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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

00:30:15

AH044 - Searching for Answers: Understanding...

The Astonishing Healthcare Podcast ·

2024/11/15

On Episode 44 of the Astonishing Healthcare podcast, Andrew Gordon, LSW, joins host Justin Venneri for a discussion about the extensive primary research he's conducting on transparency and incentives in the U.S. Healthcare system. Gordon, who recently interviewed Capital Rx co-founder and CEO AJ Loiacono, explained how unexpected costs associated with an MRI sparked his curiosity, leading him to question why the healthcare system functions the way it does. He describes how he secured grants to

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00:16:39

AH043 - Pharmacy Benefits 101: DMP & MTM, Explained,...

The Astonishing Healthcare Podcast ·

2024/11/08

This episode of the Astonishing Healthcare podcast covers the ins and outs of two programs in the government sector - i.e., Medicare and Medicaid - and how modern technology JUDI® allows for more agility and flexibility in delivering care to Part D plan members and meeting CMS requirements. Capital Rx's Nash Albadarin, PharmD, explains changes to the Medication Therapy Management (MTM) criteria for 2025, which will increase membership, and provides an update on how MTM impacts Medicare star ratings

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00:19:08

AH042 - Pharmacy Benefits 101: The Network, with Kasi...

The Astonishing Healthcare Podcast ·

2024/11/01

In this episode of the Astonishing Healthcare podcast, Capital Rx's Vice President of Provider Relations, Kasi Ortiz, joins Justin Venneri in the studio to discuss the network component of pharmacy benefits. They discuss how modern technology - JUDI® - allows for flexibility and customization of the network to meet plan sponsors' varying needs based on their unique member populations. The network - the retail, mail order, or specialty pharmacies that dispense prescriptions for patients - is a

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00:38:05

AH041 - ERISA Litigation Outlook and Meeting CAA...

The Astonishing Healthcare Podcast ·

2024/10/25

On this episode of the Astonishing Healthcare podcast, three experts weigh in on rising litigation against employers and pharmacy benefit managers (PBMs) and 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

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00:15:34

AH040 - Celebrating Women Pharmacist Day 2024

The Astonishing Healthcare Podcast ·

2024/10/18

On this episode of the Astonishing Healthcare podcast, four women pharmacists across Capital Rx's teams join host Justin Venneri to celebrate #WPD2024! Amy Stockton, PharmD (our guest for Episode 6); Symara Schmidt, PharmD, BCGP; Lauren Carroll, PharmD, BCACP; and Marissa Miller, PharmD, discuss the significance of Women Pharmacist Day and highlight the progress women have made in the pharmacy field and how and why they are celebrating this unique holiday within American Pharmacists Month.

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00:18:15

AH039 - Transition Benefits and the Relationship...

The Astonishing Healthcare Podcast ·

2024/10/11

On this episode of the Astonishing Healthcare podcast, Capital Rx's Samantha Custer, Director of Member Experience, and Jake Mulkey, Product Manager, join host Justin Venneri to discuss a niche, important aspect of Medicare Part D plans: Transition Benefits. What goes on behind the scenes to enable a plan member to receive uninterrupted care? What role does modern software - i.e., JUDI® - play in providing members with a temporary supply of their medication and meeting notification requirements

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00:15:37

AH038 - Navigating Flu Season! A Quick Update on...

The Astonishing Healthcare Podcast ·

2024/10/04

In Episode 38 of the Astonishing Healthcare podcast, Formulary Operations Manager Libbi Green, PharmD, joins host Justin Venneri in the studio for a timely discussion about flu season. The conversation covers the background of flu season, this year's flu vaccines, the timing and importance of vaccinations, how the flu vaccine performed last season, predicting flu trends, and the availability of different vaccine formulations to accommodate patients' varying needs.

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00:23:54

AH037 - The Story of a Claim: Redefining the Benefit...

The Astonishing Healthcare Podcast ·

2024/09/27

On this episode of the Astonishing Healthcare podcast, Kevin Sunquist, VP of Product at Capital Rx, joins host Justin Venneri to discuss the journey of a pharmacy claim, from the prescription at the doctor's office to the pharmacy counter. Kevin explains how JUDI® allows claims to be processed efficiently and transparently and why benefit design, network selections, and utilization management programs such as prior authorization ultimately dictate how easy it is for plan members to fill their

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00:28:57

AH036 - The Rise of GLP-1s & Partnering to Manage...

The Astonishing Healthcare Podcast ·

2024/09/20

In this episode of the Astonishing Healthcare podcast, Joe Murad, CEO of Vida Health, joins host Justin Venneri and Capital Rx Chief Clinical Officer Sara Izadi, PharmD, in the studio for a discussion about glucagon-like peptide-1 (of GLP-1) medications and how partnering to manage cardiometabolic health can help plan sponsors control costs and keep their populations healthy. Joe and Sara review the latest data, including the rising prevalence of obesity and diabetes, GLP-1 discontinuation rates,

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00:17:35

AH035 - Pharmacy Benefits 101: Clinical Programs,...

The Astonishing Healthcare Podcast ·

2024/09/13

In this episode of the Astonishing Healthcare podcast, Justin Venneri speaks with Bonnie Hui-Callahan, PharmD, CDCES, Senior Director of Clinical Programs at Capital Rx, about the significance of clinical programs within the pharmacy benefit management (PBM) space. Bonnie explains how clinical programs serve as an "added layer of service" similar to after-school programs. They enhance the core functions of PBMs (claim administration) and help plan sponsors reduce costs, improve quality of care,

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00:26:37

AH034 - Customer Care in Healthcare: Setting a Higher...

