Capital Rx
2025 got off to a fast start here at Capital Rx, with spotlights in Forbes and Business Insider, bylines in EBN and BenefitsPRO, new award wins, and our annual Partner Summit! Read on for a deep dive into all our newsworthy moments from January to March 2025.
80 New Partnerships in 2024, 2025 Off To an Incredible Start
We started the year off with a bang, announcing more than 80 new partnerships added in 2024, including iconic brands, innovative health systems, state municipalities and governments, and several of America’s larger employers. Now, more than ever, it’s vital for plan sponsors and health plans to have objective pharmacy benefit administration that prioritizes their plan’s success and wellbeing over everything else.
As our Chief Commercial Officer, Kristin Begley, PharmD, explained, “There are very real, tangible benefits of working with an objective, conflict-free, and financially aligned partner.”
Last year's growth set us up for another big year in 2025, and it's off to an astonishing start. So, stay tuned – we’ll have plenty of news to share.
Going Beyond the PBM Model – Healthcare’s First Unified Pharmacy and Medical Claims Processing Platform, Judi Health™
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While eagle-eyed readers of Capital Rx Insights and listeners to our podcast, Astonishing Healthcare, may not be entirely surprised by this announcement (we hinted at it more than a few times in 2024), we announced that our team built and deployed healthcare’s first Unified Claims Processing™ platform, capable of processing both medical and pharmacy claims on the same platform (with dental and vision in the near future).
There is no understating how big this development is. With likely more than $1 trillion worth of administrative waste in healthcare attributable to legacy infrastructure and redundant processes, Judi Health represents an opportunity to create and implement a single source of truth for benefit administration, eliminating that waste and creating a more streamlined, accurate, and cost-effective process.
Furthermore, starting in January 2025, we moved our team to Judi Health. Although it’s still very early, we’re seeing cost savings overall for our population of ~1,100 members, and the initial member experience stats are amazing.
Capital Rx 2025 Partner Summit Highlights: The Future of Claim Administration & Benefit Management
In March, Capital Rx held its 2nd annual Partner Summit in New York City, bringing together over 100 industry partners, experts, clients, prospects, and team members to discuss pressing healthcare issues. Over the course of 2 days, we held sessions on legislative trends and regulatory updates, GLP-1s, AI in healthcare, how to assess PBM value outside of the traditional spreadsheet approach, and how Judi Health and Unified Claims Processing usher in a more efficient, cost-effective, and accurate future for healthcare.
Some of the biggest takeaways from our Partner Summit included:
- States are aggressively pushing for PBM reform, but PBMs continue to claim ERISA exemption. The potential remains for de-linking and other reform initiatives to eventually pass at the federal level.
- The gross-to-net bubble, with all value put in, is estimated to be ~$330 billion, and total drug spend in the U.S. stands at ~$800 billion. That is an immense amount of money – rebates, copay assistance, discounts, patient assistance programs, etc. – flowing through the healthcare system for pharmaceuticals to the benefit of traditional middlemen.
- The U.S. healthcare system likely contains more than $1 trillion of administrative waste attributable to legacy infrastructure and redundant processes. That’s why we need a single source of truth where everyone can see all the workflows in real time.
- Jeannine Chiappini (Vice President, Benefits Consulting Practice Leader, Borislow Insurance) about being a Capital Rx client: “We are two years into the contract now, and we are at the point in our annual cycle where consultants are meeting with the schools and doing renewals. We are forecasting negative pharmacy trend for the schools. And we have a $30 PMPM savings versus two years ago.”
Karen Dierker Ranks Among the Top 50 Women Leaders in Healthcare Technology
As our co-founder & CEO, AJ Loiacono, always says, “You can’t build a great company without great people.” And this year, one of the organization’s leaders, Karen Dierker, was recognized for all her hard work, being listed on The Healthcare Technology Report’s Top 50 Women Leaders list!
Karen was one of Capital Rx’s first ten employees, and over the years she has been instrumental in numerous projects and initiatives, including helping develop, deploy, and enhance Judi, which has enabled everything from future proof pharmacy benefit administration to more seamless customer care capabilities and healthcare’s first Unified Claims Processing platform.
She also has been instrumental in implementing our organization’s first SaaS solution contract, as part of Capital Rx’s strategic alliance with Prime. implementing the first SaaS solution contract under the alliance with Prime, whereby Prime will leverage an instance of Judi to support its operations.
Put simply, Karen has been an integral part of our organization, and we could not be happier to celebrate this incredible win!
Capital Rx Inducted into the Inaugural Hall of Fame by Digital Health New York (DHNY)
As some may have read in 2024, Capital Rx appeared on the Digital Health NY (DHNY) 100 list for five straight years. As a result of that accomplishment, Capital Rx was named to DHNY’s inaugural Hall of Fame, making our organization one of just 28 to earn that distinction. The Hall of Fame honorees were published alongside DHNY’s 2025 New York Healthcare Innovation Report, which analyzes the digital health sector's investment trends, challenges, and opportunities.
