The Astonishing Healthcare Podcast

This episode of the Astonishing Healthcare podcast features Michael Kleinrock, Director, Research Development at the IQVIA Institute for Human Data Science. We explore key highlights from their most recent annual report - Understanding the Use of Medicines in the U.S. 2025 - with an eye toward implications for plan sponsors and the health benefits market. What are the key drivers of higher drug spend beyond GLP-1s? At what cost do consumers abandon prescriptions at the counter? How is biosimilar adoption going, and what impact is it having on trend? We answer these questions and many more, including how the IRA could impact innovation, vaccination rates, and what was most surprising to Michael in the data: hint, it's how much prices really changed year-over-year!

Additional Reference Materials (IQVIA Institute Reports & Publications)

• Assessing the Biosimilar Void in the U.S.
• Proliferation of Innovation Over Time

Related Content

• AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker
• AH055 - Pharmacy Benefits 101: Stop-Loss Insurance, with Mike Miele, FSA, MAAA
• Replay - Innovative partnerships for GLP-1 management, with Vida Health
• How to Manage Pharmacy Benefit Spend in a GLP-1 World

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

This "Best of '25!" episode of the Astonishing Healthcare podcast highlights Episode 58, which featured Liya Lomsadze (Director, Product Management) at Capital Rx. Liya highlights her journey from data analytics on the provider side to leading the product development of Capital Rx's Unified Claims Processing™ product, Judi Health™. We'll be back with a fresh new episode next week, but given the acquisition of Amino Health and launch of Judi Care, a unified "front end" pharmacy and medical care navigation solution, we think having an understanding of what the back end - or "chassis" - is capable of helps paint a picture of what the future of health benefits management can look like!

Liya and host Justi Venneri dive into several recent updates to the Judi® platform, highlighting Judi's overall agility and how it aids in the administration of benefit plans for Capital Rx's clients. During the discussion, they also explore:

• Improvements to the Prior Authorization (PA) Tool, including a new supervisor dashboard for PA requests.
• Judi's ability to ingest historical claims data for seamless onboarding of new clients.
• The potential expansion of Unified Claims Processing to include other insurance (e.g., vision and dental).
• Capital Rx's new Medicare Prescription Payment Plan (M3P) and Judi's ability to meet evolving CMS requirements.
• Judi's Formulary Management Tool, which aims to improve how claims are adjudicated by making formulary data both accessible and functional.
• How Judi Health aims to streamline member care and improve the patient experience.

Last, Liya praises one of Judi's most loved features - can you guess what it is? Hint: if, then.

Related Content

• Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform
• Capital Rx Receives a US Utility Patent Covering its Enterprise Health Platform - Judi®
• How Our Favorite New JUDI Features Aid Pharmacy Benefit Administration
• AH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1
• AH028 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 2

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

In this special episode of the Astonishing Healthcare podcast, Capital Rx Co-Founder and CEO, AJ Loiacono, and John Asalone, Executive Vice President of the newly formed Judi Care (former CEO of Amino Health), join Justin Venneri in the studio for a discussion about Capital Rx's acquisition of Amino, a unique care navigation company. The conversation covers everything from the background on how AJ and John met to "What is care navigation?" and how Judi Care offers 1) health plan members (i.e., healthcare consumers) a differentiated way to take control of their individual healthcare journeys, and 2) plan sponsors and other payers a user-friendly, unified pharmacy and medical care navigation front end that empowers plan members to find the care they need, when they need it.

We're incredibly excited about the future and the opportunity to meaningfully improve access to care and the overall health benefits experience while helping reduce costs. Capital Rx has evolved into an HBM - or health benefits manager - as a result of Judi® processing medical AND pharmacy claims (and supporting all related workflows in one system), and a unified front end that "puts quality, cost insights, and all of the benefits that your health insurance provides into one simple search box" is a natural extension of our enterprise health tech capabilities. We hope you enjoy learning more about our journey and evolving mission!

Related Content

• Judi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards Program
• Capital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform
• Capital Rx Adds More than 80 New Partnerships in 2024 and Eyes Another Year of Record Growth in 2025
• AH065 - The Bridge to Value-Based Care: Unified Claims Processing™, with Dr. Sunil Budhrani

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

This episode of the Astonishing Healthcare podcast highlights two recent posters presented by Zachary Brunko, PharmD (PGY1 Managed Care Pharmacy Resident), and Nash Albadarin, PharmD, MBA (Associate Director, Clinical Programs Business Development), at AMCP 2025 and the 2025 PQA Annual Meeting, respectively.

