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PODCAST

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 Judi Health (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

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All Episodes

00:19:34

AH061 - Empowering Unions with Technology: A New...

The Astonishing Healthcare Podcast ·

2025/04/04

On this episode of the Astonishing Healthcare podcast, we discuss how modern technology - Judi® - brings efficiency to the labor union market with Capital Rx's Mike Miele, FSA, MAAA (Senior Vice President of Insured Services), Christie Peperato (Manager, Payment & Operations), and Kelly Smith (Product Manager). Who knew that Capital Rx has an hours banking system? Why did we build one? Well, every hour a union worker works may be tracked and "banked" for benefits eligibility purposes. So, those

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00:23:22

AH060 - A New Approach to CRC Screening, with Geneoscopy

The Astonishing Healthcare Podcast ·

2025/03/28

For this special episode of the Astonishing Healthcare podcast, Andrew Barnell, CEO of Geneoscopy, joins Justin Venneri in the studio for an insightful discussion about colorectal cancer (CRC) screening in observance of National CRC Awareness Month! Andrew explains how he and his "very talented" sister, Erica Barnell, MD, PhD, co-founded Geneoscopy to develop diagnostic tests using RNA biomarkers extracted from stool samples. Their newly FDA-approved test, ColoSense™, provides a non-invasive

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00:21:21

AH059 - Healthcare Sector Update & Outlook, with...

The Astonishing Healthcare Podcast ·

2025/03/21

On this episode of the Astonishing Healthcare podcast, Bloomberg Intelligence's Jonathan Palmer (Sr. Equity Analyst & Team Lead, Healthcare) joins us in the studio for a discussion about the work his team does and the evolving landscape of health tech. Palmer notes interest in Hinge Health's potential IPO and how the market's receptivity to tech-enabled healthcare companies has improved recently. While these companies face pressure to demonstrate profitability amid evolving market dynamics, there's

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00:22:55

AH058 - Building Judi®, the Healthcare Infrastructure...

The Astonishing Healthcare Podcast ·

2025/03/14

On this episode of the Astonishing Healthcare podcast, host Justin Venneri speaks with Liya Lomsadze (Director, Product Management) at Capital Rx. Liya discusses her journey from data analytics on the provider side to leading the product development of Capital Rx's Unified Claims product. They dive into recent updates to the Judi® platform, particularly improvements to the Prior Authorization Tool, including Medicare and Medical PA case processing and a supervisor dashboard for managing PA requests,

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00:27:32

AH057 - How First-Movers are Taking Control of their...

The Astonishing Healthcare Podcast ·

2025/03/07

On Episode 57 of the Astonishing Healthcare podcast, host Justin Venneri welcomes Jeff Hogan, President of Upside Health Advisors, back to the show to discuss the major trends he observed in healthcare procurement and plan management in 2024 and areas of focus in 2025. Jeff highlights the evolving role of employer fiduciaries under the Consolidated Appropriations Act of 2021 (CAA), building on Episode 30 and re-emphasizing the necessity of real-time data access and process-driven strategic

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00:12:28

AH056 - Medicare Star Ratings: Updates, How Judi®...

The Astonishing Healthcare Podcast ·

2025/02/28

On this episode of the Astonishing Healthcare podcast, Justin Venneri chats with Angela Kalantarova, PharmD, a senior clinical programs manager at Capital Rx, about recent updates to Medicare's star ratings. Angela shares her path to Capital Rx and experience working in managed care and on clinical programs, and she explains what's new for 2025: star measures for polypharmacy and concurrent use of opioids and benzodiazepines.

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00:16:30

AH055 - Pharmacy Benefits 101: Stop-Loss Insurance,...

The Astonishing Healthcare Podcast ·

2025/02/21

On this episode of the Astonishing Healthcare podcast, we explore the nuances of stop-loss insurance with Capital Rx's Mike Miele, FSA, MAAA (Senior Vice President of Insured Services). With premiums on the rise due to high-cost claims reaching levels actuaries never thought possible, self-insured plan sponsors need new options and better tools to monitor their costs. Mike, who is a healthcare actuary by training, discusses everything from "What is stop-loss?" and who it's for to what's driving

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00:34:08

AH054 - Judi Health™: Going Beyond Pharmacy and into...

