The Astonishing Healthcare Podcast

Capital Rx
  • 5.0 (13)
  • MEDICINE
  • UPDATED WEEKLY
The Astonishing Healthcare Podcast

If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.

  1. 1D AGO

    AH074 - How Fast is the Way Consumers Search for Care Evolving? Almost Beyond Comprehension, with Carrie Liken

    On this episode of the Astonishing Healthcare podcast, Carrie Liken (now with Snowflake) returns to the show to discuss the exceptionally rapidly evolving search landscape and Google's new AI Mode. Are websites dying as AI-powered search ascends in popularity? According to Carrie, it looks that way. She and host Justin Venneri discuss the transformative impact of AI on healthcare search and patient journeys. They explore how tools like Google’s new AI Mode and ChatGPT are reshaping how consumers find healthcare information, reducing reliance on traditional websites. Carrie shares insights from her "mini research studies," highlighting the challenges and decisions healthcare organizations face in adapting to the new world. Highlights include: The Decline of Traditional Websites: AI Mode summarizes information directly on search results, reducing the need for users to visit websites and challenging healthcare organizations to rethink their content strategies. The Importance of Data Strategy: Carrie emphasizes that a robust data strategy is essential for organizations to succeed in an AI-driven world. The Role of AI in Patient Journeys: AI tools can guide patients through initial research and even help locate care providers, though booking appointments still requires human interaction. The Future of AI Agents in Healthcare: Carrie envisions AI agents automating tasks such as appointment scheduling and care coordination to significantly reduce friction in the healthcare system. Related Content & Reference Materials Maybe we should write an obituary for the website (3/20/25)AI Mode is the training ground for AI Overviews (and yes, websites are still dying) (6/7/25)AH070 - Inside Capital Rx's Acquisition of Amino Health: Creating the Health Benefits Platform of the Future, Today For more information about Capital Rx and this episode, please visit Capital Rx Insights.

    27 min

  2. JUL 11

    AH073 - How Low Cost Alternative Programs Can & Should Work, with Jackie Lolos, PharmD, and Haleh Campbell, PharmD

    The latest episode of the Astonishing Healthcare podcast dives into the functionalities and real-world impact of Rx Smart Save, a low-cost alternative program designed to reduce medication costs for both patients and plan sponsors. Jackie Lolos, PharmD, and Haleh (Halls) Campbell, PharmD, join Justin Venneri in the studio for a discussion highlighting the innovation and care behind this clinical program. Jackie and Halls outline how the two levels of Rx Smart Save work, with Level 1 empowering members to independently switch to lower-cost, clinically equivalent medications via notifications on the Capital Rx app or web portal. Level 2 increases access with a proactive, high-touch approach, where a team of pharmacists and specialists assist members, prescribers, and pharmacies throughout the process. Halls also shares a quick case study demonstrating how one retiree saved $75 per prescription by switching from an injection-based migraine treatment to a tablet, and Jackie explains how modern technology aids the process.. Related Content AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmDPharmacy Benefits 101: Building an Award-Winning Call Center from ScratchAH006 - Pharmacy Benefits 101: Clinical Care Teams, with Amy Stockton, PharmDSigns it is time to change your PBM vendor, and how to overcome common hesitations (Capital Rx / Benefits Pro) For more information about Capital Rx and this episode, please visit Capital Rx Insights.

    17 min

  3. JUL 3

    AH072 - The Benefits You Probably Didn't Know You Have, with Marsha Perry

    On Episode 72 of the Astonishing Healthcare podcast, Marsha Perry, Capital Rx's Head of Benefits and Compensation, joins host Justin Venneri in the studio for a conversation about the intricacies of employee benefits, beyond pharmacy benefits! At a high level, she shares her thoughts on setting up a "well-rounded and affordable" benefits package, what should be in the benefits guide, and how to drive app usage and engagement in underutilized programs (a little humor and sharing personal stories almost always helps 😀). Additionally, Marsha offers some specific examples of "benefits people [often] forget they have," and she dives into the importance of dental benefits (a surprisingly underutilized benefit). Lastly, but not least, Marsha shares her opinions on covering GLP-1s and the importance of maintaining a solid relationship with the finance team. Related Content Replay - Strategic Well-Being: Rethinking Health Benefits to Empower Employees and Drive ImpactAH021 - Managing Pharmacy Costs in a GLP-1 World, with Bridget MulvennaReplay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better Outcomes Please visit Capital Rx Insights for more information, including this episode's transcript!

    20 min

  4. JUN 27

    AH071 - A Look at What's Really Driving Drug Spend, and How it Impacts Us, with IQVIA's Michael Kleinrock

    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 BrickerAH055 - Pharmacy Benefits 101: Stop-Loss Insurance, with Mike Miele, FSA, MAAAReplay - Innovative partnerships for GLP-1 management, with Vida HealthHow to Manage Pharmacy Benefit Spend in a GLP-1 World For more information about Capital Rx and this episode, please visit Capital Rx Insights.

    36 min

  5. JUN 20

    Best of '25! AH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya Lomsadze

    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 PlatformCapital Rx Receives a US Utility Patent Covering its Enterprise Health Platform - Judi®How Our Favorite New JUDI Features Aid Pharmacy Benefit AdministrationAH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1AH028 - 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.

    24 min

  6. JUN 13

    AH070 - Inside Capital Rx's Acquisition of Amino Health: Creating the Health Benefits Platform of the Future, Today

    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 ProgramCapital Rx Unveils Healthcare’s First Unified Pharmacy and Medical Claims Processing PlatformCapital Rx Adds More than 80 New Partnerships in 2024 and Eyes Another Year of Record Growth in 2025AH065 - 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.

    30 min

  7. JUN 6

    AH069 - Poster Presentations: The Utility of ICD Codes, and How Text Messages & Pharmacist Outreach Aids Medication Adherence

    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 PopulationAH043 - Pharmacy Benefits 101: DMP & MTM, Explained, with Nash Albadarin, PharmDAH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmDAH006 - Pharmacy Benefits 101: Clinical Care Teams, with Amy Stockton, PharmD Please visit Capital Rx Insights for more information, including this episode's transcript!

    20 min

  8. MAY 30

    AH068 - The Future of Health Benefits: Integrating the Power of Pharmacogenomics (PGx), with Burns Blaxall, PhD, and Caitlin Munro, PharmD

    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 PopulationAH005 - Star Ratings, MTM, & CMS Translation Requirements with Jay Tran, PharmDAH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmDAH006 - Pharmacy Benefits 101: Clinical Care Teams, with Amy Stockton, PharmD For more information about Capital Rx and this episode, please visit Capital Rx Insights.

    27 min
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Ratings & Reviews

5
out of 5
13 Ratings

About

If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Capital Rx is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Capital Rx, visit https://www.cap-rx.com/insights.

Information

  • Creator
    Capital Rx
  • Years Active
    2024 - 2025
  • Episodes
    79
  • Rating
    Clean

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