We won't give away the conclusions, but Zach explains the team's research on International Classification of Diseases (ICD) codes and how they evaluated the accuracy and reliability of ICD codes submitted on pharmacy claims. Additionally, they sought to identify patterns in ICD code submissions across client types, drug classes, disease states, pharmacy networks, and regions.

Nash highlights how text messaging and pharmacist outreach to patients through Rx Enhance - a clinical program designed to improve adherence and close gaps in care - drove marked improvement in medication adherence in 2024 for commercial plan members with diabetes, hypertension, and high cholesterol. If you're interested in the potential to streamline processes and improve decision-making by using data like ICD codes, or the potential for tech-enabled clinical programs to improve health outcomes, this episode is for you!

Reference Materials & Related Content

• Poster: Evaluating ICD Codes on Pharmacy Claim Submissions: Are They Reliable?
• Poster: The Impact of Text Messaging and Pharmacist Outreach Interventions on Medication Adherence Rates in a Commercial PBM Population
• AH043 - Pharmacy Benefits 101: DMP & MTM, Explained, with Nash Albadarin, PharmD
• AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD
• AH006 - Pharmacy Benefits 101: Clinical Care Teams, with Amy Stockton, PharmD

Please visit Capital Rx Insights for more information, including this episode's transcript!

This episode of the Astonishing Healthcare podcast is all about Pharmacogenomics (PGx), a critical component of precision medicine that ensures the medications prescribed to patients align with their genetic makeup.. To explain everything from what PGx is and barriers to broader adoption to the future state of integrated care, Burns Blaxall, PhD (Senior Vice President of Precision Medicine at Aranscia), and Caitlin Munro, PharmD (Sr. Clinical Programs Manager at Capital Rx), joined Justin Venneri in the studio.

Burns and Caitlin discuss the growth of biomarkers on drug labels and use cases where PGx has been most helpful to date (e.g., behavioral health), the cost of testing, lack of insurance coverage and appropriate clinical guidelines, and the general level of physician awareness. They also dive into ongoing efforts to overcome the common barriers to using PGx and how Capital Rx is approaching the opportunity - leveraging Judi® - to bring PGx to employer plan sponsors and others who would like to offer plan members this option as part of the health benefits program. They also highlight the important role pharmacists can play on care teams and in the delivery of specialized care and acknowledge that regulation and legal action will help drive change and improve greater accessibility and usage of PGx tools, which, based on some of the stories shared, can transform the patient experiences and improve health outcomes.

Related Content & Reference Materials

• Validation of Pharmacogenomic Interaction Probability (PIP) Scores in Predicting Drug–Gene, Drug–Drug–Gene, and Drug–Gene–Gene Interaction Risks in a Large Patient Population
• AH005 - Star Ratings, MTM, & CMS Translation Requirements with Jay Tran, PharmD
• AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD
• AH006 - Pharmacy Benefits 101: Clinical Care Teams, with Amy Stockton, PharmD

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

In this episode of the Astonishing Healthcare podcast, Justin Venneri speaks with Kristin Begley, PharmD, Chief Commercial Officer at Capital Rx, about the evolving role of Pharmacy Benefit Managers (PBMs) and the rapidly accelerating shift in demand for an "unbundled," agnostic model. But what does unbundling mean? How does this approach help to avoid conflicts of interest? What parts of a pharmacy program can be carved out or unbundled to allow plan sponsors the freedom to design a plan that meets their unique populations' needs? Kristin answers these questions and more during the conversation, and she also explains what's so astonishing about the Trump administration's executive order aimed at addressing global drug price disparities!

Related Content

• Replay - Build a Lasting Pharmacy Benefit Strategy with Never Move Again™
• Pharmacy Benefits 101: The Importance of the Network
• 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
• AH041 - ERISA Litigation Outlook and Meeting CAA Requirements: What Can Plan Fiduciaries Do?

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

In this episode of the Astonishing Healthcare podcast, Mike Tate, one of the newest members of Capital Rx's commercial team, joins Justin Venneri in the studio to discuss the latest challenges and innovations in the healthcare market, and how he's approaching growth opportunities "west of the Mississippi." Mike explains why his region has been relatively slow to adopt self-funding strategies compared to the rest of the country (despite the great work of innovative brokers and consultants), how plan members - who are more informed than ever before - are pushing their employers' benefits teams to think creatively about their strategies, and why he's so exited about Judi Health™ and the alignment of clinical programs, data, and more.

