The Astonishing Healthcare Podcast

On this episode of Astonishing Healthcare, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Judi Health, returns to the studio for a discussion about the barrage of regulatory changes shaping the pharmacy benefit manager (PBM) landscape in early 2026. Within just two weeks, the Department of Labor announced new proposed rules, the Consolidated Appropriations Act of 2026 became law, and the FTC's announced a settlement with Express Scripts. Then, to top it all off, TrumpRx went live.

Lloyd offers clear, helpful explanations of the key takeaways from each of these concurrent reforms aimed at improving transparency and how PBMs...

On this episode of Astonishing Healthcare, Judi Health's Mike Tate (VP, National Business Development) and Mark Pearce (Director, TPA Operations) join us in the studio to discuss the role of Third-Party Administrators (TPAs) in the self-funded employer market. As Mike explains, TPAs act as the "enforcers" of an employer's plan document, responsible for pulling everything together and ensuring claims accuracy, network access, and financial stewardship. Mark dives into the distinction between carrier-owned (ASO) and independent TPAs, explaining how independent models offer greater flexibility in plan design. And of course, they highlight a significant industry challenge: legacy technology.

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For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had...

For Episode 99 of Astonishing Healthcare, we welcome Hannan Allen, SVP of Consultant Relations to the company and show! The discussion builds on Episodes 90 and 93, with Jim Winkler of Business Group on Health and Susana Villegas Spillman, respectively, by explaining why "pharmacy benefit consultants have a really tough job right now" and tackling some timely questions, including how has the role of the benefits broker or consultant evolved? What's making the job so complex lately? And, are plan sponsors' primary needs changing? We cover these questions and many more - including who will win Super Bowl LX. - with Hannan...

This episode of Astonishing Healthcare features three members of The Judi Group's leadership team: Jeff Hogan (Co-Founder & Managing Director), Chris Deacon (Director, Growth & Strategy), and Julie Selesnick (Director, Legal & Compliance). The Judi Group is a new venture - a premier advisory firm in healthcare on a mission to help companies evaluate the totality of their health vendors and contracts, deliver insights that lead to more responsible action, and ultimately improve the overall cost picture and health outcomes for their health plans and plan members, respectively. But why now? What steps can employer plan sponsors take to improve their contracting...

For Episode 97 of Astonishing Healthcare, we sat down with three team members who interned with Judi Health (Capital Rx) and recently joined our mission as full-time employees! Jakob Deel, Lisa Yu, and Bryan SebaRaj discuss their respective paths to Judi Health, from why they chose healthcare and how they found their internships to why they decided to join a newer, disruptive health tech company over larger "hyperscalers." So, this episode has something for every undergrad and graduate student.

That said, Episode 97 isn't just about landing an internship or transitioning from an intern to full-time employee. The trio...

For Episode 96 of Astonishing Healthcare, Jason Barretto, our SVP of Government Programs, returns to the show for a discussion about what's happening on the health plan side of the business. As a company, we spend a lot of time talking about and showing how modern technology streamlines benefit administration workflows and overall operating efficiency, solves longstanding problems, and helps clients stay nimble to meet the intent of new regulations. Well, Jason's experience managing PBM relationships at health plans helps him - and our team - add real value when working with our clients. And, thankfully, he loves to talk...

Episode 95 of Astonishing Healthcare features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that’s packed with insightful reflections and optimism about the future.

We won’t ruin it in the show notes, but ba...

We got the ball rolling in 2025 with this episode, and it ended up at the very top of the activity list, so we'll close out the year with it as well! Thank you, Dr. Eric Bricker for joining us in the studio for Episode 48 of the Astonishing Healthcare podcast. Known for his entertaining and educational videos covering all sorts of hot topics in and around healthcare and employer/employee benefits, Dr. Bricker and host Justin Venneri discussed the issues of high-cost drugs and access to claims data - two topics he covered on AHealthcareZ - Healthcare Finance Explained...

In this Best of '25! episode of the Astonishing Healthcare podcast, Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations) discuss our approach to member care! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up.

Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors and benefits consultants often ask during the RFP process (Episode 84), this episode covers:

Episode 94 of Astonishing Healthcare features two members of our product team, Liya Lomsadze (Sr. Director) and Jake Mulkey (Director), who explain how building a next-generation pharmacy claim adjudication system (Judi®), known for its split-second accuracy and streamlined workflows, served as the perfect foundation for building a unified platform that now includes medical claims, and will integrate vision and dental, too. Liya and Jake explain the contrast between pharmacy’s real-time nature and medical’s weeks-or-months-long lag, and how this gap impacts the experience for members and providers of care.

The discussion covers the challenges behind supporting complex plan...

