Reimagining pharmacy benefits to rebuild trust in healthcare.
Drug pricing in the U.S. is an illusion. For both uninsured and insured patients, drug pricing "appears" to change every hour, of every day, for every drug, generally well above what the average American can afford. The reality is that drug prices are intentionally manipulated by every insurance carrier, pharmacy benefit manager (PBM), and prescription discount cards to maximize profitability. Drug pricing is incredibly stable and contrary to popular belief, net drug prices for brands and generics have deflated for ten years, but patients never realize this. There would be no need for discount cards if PBMs and carriers would stop artificially changing prescription prices. Furthermore, discount cards contract with the very PBMs that manipulate drug prices and use the same “variable profitability” scheme to achieve margins of $7 or more per script. To put this in perspective, a discount card does not require complex integration of accumulator feeds, eligibility files, drug utilization review, clinical oversight, prior authorization, call center access, plan reporting, etc. Capital Rx charges a fee that is 50% less than a discount card’s margin but provides all these services and uniformly deliver the lowest prices for its patients. Capital Rx is the first company to expose this national fraud and put the patients’ interests first. By removing the inherent conflict of interest, created through variable drug profitability (more expensive drugs, yield more money for the PBM), Capital Rx delivers the lowest prescription prices (equally, to all customers) and the highest level of patient care.
Capital Rx believes an efficient market, where buyers (employers/patients) and sellers (pharmacies) freely communicate on price, is the only way medication truly becomes accessible, affordable and allows patients to finally receive the best care. To deliver this innovative model, Capital Rx built the industry’s first Enterprise Pharmacy Platform to facilitate electronic prescription transactions, clinical workflows, and administrative support. Our platform, JUDI, is the first cloud-based, platform-as-as-service, to pharmacy management. Unlike older PBM systems, that only contemplate the “middle-layer” of plan setup and claim processing, JUDI is a true enterprise platform that manages every workflow of a PBM, including underwriting, plan implementation, network management, client billing, net reimbursement, clinical support, call center operations, member communication, patient tools, client billing, financial recon, reporting, and network reimbursement. JUDI’s holistic, connected approach between the provider, pharmacy, plan, and patient, provides the necessary framework to reduce patient costs and improve care.
As a whole, the PBM industry relies upon antiquated technology that was developed decades ago. Due to the industry favoring consolidation over innovation, these legacy systems never evolved and remain a cobbled together patchwork of inefficient solutions. These systems are incredibly expensive to maintain and rely upon the hidden profitability of spread pricing to obscure costly overhead. For example, these aging systems are incapable of moving beyond a “one-size-fits-all” formulary (PBM level) and static plan designs for companies (group level). JUDI is the only PBM platform capable of providing the framework to administrate individual plan designs and unique treatment programs at the patient level. To democratize drug prices and deliver upon the promise of precision medicine, Capital Rx needed to build the industry’s first enterprise pharmacy platform. JUDI, which is short for “adjudication,” moves beyond simple claim processing and manages every administrative workflow within a PBM, from underwriting, to implementation, clinical support, and call center operations. JUDI is the not only the brains behind our company’s operational infrastructure, but also the clinical watchdog, politely making recommendations to patients for lower cost medications that improve their health in real time.
Capital Rx is the industry leader in prescription cost savings and customer satisfaction. The following press releases and customer testimonials validate our success story: https://www.businesswire.com/news/home/20210330005144/en/Capital-Rx-Crushes-Net-Promoter-Score%C2%AE-and-Receives-100-Percent-Positive-Feedback-on-Client-Implementation-Satisfaction
Our clients achieve negative drug trend, with prescription spend decreasing each year. For Q1 2021, all our clients realized a 27% cost savings and we’ve received an industry-leading customer satisfaction. We’re proud to change the way prescriptions are priced, making medications more affordable for patients and delivering better health outcomes.