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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

00:25:30

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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00:23:36

AH004 - Data, Fiduciary Responsibility, and Reversing...

The Astonishing Healthcare Podcast ·

2024/02/09

In this episode of the Astonishing Healthcare Podcast, Jeffrey Hogan, President of Upside Health Advisors, shares his insights on the current state of healthcare and the challenges plan sponsors, including employers and other payers, face. He discusses the importance of aligning supply and demand in the healthcare system in the post-COVID era, the significance of the Consolidated Appropriations Act (CAA), and the importance of establishing a process to evaluate plan data.

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00:16:01

AH003 - What's New in the Partner Channel, with Brian...

The Astonishing Healthcare Podcast ·

2024/02/02

Brian TenEyck, National Director of Consultant Relations at Capital Rx, shares his insights on the pharmacy benefit management (PBM) industry in episode 3 of The Astonishing Healthcare Podcast. He discusses the importance of early engagement in pharmacy procurement, increasing utilization of GLP-1 drugs and prior authorization (PA) approval rates, and the need to hold PBMs accountable for managing plan spend. Brian notes the importance of monitoring per member per month (PMPM) cost trends vs

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00:28:57

AH002 - A Former Pharmacy Program Director's View on...

The Astonishing Healthcare Podcast ·

2024/01/26

Bridget Mulvenna joined Erickson Senior Living to manage pharmacy costs and develop the pharmacy program. She ended up applying what she had learned over years of working in various pharmacy settings and in pharmacy procurement to their pharmacy benefit programs. In this episode of The Astonishing Healthcare Podcast, Bridget shares why it's so hard to control pharmacy costs, as well as her thoughts about reining in specialty drug costs, rebates, coverage of GLP-1s, and the most astonishing thing

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00:39:35

AH001 - Building a PBM: Tech, Navigating Growth, and...

The Astonishing Healthcare Podcast ·

2024/01/19

Capital Rx Co-Founder & CEO AJ Loiacono discusses the path to becoming a pharmacy benefit manager (PBM). He describes why and how using JUDI® aided in the development of a next-generation enterprise health platform, recounts the challenges of growing through the pandemic and transitioning to a distributed workforce, and shares what plan sponsors need from their PBM partners and what is most astonishing to him (hint: it relates to knowing the cost to administer a pharmacy benefit plan)!

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97 results

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