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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

health & fitness medicine

All Episodes

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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00:25:30

AH017 - Pharmacy Benefits 101: Prior Authorization

The Astonishing Healthcare Podcast ·

2024/05/10

In this episode of the Astonishing Healthcare podcast, we tackle one of the more polarizing issues in healthcare: prior authorization (PA for short). Sara Izadi, PharmD, Capital Rx's Chief Clinical Officer, Lorece Shaw, PharmD (Director of PA), and Product Manager Callie Burton-Callegari, join host Justin Venneri for a candid discussion about PA. They cover everything from basics like what a PA is, who decides the criteria, and common reasons for denials to why they are necessary and how technology

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00:19:20

AH016 - The Intersection of Pharmacy, Government...

The Astonishing Healthcare Podcast ·

2024/05/03

This episode of the Astonishing Healthcare podcast explores the intersection of pharmacy and Medicaid in a relatable and understandable way. Jessin Joseph, PharmD, MBA, Senior Director of Pharmacy Benefits Administration (PBA) Services at Capital Rx, joins Justin Venneri for a discussion that starts with his journey from pharmacy school to Kentucky Medicaid, twists through acronyms like NADAC, AMP Cap, and M3P; and ends with why states are using or interested in preferred drug lists (PDLs) and

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00:17:29

AH015 - PBM Legislation, Contracting, and More, with...

The Astonishing Healthcare Podcast ·

2024/04/26

In this episode of the Astonishing Healthcare podcast, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Capital Rx, shares his expertise and experiences from over 25 years in the pharmacy space. He acknowledges that employers and benefits consultants face challenges in a rapidly evolving, complex healthcare landscape and covers several topics impacting health plan sponsors and fiduciaries, including the implications of the Consolidated Appropriations Act (CAA) and avoiding penalties and

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00:31:20

AH014 - The Rise of Conversational AI: Healthcare...

The Astonishing Healthcare Podcast ·

2024/04/19

The astonishing potential of artificial intelligence (AI) for personal and professional use, and in healthcare in particular, is what we explore in this episode of Astonishing Healthcare with Christian Ward, Chief Data Officer at Yext, and Carrie Liken, Head of Yext's Healthcare Industry Practice. They discuss the trends they see in search that reflect changing behavior and ultimately influence how people will find information online. Health systems and other healthcare providers must structure

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00:31:03

AH013 - Redefining Virtual Care: A Blueprint for...

The Astonishing Healthcare Podcast ·

2024/04/12

In this episode of the Astonishing Healthcare podcast, Robert Longyear, Co-Founder of Avenue Health, joins Justin Venneri to discuss virtual care and remote patient monitoring, including the role nurses and pharmacists can play as care models evolve and the importance of timely information exchange.

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00:18:58

AH012 - Revolutionizing Healthcare: Prime & Capital...

The Astonishing Healthcare Podcast ·

2024/04/05

This episode of the Astonishing Healthcare podcast features the CEOs of Prime Therapeutics, Mostafa Kamal, and Capital Rx, AJ Loiacono. They join Michael Passanante, SVP of Marketing & Communications at Capital Rx, to share the story behind the strategic alliance between the organizations and their vision to reimagine pharmacy and provide better care to patients across the country leveraging next-generation technology: JUDI®.

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00:21:04

AH011 - Navigating CMS' M3P, PDE, and Other...

The Astonishing Healthcare Podcast ·

2024/03/29

Navigating and understanding government programs in healthcare can be a daunting task. In this podcast episode, Jason Barretto, Vice President of Government Program Operations at Capital Rx, joins Justin Venneri to shed light on the complexities of regulatory compliance and the importance of meeting the intent of legislation and regulations, including the CENTERS for MEDICARE & MEDICAID SERVICES’ Medicare Prescription Payment Plan (M3P) requirements and new Prescription Drug Event (PDE)

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00:21:11

AH010 - The Power of PMPM: Holding PBMs Accountable...

The Astonishing Healthcare Podcast ·

2024/03/22

Per member, per month (PMPM) cost plays a crucial role in healthcare, particularly in pharmacy benefit management. On this episode of the Astonishing Healthcare Podcast, Kristen Begley, PharmD, Chief Commercial Officer at Capital Rx, emphasizes the significance of PMPM guarantees and how they help hold pharmacy benefit managers (PBMs) accountable for total drug spend. The PMPM calculation provides a simplified way to evaluate drug spend by dividing the total plan spend by the number of members. This

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00:21:07

AH009 - Modern Technology in Healthcare: Enhancing...

The Astonishing Healthcare Podcast ·

2024/03/15

Capital Rx Co-Founder and Chief Technology Officer Ryan Kelly joins Justin Venneri for a discussion about the genesis of JUDI, Capital Rx's enterprise health platform, security in the wake of recent cyber attacks, AI use cases, what frustrates him to no end, and the most astonishing thing he [continues to] see in the industry (hint: it should have died long ago, but it's still used, and sometimes favored).

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00:21:39

AH008 - Ask the Right Questions to Future-Proof Your...

The Astonishing Healthcare Podcast ·

2024/03/08

In this episode of the Astonishing Healthcare podcast, Justin Venneri interviews Josh Golden, who brings his extensive experience as a healthcare consultant and Senior Vice President of Strategy at Capital Rx to the discussion to highlight key questions that plan sponsors should ask to future-proof their pharmacy benefit programs. It is crucial to understand how PBMs make money and how much a plan sponsor is paying their PBM. The answer to the first part helps explain PBMs' behavior, and the answer

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00:34:17

AH007 - There’s No Value-Based Care Without...

The Astonishing Healthcare Podcast ·

2024/03/01

In this episode of the Astonishing Healthcare podcast, Dr. Sunil Budhrani, Chief Innovation and Medical Officer at Capital Rx, discusses the intersection of value-based care and pharmacy. He explains the concept of value-based care in a clear and relatable way and describes how it has evolved over the years. Dr. Budhrani, who remains an active ER physician, shares his experiences from different roles across the healthcare system and highlights how we can move toward a true value-based framework

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00:20:47

AH006 - Pharmacy Benefits 101: Clinical Care Teams,...

The Astonishing Healthcare Podcast ·

2024/02/23

On this episode of The Astonishing Healthcare Podcast, Amy Stockton, PharmD, who manages the clinical care team at Capital Rx, discusses what, exactly, her team of pharmacists in a non-traditional, managed care setting does (hint: it's a lot behind the scenes). She highlights the clinical programs the team supports, including low-cost alternative, pharmacogenomics, and medication therapy management (MTM), to name a few, what it's like working with frontline customer care, how technology - i.e.,

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00:17:37

AH005 - Star Ratings, MTM, & CMS Translation...

The Astonishing Healthcare Podcast ·

2024/02/16

Discover the ins and outs of Medicare Star Ratings and CMS translation requirements in this insightful podcast episode. Join Justin Venneri and Jay Tran, PharmD as they delve into the significance of Star Ratings for health plans and Medicare payers, discussing what the ratings are based on, what drives bonus payments, as well as the role of medication therapy management (MTM) in star ratings and upcoming changes in the eligibility criteria. Additionally, this episode explores the importance of the

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104 results

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