The Astonishing Healthcare Podcast ·

2025/02/14

This episode of the Astonishing Healthcare podcast highlights the transformative potential of Judi Health™, the first unified claims processing platform that integrates medical and pharmacy claim administrative workflows and data to create a seamless experience for stakeholders including patients, providers, and employers. Guests AJ Loiacono (Co-Founder & CEO of Capital Rx) and Dr. Sunil Budhrani (Chief Innovation & Medical Officer) emphasize the limitations of the traditional fee-for-service model

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00:27:13

AH053 - Selling Pharmacy Benefits: Relationships,...

The Astonishing Healthcare Podcast ·

2025/02/07

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

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00:21:04

AH052 - ERISA Insights: Challenges & Compliance in...

The Astonishing Healthcare Podcast ·

2025/01/31

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

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00:31:58

AH051 - Why Drug Prices & Modern Tech Matter in...

The Astonishing Healthcare Podcast ·

2025/01/24

For Episode 51 of the Astonishing Healthcare podcast, we spoke with Nick Opalich, CEO of HospiceChoice Rx, and 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

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00:17:36

AH050 - PBM Pain Points and Overcoming the Fear of...

The Astonishing Healthcare Podcast ·

2025/01/17

On this AOn this 50th episode of the Astonishing Healthcare podcast, Capital Rx Vice President of Business Development, Hope Nakazato, PharmD, joins Justin Venneri to share 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 its cost inflation for so long? Listen in to find

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00:23:04

AH049 - Pharmacy Benefits 101: Pharmacy Audits

The Astonishing Healthcare Podcast ·

2025/01/10

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!

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00:25:27

AH048 - High-Cost Orphan Drugs, Securing Claims Data,...

The Astonishing Healthcare Podcast ·

2025/01/03

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

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00:39:33

Best of "24! AH041 - ERISA Litigation Outlook and...

The Astonishing Healthcare Podcast ·

2024/12/27

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!

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00:37:35

Best of '24! AH020 - Why NADAC is a "Ray of...

The Astonishing Healthcare Podcast ·

2024/12/20

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

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00:36:23

AH047 - What Project 2025, RFK Jr., and Dr. Oz Could...

The Astonishing Healthcare Podcast ·

2024/12/13

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, Robert Longyear, Co-Founder of Avenue Health, returns to the show and shares his view from K Street after reviewing Project 2025 and what RFK Jr. and Dr. Mehmet Oz could

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00:35:10

AH046 - What's Hot In and Around the Pharmacy Supply...

The Astonishing Healthcare Podcast ·

2024/12/06

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

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00:40:26

Best of '24! AH001 - Building a PBM: Tech, Navigating...

The Astonishing Healthcare Podcast ·

2024/11/29

Our first "Best of" Astonishing Healthcare podcast episode goes back to the beginning. For those who have been listening, "Thank you!" - we'll be back with a new episode next week. For new listeners, a lot has happened since our co-founder and CEO AJ Loiacono kicked things off. Fortunately, the overarching message/theme remains highly relevant, and AJ's experience and insights are always interesting to hear. Employer plan fiduciaries and health plans need aligned, focused, and unconflicted partners

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00:16:22

AH045 - Pharmacy Benefits 101: Formularies &...

The Astonishing Healthcare Podcast ·

2024/11/22

In this episode of the Astonishing Healthcare podcast, Nisha Bhide, PharmD, joins Justin Venneri in the studio to discuss an integral aspect of pharmacy benefit management (PBM) - the Formulary. They explore everything from what a formulary is to how they are created, why and how often they change, the role JUDI® plays in managing a formulary efficiently, the difference between open and closed formularies, and more!

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104 results

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