a high level of customer satisfaction (99%) while handling a 50% spike in call volume year-over-year.
• The communication strategy used to educate members and help them navigate new offerings effectively.
• The role of AI and how agentic AI can support member care and free up our skilled, PTCB-certified reps to handle more complex issues.
• Future-proofing the service model and preparing for the 2026 welcome season.

Related Content

• Pharmacy Benefits 101: Building an Award-Winning Call Center from Scratch
• Watch: Are Your Prior Authorizations Actually Working?
• AH017 - Pharmacy Benefits 101: Prior Authorization
• How employers can take back control of unnecessary pharmacy spending
• Capital Rx’s Customer Care Team Wins 5 Stevie® Awards for Customer Service

For more information about Capital Rx and this episode, please visit Judi Health - Insights.

This episode of the Astonishing Healthcare podcast features a unique client of ours - Andy Glade, Senior Director of Trade Operations at Valeris. We discussed how to remove financial barriers to care and streamline access to the medications people need through the use of copay cards, vouchers, and patient assistance programs (PAPs). In a rapidly evolving market, these programs play an important role in reducing prescription abandonment and increasing adherence in convenient ways, particularly for chronic conditions and when extremely expensive specialty medications are prescribed.

Additional highlights from the conversation with Andy include:

• How modern technology - Judi® - helps make life easier by giving the Valeris team control and the flexibility to quickly design programs, test new features, and monitor their programs through detailed reporting.
• How copay cards help with brand-name prescription drugs, especially those with higher price tags or drugs that are on the higher tiers of insurance (where out-of-pocket costs can be significant): "They're super common in competitive drug categories like diabetes, or asthma, or psoriasis, where multiple branded drugs are fighting for market share."
• What the patient pays: these programs differ in terms of cost for patients, but all are designed to improve access. Some programs have a maximum dollar amount or a limit on the number of fills you can get; others are more flexible and don't have a cap at all.
• An astonishing - but all too common - example of a patient who was able to overcome embarrassment and access an expensive branded injectable at no cost.

Related Content

• 12 New Judi® Features Innovating Pharmacy Benefit Administration
• Replay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better Outcomes
• AH081 - Promoting Competition & Innovation: The Push for PBM Reform, with Rep. Jake Auchincloss
• Health Benefits 101: The Importance of a Transparent PBM Model
• Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive Impact

For more information about Capital Rx and this episode, please visit Judi Health - Insights.

In this episode of the Astonishing Healthcare podcast, host Justin Venneri is joined by Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, for a timely discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, but, as Josh describes, there are some "tectonic shifts" happening as plan sponsors demand to see more options (i.e., transparent PBMs) and benefits brokers and consultants upgrade the questions and scoring used to force accountability and drive meaningful results for plans and plan members.

Highlights

• Unit-cost-based spreadsheet comparisons and marketing fluff are "out;" evaluating drug mix and how the PBM manages the plan (the 'M' in PBM) or makes money off of the plan are "in."
• Plan sponsors and benefits consultants must demand flexibility - the PBM contract should not be a "house of cards." For example, agreements should provide the freedom to add new vendors or carve out services without collapsing your financial arrangement.
• Legacy tech platforms are a barrier to innovation; ask potential partners if their technology can handle customizations and integrations with agility to avoid being told, "We just can't do that."
• Precise questions about member experience are a must; RFPs should move beyond open-ended questions that invite marketing fluff. Use specific, binary questions to obtain an accurate measure of the member experience and the effectiveness of clinical programs (e.g., NPS, turnaround times for prior authorizations, etc.).

Related Content

• Replay: PBM Procurement Decoded: Insights from a Pharmacist and an Actuary 
• Why Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook 
• AH034 - Customer Care in Healthcare: Setting a Higher Bar, with Will Tafoya
• AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD
• 5 ways to improve PBM procurement (EBN) 

For more information about Capital Rx and this episode, please visit Judi Health - Insights.

Episode 83 of the Astonishing Healthcare podcast features returning guest, Bridget Mulvenna (VP, National Business Development at Capital Rx)! We discuss specialty drugs, pharmaceutical manufacturer rebates, and the shift to biosimilars. Yes, GLP-1s come up as well (how could they not?), and Bridget explains how employer plan sponsors can consider opportunities to provide access to these medications while not ignoring their inflationary potential and the economic impact on the plan - i.e., how to pivot from a rebate-driven models to a net-cost approach, facilitating more accurate cost management and budgeting.

Highlights

• Traditional PBMs remain focused on rebate value, which doesn’t always mean the lowest net cost for the plan sponsor.
• Biosimilar adoption and precision formularies/benefits are a threat to old models.
• Plan sponsors must get [and use] their data - without detailed information, it's impossible to determine the true net cost or implement effective communication and education strategies.
• GLP-1s should be supported by wellness programs, and respecting FDA labeling is crucial.
• Surprisingly, many plan sponsors still choose the PBM that offers the highest rebates.

Related Content

• Will Biosimilar Rebates Pass-Through?
• Health Benefits 101: The Importance of a Transparent PBM Model
• How to Manage Pharmacy Benefit Spend in a GLP-1 World
• Pharmacy Benefits 101: What is a Formulary?
• Pharmacy Benefits 101: Pharmaceutical Rebates

For more on the importance of access to plan data:

🎧 AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan

🎧 AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker

For more information about Capital Rx and this episode, please visit Capital Rx Insights.