Market Mover

Rising pharmacy spend is a primary concern for most employers, health plans, and health systems who are increasingly frustrated by the opaque pricing, fees, and misaligned incentives that the pharmacy benefit management (PBM) industry is known for.

With this market backdrop, Capital Rx, the fastest-growing independent PBM in the country, announced two industry-shaking partnerships in the span of 6 months.

• Prime Therapeutics (Prime), a pharmacy solutions organization owned by a consortium of 19 Blue Cross and Blue Shield health plans, announced a strategic alliance through which Prime will be able to leverage its own instance of Capital Rx’s software JUDI® - a modern enterprise health platform - to serve its 50M+ members. JUDI will help Prime accelerate its pace of innovation while enhancing core capabilities and ensuring state-of-the-art security. ‍
• Capital Rx announced major commercial and investment partnerships in Q4 2023 with a consortium of major health systems.
  • Capital Rx was identified as best-in-class by the Health Management Academy’s Strategic Partnership Alliance due to Capital Rx’s mission-aligned PBM model and technology stack.
  • Over 10 of the nation’s leading health systems - and HMA members - invested in a more than $50 million strategic round.  Atlantic Health System, Banner Health, Hawai’i Pacific Health, Inova Health System, Lehigh Valley Health Network, Memorial Hermann Health System, Nebraska Medicine, Novant Health, Ochsner Health, and WellSpan Health, among other innovative health systems.
  • Partners recognize the strategic importance of collaboration to accelerate the pace of innovation in the PBM industry, improve the affordability of drugs, and bring transparency to drug costs.

The pharmacy supply chain is incredibly complex and confounding.      

• Despite generic and brand drug price deflation for years, prescription drug costs for payers providing pharmacy benefits to their employees or members have been soaring due to:
  • increased utilization of high-cost specialty therapies, and‍
  • broken drug pricing model fueled by spread pricing and manufacturer rebates that drive decisions toward more expensive drugs.

Capital Rx provides an end-to-end PBM solution built on a simple, transparent pricing model, including 100% rebate pass-through and the first modern, cloud-based platform in decades - JUDI - that can be licensed separately to health systems and health plans, or accessed by employers to use for self-administration, including network and formulary customization, for example.      

Capital Rx:

• Services all lines of business across commercial and government plans
• Boasts a client NPS of > 90, one of the highest among healthcare companies, and is a leader in member service (>85 member NPS)
• Provides 10% – 30% average first-year savings on pharmacy benefit spend, and
• Best-in-class industry client retention of 98%

Given rising federal and state pressure for PBM reform to ban or substantially alter legacy PBM business practices, and the potential for JUDI’s utility to include medical claims, the Capital Rx business model is making waves.