The Astonishing Healthcare Podcast

On Episode 53 of the Astonishing Healthcare podcast, Bridget Mulvenne, VP of Business Development, joins Justin Venneri in the studio again to share highlights of her first full year of selling pharmacy benefit solutions ahead of her webinar on February 13: 5 Ways to Improve your PBM Procurement Process in 2025 (click here to learn more and register). They discuss the evolving healthcare landscape, regulatory pressures, expanding indications for GLP-1s, and the need for transparency in pharmacy benefits. Bridget shares stories from the field, explaining why focusing on drug manufacturer revenue and breaking the industry’s dependence on rebates are so important and how modern technology helps provide real-time data access and actionable insights to plan sponsors.

Previous AH episodes featuring Bridget:

• AH002 - A Former Pharmacy Program Director's View on Controlling Pharmacy Costs
• AH021 - Managing Pharmacy Costs in a GLP-1 World, with Bridget Mulvenna

Bridget also shares insights on the evolving landscape of GLP-1 medications and their growing number of FDA-approved indications beyond diabetes and highlights the challenges plan sponsors face with coverage decisions, balancing short-term costs with potential long-term savings. Discussing Capital Rx’s Never Move Again™ offering, Bridget emphasizes its flexibility and appeal to sophisticated plan sponsors.

Related Content:

• Pharmacy Benefits 101: Pharmaceutical Rebates
• Our Single-Ledger Model™ - Pharma Revenue Explained
• AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan

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

In this episode of the Astonishing Healthcare podcast, Nick Welle, Partner & Chair of the Health Benefits Practice at Foley & Lardner LLP, joins host Justin Venneri in the studio for a discussion about ERISA and how employer plan fiduciaries can navigate a relatively complex set of responsibilities. With the recent developments around the J&J lawsuit and interest in how that may progress following the dismissal of the allegations, and questions swirling about i) what the Trump administration will do regarding the ACA and ii) CAA compliance and reporting, the timing couldn't be better to publish Episode 52.

They dive into common traps Nick has seen employers fall into, processes and resources to leverage to show that "homework" - i.e., reasonable due diligence - is being done on the vendors providing services to the plan and its members, and much more. The ability to see and evaluate plan data and costs has never been more important!

Note that Nick's comments on this podcast are his own personal comments and do not represent any views or positions of the clients of Foley & Lardner.

Reference Materials for Plan Sponsors

• Employer Checklist for New Health Plan Price Transparency Rules and CAA
• Final Mental Health Parity Rules – Top Five Changes to the Status Quo

Related Content

• AH041 - ERISA Litigation Outlook and Meeting CAA Requirements: What Can Plan Fiduciaries Do?
• Replay - Build a Lasting Pharmacy Benefit Strategy with Never Move Again™
• The Consolidated Appropriations Act (CAA): Kudos to the Department of Labor (AJ Loiacono at ViVE)

To connect with Nick, CLICK HERE.

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

For Episode 51 of the Astonishing Healthcare podcast, we spoke with Nick Opalich, CEO of HospiceChoice Rx. We learned about how end-of-life care is evolving in the U.S., including the roles pharmacy and technology play in the hospice industry. Nick and host Justin Venneri discuss some similarities between the hospice pharmacy benefit management (PBM) and commercial PBM spaces, such as the importance of a great pharmacy network and independent pharmacies, why the drug price index matters (NADAC vs. AWP), medication access, and disconnected systems.

A former pharmacy owner himself, Nick explains the importance of helping hospice providers control drug spend, which is usually the second highest cost behind labor for providers, and reimbursement trends/pressure. He also touches on dispense fees, the potential to improve ePrescribing, and leveraging AI for enhanced reporting.

Related Content

• What is NADAC & How Does It Differ From AWP?
• Pharmacy Benefits 101: The Importance of the Network

For Reference

• Hospice industry Facts & Figures (NHPCO, 2024)

Thank you for listening, and check out Capital Rx Insights for more, including this episode's transcript!

On this 50th episode of the Astonishing Healthcare podcast, Capital Rx Vice President of Business Development Hope Nakazato, PharmD, joins Justin Venneri to discuss her observations, based on diverse industry experience, about the three most common friction points between plan sponsors and pharmacy benefit managers (PBMs): lack of execution, poor communication, and inflexibility. So, why have plan sponsors dealt with the status quo and rising costs for so long? Great question.

Hope uses the book, "Who Moved My Cheese?", by Dr. Spencer Johnson, to explain the fear of change, as well as three things people can look for in a true partner who will work with them in a collaborative and generally supportive way. If a new PBM or other vendor is aligned, consistent, and future-proof, change won't be as scary as it may seem, and plan sponsors can make more strategic decisions benefiting the plan and its members.