This distinction was special for Capital Rx, since we are based in NYC. As AJ explained, “Our roots are here in New York City, and we’re proud to call this city, which has become the health technology capital of America, our home. New York has a special blend of talent, resources, and community that has driven healthcare innovation to new heights.”
Capital Rx Was Highlighted Numerous Times in the News for its Innovative Approach to Health Benefit Administration
Capital Rx has been mentioned a few times in the news to start the year off. Two articles in particular were in Forbes Magazine, discussing our financially aligned and unbiased approach to pharmacy benefit administration.
The first article, penned by Seth Joseph, gave a look at everything that’s going on in health technology right now, including the increased pressure on the traditional PBM model from Congress and ERISA class-action lawsuits. As he mentions in the article, both Federal and State governments are attempting to enact bipartisan legislation to regulate PBMs’ power.
AJ was asked about his thoughts on these developments, and he said, “It matters because of the inherent conflicts of interest that come with a PBM making money on drug spend through mail order or at a retail pharmacy, for example. The more expensive a medication is, the worse the optics are if a traditional PBM earns a spread.”
The second article, written by Joshua Cohen, covers how different PBMs approach patience access to cheaper biosimilar drugs. As Cohen notes in the article, the traditional PBM model tends to favor higher list-priced products, as they tend to bring in greater rebates. But that’s not Capital Rx’s approach. As Cohen notes, “And then there are examples of non-traditional PBMs, like...Capital Rx, which operate a model in which rebates don’t play a role. Here the cheapest products do tend to be favored.”
It should come as no surprise to anyone familiar with our financially aligned model that we prefer to help our clients reduce costs, not raise them, and these articles offer keen insight into how we accomplish that goal.
Rebecca Torrance from Business Insider also wrote about our organization and our tech-enabled approach to pharmacy benefit administration. AJ was quoted in that article, noting, “"We are witnessing a tipping point in the PBM industry, with millions of lives moving to Capital Rx for superior customer service, improved patient outcomes, and reduced drug prices."
Last but certainly not least, our General Counsel & Chief Compliance Officer, Lloyd Fiorini, was highlighted in HR Brew for an article about the recent ERISA lawsuits and the implications they have for HR professionals. As Lloyd mentioned, the aggregate pricing model results in “some really irrational pricing for drugs that shouldn’t be anywhere close to that price.” The article also mentions that Capital Rx advocates “a framework that provides more visibility into the individual price of specific drugs, with consistent pricing across plans.”
Hope Nakazato and Bridget Mulvenna Penned Articles in External Publications
If you read BenefitsPRO or Employee Benefit News over the last few months, you likely saw articles written by our National Vice Presidents of Business Development, Bridget Mulvenna and Hope Nakazato.
In February, Hope wrote an article in BenefitsPRO discussing why switching away from a traditional PBM model could be beneficial, even if it’s scary. As she notes, “...with pharmacy costs and health care spending nearing unsustainable levels and all-time highs and great scrutiny of the fiduciary obligations of plan sponsors, the stakes are too high to hope for better communication, collaboration, and results from traditional PBMs.”
Then, in March, Bridget Mulvenna wrote an article in Employee Benefit News that detailed five strategies employers can use improve their PBM procurement process, including starting the RFP process earlier, thinking beyond traditional spreadsheet analysis when assessing a PBM’s value, and breaking the addiction to rebates. She also followed this up with a webinar where she dove deeper into this strategies and fielded questions about them.
Bonnie Hui-Callahan Recognized as One of Modern Healthcare’s Leading Women for Her Clinical Leadership
Bonnie has been a rockstar at Capital Rx for years, and it was amazing to see her listed as one of Modern Healthcare’s Leading Women, under the Rising Stars category!
Ever since joining the organization back in 2021, she has led our Clinical team to deliver quality programs that cut costs, promote patient safety, and improve the quality of care. Among her many accomplishments, Bonnie and her team revamped Capital Rx’s opioid safety program, resulting in a significant reduction in daily opioid exposure for members.
In addition to her work on Capital Rx’s clinical programs, Bonnie also helped found Capital Rx’s first affinity group for Asian Americans, CAPTAIN, and has hosted over a dozen virtual events for Capital Rx’s hundreds of employees between discussing challenges as women of color in the workplace, celebrating Asian holidays, and promoting overall health and wellbeing.
We could not be prouder of Bonnie’s success and look forward to everything she’ll accomplish in the future.
Capital Rx Ranks No. 18 on Inc.’s 2025 List of the Fastest-Growing Private Companies in the Northeast
For the fourth year in a row, Capital Rx has ranked on Inc.’s 2025 Northeast Regional list. Ranking on this list for consecutive years is not easy, as it requires business to consistently be growing and to be at least meeting or exceeding the median growth rate of other companies in the area.
This year, Capital Rx improved its ranking by double digits, from #32 to #18. This growth has been driven by increased demand for our aligned approach to pharmacy benefit administration and our tech innovation (not to mention our introduction of a new Medicare Prescription Payment Plan (M3P) solution, our strategic alliance with Prime, and the numerous certifications and accreditations our team earned).
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