Why did Mike join Capital Rx? How is a rising "Healthcare IQ" impacting the market? What are plan sponsors thinking about strategically? Listen in to find out!

Related Content

• Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive Impact
• Capital Rx Unveils Healthcare's First Unified Pharmacy and Medical Claims Processing Platform
• Why this benefit leader switched to a more modern, transparent PBM
• AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD

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

This episode of the Astonishing Healthcare podcast with Dr. Sunil Budhrani (Chief Innovation & Medical Officer) highlights the transformative potential of Judi Health™, the first Unified Claims Processing™ platform offering a combined medical and pharmacy benefit experience (with vision and dental soon to follow)! Why is unifying claim administration necessary to reach a value-based world? Well, everyone has been talking about VBC for years, and it's proved to be an elusive target. On Episode 7, Dr. Budhrani explained why pharmacy must be included in the equation along with providers, patients, and payers, and today we go a level deeper, explaining why "everything" - all the patient's data - must be in one system to be able to achieve better health outcomes at a lower cost. On AH054 - Judi Health™: Going Beyond Pharmacy and into Medical Claims, with AJ Loiacono and Dr. Sunil Budhrani, we revealed what we're doing and why.

Today, Sunil discusses our experience thus far - 5 months into our unified claims experience - and the importance of flexibility in plan design to achieve a plan's goals. He also explains how Judi Health helps to empower providers and the provider-patient relationship via a "transparent architecture." What should the experience be like for patients? How about the plan sponsor/HR team side of the equation? Tune in to find out and hear why Judi Health represents an "opportunity to see - and achieve - what many people in healthcare say cannot exist" (hint: it's a win for all stakeholders).

Related Content:

• Judi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards Program
• Capital Rx Unveils Healthcare's First Unified Pharmacy and Medical Claims Processing Platform
• AH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya Lomsadze
• Replay - Build a Lasting Pharmacy Benefit Strategy with Never Move Again™
• Setting a New Standard for the Future of Pharmacy Benefit Administration

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

This Astonishing Healthcare podcast episode features Bridget Mulvenna, who joins us in the studio again for an insightful discussion about addressing data access hurdles and utilizing pharmacy claims data. Building on her previous episodes, we dig into the "how" here - how can plan sponsors get their data, analyze it, and use it to make more informed decisions. It's encouraging that things are getting a little better out there, but data transparency and sharing remain top concerns for channel partners and plan fiduciaries alike; everyone is trying to understand what's driving costs higher within their plans (aside from GLP-1s, of course)!

What data do you need? Who can/should do the analysis? What do contract definitions have to do with this? We cover it all, offering practical suggestions to hold partners accountable based on Bridget's experience.

Related Content

• Why this benefit leader switched to a more modern, transparent PBM.
• 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
• AH053 - Selling Pharmacy Benefits: Relationships, Rebates, GLP-1s, and More, with Bridget Mulvenna

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

In this episode of the Astonishing Healthcare podcast, we welcome Jessin Joseph, PharmD, MBA, back to the studio. Jessin's focus on the pharmacy benefit administration side of the business and experience at Kentucky Medicaid and working with health plan clients inform the discussion about the impact the new administration and appointments in Washington, D.C., may have on health plan partners, MPPP (M3P), various models of Pharmacy Benefit Management (PBM) for Medicaid, including the single PBM and carve-out/unbundling approaches, and how the drug price benchmark can influence access to medication for plan members.

In Episode 16 - The Intersection of Pharmacy, Government Requirements, and Medicaid, Jessin highlighted the momentum that discussions around single PBM seemed to have, and this time around, nearly a year later, he dives into why everyone is talking about unbundling the pharmacy benefit!

Related Content

• Replay: How You Can Leverage Modern Technology to Meet the CMS Medicare Prescription Payment Plan Requirements
• Partnership & Collaboration: Why PBMs and Health Plans Should Sync on Regulatory Change Management 
• AH033 - Never Move Again™, a Paradigm Shift in Pharmacy Benefits, with AJ Loiacono (for more on unbundling)

Please visit Capital Rx Insights for additional content, including this episode's transcript!