Hope also shares the advice she'd give her younger self, as well as the most astonishing thing she's seen over the years (hint: it relates to drug prices).

Related Content

• Capital Rx Adds More than 80 New Partnerships in 2024 and Eyes Another Year of Record Growth in 2025
• Pharmacy Benefit Procurement: How to Ensure That Savings Materialize
• Replay: 5 Ways to Improve Your PBM Procurement Process In 2024 (stay tuned for the 2025 edition!)
• 5 Recommendations for an Optimal PBM Deal (free eBook)

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

On this Astonishing Healthcare podcast episode, return guests Heidi McKinnon, PharmD, CHC (Head of Compliance at Capital Rx), and Symara Schmidt, PharmD, PMP, CHC, BCGP (Director, Compliance Programs), join host Justin Venneri in the studio for another Pharmacy Benefits 101 discussion about Pharmacy Audits, including how pharmacy benefit managers (PBMs) and pharmacies can work together to avoid issues and improve compliance - it is possible!

They explain everything from common audit triggers and types of audits to how the audits work and resources pharmacies can leverage to improve compliance and reduce friction/errors. Why are compliance executives at a PBM explaining all this? Well, it's an important topic, and there are misperceptions about pharmacy audits. There can be positive outcomes, and reducing fraud, waste, and abuse in the pharmacy supply chain is always a good thing.

Related Content

• AH023 - Compliance Matters, with Heidi McKinnon, PharmD, CHC
• AH025 - Empowering Pharmacists, with NASPA's Krystalyn Weaver, PharmD, JD

Reference Materials

• The Capital Rx Pharmacy Provider Manual
• PHARMACY AUDITS, An Important Tool for Fighting Fraud, Waste, and Abuse and Protecting Patients
• PAAS National - Home Page

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

What better way to kick off 2025 than having Dr. Eric Bricker join us in the studio for Episode 48 of the Astonishing Healthcare podcast? Known for his entertaining and educational videos covering all sorts of hot topics in and around healthcare and employer/employee benefits, Dr. Bricker and host Justin Venneri discuss the issues of high-cost drugs and access to claims data - two topics he recently covered on AHealthcareZ - Healthcare Finance Explained - that should be top of mind for plan sponsors this year as pharmacy costs continue to rise.

Dr. Bricker shares several ways employers, depending on their size and risk tolerance, may be able to navigate the challenge of rising pharmaceutical costs for orphan and other expensive drugs - including GLP-1s. He also explains how the RFP process can be used to secure the plan's claim data, which is necessary to meet fiduciary obligations.

While every plan is unique, most plan sponsors face similar challenges that the traditional PBM model isn't flexible or aligned enough to solve. Dr. Bricker is astonished by the complacency out there, but he does see the potential for an acceleration in the pace of change this year and next... tune in to hear why, and check out the links below for more information!

AHealthcareZ Reference Videos

• High Cost Orphan Disease Drugs Explained
• Do Employers Own Their Claims Data? It's Complicated.

Related Content

• Replay - Cracking the Code: Unraveling Specialty Drug Costs & PBM Profits
• How to Manage Pharmacy Benefit Spend in a GLP-1 World
• AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan

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

On this final encore episode of the Astonishing Healthcare podcast this year, we're replaying Episode 41, which featured three experts weighing in on rising litigation against employers and pharmacy benefit managers (PBMs) and was one of our most popular. We also want to take the opportunity to say, "Happy Holidays and New Year!" and thank our listeners and guests this year, including current and former colleagues; we couldn't have done it without you!

In Episode 41, we discussed what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and assess how "reasonable" the fees they pay are. Chris Deacon, Founder of VerSan Consulting; Jonathan Levitt, trial attorney and Co-Founding Partner at Frier Levitt; and Julie Selesnick, Senior Counsel in the employee benefits and ERISA Group at Berger Montague, joined host Justin Venneri for the discussion covering relevant provisions of the Consolidated Appropriations Act of 2021 (CAA), the recent lawsuits against Johnson & Johnson and Wells Fargo, and how plan sponsors can approach things like getting their data to make informed decisions.

This episode built on previous conversations, including AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan.

Chris, Jon, and Julie share their opinions about the similarities - or lack thereof - of the health plan lawsuits to the 401(k) and pension litigation of the early 2000s, why we will likely see more litigation, the reality and frustration of relying on traditional PBMs and carriers for data (and what to do about it), conflicts of interest in and around PBM procurement and broker/consultant relationships, and why Julie has a "fainting couch!"