The Astonishing Healthcare Podcast ·

2024/09/06

In this episode of the Astonishing Healthcare podcast, Will Tafoya, Senior Vice President of Operations and the leader of Capital Rx's contact center, shares his views on building and leading Capital Rx's award-winning customer care team, which is available 24/7/365 to serve millions of pharmacy plan members. Will's passion for customer care and his team shines through, as he explains why hiring PTCB pharmacy technicians and other individuals with healthcare experience is so important, the benefits

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00:35:59

AH033 – Never Move Again™, a Paradigm Shift in...

The Astonishing Healthcare Podcast ·

2024/08/30

In this episode of the Astonishing Healthcare podcast, AJ Loiacono, co-founder & CEO of Capital Rx, joins Justin Venneri to discuss Never Move Again™, the recently launched "unbundled" pharmacy benefit administration solution for large employers. It turns out larger employer groups, TPAs, and other groups with 50,000+ lives are very similar to health plans, which value the flexibility and transparency an unconflicted administrator provides. Supported by JUDI®, our single scalable enterprise health

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00:32:36

AH032 - Prescription Rebates: Agreements, Guarantees,...

The Astonishing Healthcare Podcast ·

2024/08/23

In this episode of the Astonishing Healthcare podcast, we dive into the National Pharmaceutical Council's recent employer survey on rebates and rebate guarantees published in the AJMC, Prescription Rebate Guarantees: Employer Insights ((7/19/24). NPC CEO John O'Brien, PharmD, MPH, and Senior Research Director Julie Patterson, PharmD, PhD joined Capital Rx's Co-Founder and CEO AJ Loiacono in the studio for the discussion, which covered everything from how and why rebates have become so important to

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00:20:22

AH031 - Dissecting Pharmacy Cost Drivers and the...

The Astonishing Healthcare Podcast ·

2024/08/16

In this episode of the Astonishing Healthcare podcast, Justin Venneri sits down with Kristen Begley, PharmD, Chief Commercial Officer, and Michael Miele, FSA, MAAA, Senior Vice President of Insured Services for a discussion about some of the finer points of pharmacy benefit management (PBM) procurement and pharmacy program cost evaluation, including how misaligned incentives can drive costs higher than they should be for plan sponsors. They delve into the misleading nature of focusing on unit costs

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00:22:02

AH030 - Plan Sponsors Need a Source of Truth; Get...

The Astonishing Healthcare Podcast ·

2024/08/09

In this episode of the Astonishing Healthcare podcast, Jeffrey Hogan, President of Upside Health Advisors, returns to the show for a timely discussion with Justin Venneri about why the timing is perfect for health plan sponsors and fiduciaries to engage their partners to secure necessary disclosure requirements and access to their data: it's renewal season!

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00:21:35

AH029 - Selling Pharmacy Benefits: Building...

The Astonishing Healthcare Podcast ·

2024/08/02

In this episode of the Astonishing Healthcare podcast, Nick Van Hook (VP, Commercial Markets) joins host Justin Venneri to discuss the pharmacy benefits selling season and the importance of building relationships and trust in B2B sales. They discuss Nick's career journey - from pursuing a professional golf career and not knowing what a pharmacy benefit manager (PBM) is to consulting and, ultimately, Capital Rx - as well as the top questions and issues Nick fields and must address while building

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00:18:58

AH028 - What is Pharmacy Benefit Management? With...

The Astonishing Healthcare Podcast ·

2024/07/26

In this Part 2 episode of Astonishing Healthcare, Justin Venneri continues the discussion about what a pharmacy benefit manager (PBM) does with Capital Rx team members Jillian Lonson, PMP®, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration. They dive deeper into the weeds and geek out on topics including benefit configuration, enhancements, and testing to be sure everything is set up correctly! They also explain how JUDI® is different

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00:14:57

AH027 - What is Pharmacy Benefit Management? With...

The Astonishing Healthcare Podcast ·

2024/07/19

In this episode of the Astonishing Healthcare podcast, Jillian Lonson, PMP®, Sr. Director, Benefits Administration & Operations, and Jean Beman, Manager, Benefits Operations & Administration, join host Justin Venneri for part 1 of a two-part discussion about what pharmacy benefit management (PBM) entails. They describe the basics and then peel back the layers of what PBMs do to ensure that a medication processes correctly for your pharmacy benefit so you can pay the correct amount at the pharmacy

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00:16:20

AH026 - The Power of APIs in Healthcare, with Alfonso...

The Astonishing Healthcare Podcast ·

2024/07/12

In this episode of Astonishing Healthcare, Alfonso Martinez joins Justin Venneri to discuss the transformative role APIs - application programming interfaces - play in the healthcare industry and the flexibility they offer plan sponsors and benefits administrators to be imaginative. He explains how APIs facilitate seamless integration, automate critical workflows, and empower real-time data access and exchange, significantly enhancing user experiences.

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00:18:34

AH025 - Empowering Pharmacists, with NASPA's...

The Astonishing Healthcare Podcast ·

2024/07/05

Executive Vice President and CEO of the National Alliance of State Pharmacy Associations (NASPA), Krystalyn Weaver, PharmD, JD, joins host Justin Venneri for a discussion about pharmacists and expanding their scope of practice. She shares her insights on the role pharmacists can play in the healthcare system and highlights several positive developments recently, including Iowa changing the scope of practice to be a standard of care model and Tennessee passing a law that allows pharmacists to

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104 results

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