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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 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

health & fitness medicine

All Episodes

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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00:15:21

AH024 - PBMs in the News, Again, with Ryan Duffy and...

The Astonishing Healthcare Podcast ·

2024/06/28

We dedicated this episode of Astonishing Healthcare to discussing the ongoing challenges within the pharmacy benefit management (PBM) industry, as unveiled by a recent front-page New York Times article (subscription required). Capital Rx Senior Vice Presidents Josh Golden and Ryan Duffy join host Justin Venneri to share their reactions to the article and opinions about where the spotlight should be at this time. The article brings several issues to the forefront, including new "layers" of profit

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00:16:13

AH023 - Compliance Matters, with Heidi McKinnon,...

The Astonishing Healthcare Podcast ·

2024/06/21

On this episode of the Astonishing Healthcare podcast, Capital Rx's head of compliance, Heidi McKinnon, PharmD, CHC, joins Justin Venneri for a discussion about a few of the critical issues she's tracking today that are either currently impacting or could impact the pharmacy benefits industry. With over 20 years of experience, she expertly navigates topics like the role of AI in detecting fraud, risks associated with compounding GLP-1 medications, and the nuances of digital pharmacy operations (vs

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00:13:51

AH022 - Pharmacy Benefits 101: Pharmaceutical...

The Astonishing Healthcare Podcast ·

2024/06/14

In this episode of the Astonishing Healthcare podcast, Ben Schuster, Senior Director of Rebate Administration at Capital Rx, joins Justin Venneri for a dive into the world of pharmaceutical rebates. From the basics of what rebates are and how they flow through the supply chain to the intricacies of rebate guarantees and contractual definitions, Ben shares his thoughts on the importance of understanding how various factors can impact the amount of money plan sponsors receive and rebate eligibility

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00:29:04

AH021 - Managing Pharmacy Costs in a GLP-1 World,...

The Astonishing Healthcare Podcast ·

2024/06/07

In this episode of Astonishing Healthcare, we discuss glucagon-like peptide-1 (GLP-1) agonists, but it's not another "these drugs are going to blow up every plan" sort of discussion. Bridget Mulvenna, a former pharmacy program director and our guest on Episode AH002, shares her experience and opinions about how plan sponsors can work through the decision-making process to cover GLP-1s for weight loss. She also offers some suggestions for consideration and stresses the importance of leveraging data

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00:36:53

AH020 - Why NADAC is a "Ray of Sunshine," with AJ...

The Astonishing Healthcare Podcast ·

2024/05/31

What do you get when schedules line up and AJ Loiacono and Antonio Ciaccia are the guests on a podcast? An episode you must listen to if your work or interests are in any way centered on drug prices. NADAC - national average drug acquisition cost - was the focus of our discussion on this episode of the Astonishing Healthcare podcast. Recent methodology changes and a new survey participant have combined to drive meaningful deflation in generic drug prices. AJ and Antonio dive into why this is

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00:28:02

AH019 - Wrestling with Coverage of High-Cost CGTs,...

The Astonishing Healthcare Podcast ·

2024/05/24

On this episode of the Astonishing Healthcare podcast, Casey Stockman, PharmD, Vice President of PBA Services, joins host Justin Venneri and shares her insights on the complexities of high-cost cell and gene therapies (CGTs), glucagon-like peptides (GLP-1s), and much more. Given the advancements in drug development and million-dollar-plus price tags for many of the CGTs, it is crucial for health plans to navigate the challenges of covering these therapies. Casey discusses outcomes-based agreements,

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00:20:14

AH018 - What's the Right Path? Post-grad Options for...

The Astonishing Healthcare Podcast ·

2024/05/17

On this episode of Astonishing Healthcare, a trio of pharmacists on the Capital Rx team join Justin Venneri and share their experiences and opinions about residency and fellowship programs, including the details of well-designed programs that foster personal and professional growth.

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97 results

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