Related Content

• AH004 - Data, Fiduciary Responsibility, and Reversing Trend with Jeff Hogan
• The Consolidated Appropriations Act & Prescription Drug Data Collection (RxDC): New Rules & Regulations Equal New Responsibilities
• Self-funded plans ignore the Consolidated Appropriations Act at their peril

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

Episode 20 of the Astonishing Healthcare podcast caught some folks' attention, as it featured Capital Rx Co-Founder and CEO AJ Loiacono and 3 Axis Advisors President/46brooklyn Research CEO Antonio Ciaccia. It's an episode you must listen to if your work or interests involve drug prices in any way. NADAC - national average drug acquisition cost - was the focus of our discussion on this episode, which was among the most downloaded and streamed episodes in 2024, and with PBM reform and drug prices top of mind, what better time to highlight it?

NADAC serves as a crucial price benchmark for our industry, providing freely available visibility and some level of understanding - a "source of truth" - of drug prices in the United States. Average wholesale price (AWP) and other indexes fail to reflect actual acquisition cost/supply chain economics but have prevailed for years. Is it the pharmacy benefits managers (PBMs)? Is it the wholesalers? At Capital Rx, we have always preferred to leverage NADAC whenever possible because of its numerous positive attributes. Tune in to learn more about the changes that occurred early in 2024, and you can click here to see the most recent updates to NADAC.

Related Content

What is NADAC & How Does It Differ From AWP?

Why Use NADAC-Based Pricing Over AWP

Medicaid.gov - Drug Pricing (where NADAC lives)

Please visit Capital Rx Insights for more information, including this episode's transcript, AND we'll add links to any new studies or documents that may interest you if you're a student of drug prices or a fan of NADAC.

This Astonishing Healthcare podcast episode covers the potential future of US healthcare policy under the Trump administration, focusing on the business of healthcare services and possible changes to Medicare and Medicaid, support for telehealth, solving workforce issues, and managing chronic diseases. Our guest from Episode 13, Redefining Virtual Care: A Blueprint for Effective RPM, Robert Longyear, Co-Founder of Avenue Health, returns to the show and shares his view from K Street after reviewing Project 2025 and evaluating what RFK Jr. and Dr. Mehmet Oz could prioritize in their roles.

Robert shares the highlights of his analysis, including what he found most interesting and what he'll be watching for on payment policy (e.g., there's bipartisan support for payment reform and price transparency), potential changes to Medicare Advantage and Medicaid, pediatric care, how to reduce administrative burden and alleviate provider burnout, abortion policies, the use of artificial intelligence, and access to patient data. If health policy matters to you, this episode is a "must-listen!"

Related Content

• Analyzing Health Policy Priorities under RFK, Jr. and Dr. Oz (Nov 27)
• What to Expect in Health Policy from the Next Trump Administration (Project 2025 Analysis; Nov 7)
• Digital Health Technologies in Rural Health: Bridging the Gap in Care Access and Delivery (Nov 26)
• AH046 - What's Hot In and Around the Pharmacy Supply Chain, with RSM's Tom Evegan

Visit Health Tech Happy Hour for more of Robert's work.

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

On this Astonishing Healthcare podcast episode, Tom Evegan, Principal, National Consulting Leader, Life Sciences at RSM, a leading provider of tax, assurance, and consulting services in the US, joins Justin Venneri for a discussion about topics ranging from health policy to drug pricing and how to provide equitable drug access. Tom shares his background and path to RSM, explaining how his experiences at a major pharmaceutical manufacturer, pharmacy benefit manager (PBM), and a biotech launching a new therapy shaped his experience and aided him in becoming a "gross-to-net expert."

Tom has helped hundreds of drug manufacturers launch, acquire, or divest assets and bring products from the regulatory phase to commercialization, so he's seen a lot and pays close attention to issues impacting drug prices and market access. Given his broad experience across the pharmaceutical supply chain, almost no topic is off the table. The conversation dives into the Inflation Reduction Act (IRA), the Chevron Ruling and 340B program, AI, why rebates likely aren't going anywhere soon, and the most astounding thing Tom's seen (hint: it relates to GLP-1s)!

Related Content

• How to Manage Pharmacy Benefit Spend in a GLP-1 World
• AH021 - Managing Pharmacy Costs in a GLP-1 World, with Bridget Mulvenna
• What is NADAC & How Does It Differ From AWP?
• AH022 - Pharmacy Benefits 101: Pharmaceutical Rebates, with Ben Schuster

To connect with Tom or for more information about RSM's Life Sciences Group/Management Consulting Services, please visit:

• Connect with Tom Evegan (LinkedIn)
• Life Sciences | Industries | RSM US
• Scaling at the Speed of Change: Biopharma

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