Episode 93 of Astonishing Healthcare features Susana Villegas Spillman, who brings over 20 years of health benefits plan management experience to the studio for a discussion about what works, what’s broken, and what employer plan sponsors deal with day in and day out. This “unfiltered perspective” from the plan sponsor’s seat is welcome and timely. If you’re one of the increasingly large percentage of benefits directors, CHROs, CFOs, et al. out there looking to transition from a traditional benefits experience to a new, transparent, aligned, unified model, this episode is for you!

Susana explains how a fragmented...

The level of interest in Episode 84 of Astonishing Healthcare made this one an easy choice to lift it to "best of" status. We'll be back with fresh new episodes in early December, and then we'll close out the year with two more Best of '25s. For those of you who didn't check this one out, Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, joined host Justin Venneri in the studio for a discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, b...

In this episode of Astonishing Healthcare, Judi Health's Sam Custer, who leads the member communications team, shares tips and insights on how to communicate effectively with plan members - around open enrollment and throughout the year. Sam last joined us for Episode 39, which highlighted how the communications and product teams collaborated to ensure we provide clear, compliant communication materials to Medicare members to meet CMS requirements, and this time, we dive into how to educate plan members at open enrollment and throughout the year. After all, as Marsha Perry, our head of benefits and compensation, explained during Episode 72 - The Benefits You Probably Didn't Know You Have, benefits-related education is more than just a once-a...

On Episode 91 of Astonishing Healthcare, we dove into the Workplace Intelligence Forecast for 2026 - The 10 Trends Businesses Need to Focus On! Here at Judi Health, we obviously live in the health benefits world and generally focus on content revolving around the pharmaceutical supply chain (i.e., PBM), health tech, and the administration of employee benefits, more broadly... but there is A LOT more going on our there that impacts America's workforce. Our guest, Dan Schawbel, Managing Partner of Workplace Intelligence (links below), has been tracking and publishing research on workplace trends for well over 15 years, and he unpacks the...

For Episode 90 of Astonishing Healthcare, Jim Winkler, Chief Strategy Officer at Business Group on Health, joins us in the studio for a lively discussion about the results of their 2026 Employer Health Care Strategy Survey! This annual study is packed with qualitative and quantitative information and highlights the top trends in employer-sponsored health care. Jim brings decades of experience to the table and puts helpful context around the headline data and employers' expectation for a ~9% year-over-year health care cost increase. He also shares his perspective on the evolution of the role benefits brokers and consultants play, how employers can navigate...

On Episode 89 of Astonishing Healthcare, we are talking about some "visual treats," as the title suggests! Our guest, Andrew Tsang, has been posting some very cool things on LinkedIn of late, including Sankey and other dynamic charts highlighting where the money flows in healthcare (from the premium dollars to the care plan members receive), and which stakeholders win or lose in different scenarios via a 5-Way Seesaw he developed using AI! If you're a [healthcare] data nerd, this episode is definitely for you, and you'll want to check out:

On Episode 88 of Astonishing Healthcare, we're celebrating Women Pharmacist Day (#WPD2025) and sharing stories from four of our amazing team members: Allison Gallant, PharmD (Sr. Strategic Account Executive), Cindy Strassner, RPh (Customer Success Pharmacist), Lorece Shaw, PharmD (Sr. Director of Prior Authorization and Clinical Care), and Hope Nakazato, PharmD (VP of National Business Development). These women aren't just talking about improving healthcare or celebrating one day - they're actively promoting and implementing change, mentoring the next generation of pharmacists, and building systems to improve clinical workflows and member care.

Lorece, Allison, Hope, and Cindy highlight their career...

In this episode of Astonishing Healthcare, return guest Libbi Green, PharmD (Manager, Formulary Operations) joins Justin Venneri for a discussion about the 2025 flu season, including the latest vaccine-related updates that employer plan sponsors and plan members need to know. We discuss the effectiveness of last year's flu vaccines, factors influencing the rates, vaccination timing, and how there can be differences in state vs. federal guidelines, among other topics!

Highlights

Episode 86 of the Astonishing Healthcare podcast focuses on several pharmacy and health plan member service-related topics with Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations)! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up. Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors can ask during the RFP process (Episode 84), we discuss:

This episode of the Astonishing Healthcare podcast features a unique client of ours - Andy Glade, Senior Director of Trade Operations at Valeris. We discussed how to remove financial barriers to care and streamline access to the medications people need through the use of copay cards, vouchers, and patient assistance programs (PAPs). In a rapidly evolving market, these programs play an important role in reducing prescription abandonment and increasing adherence in convenient ways, particularly for chronic conditions and when extremely expensive specialty medications are prescribed.

Additional highlights from the conversation with Andy include:

In this episode of the Astonishing Healthcare podcast, host Justin Venneri is joined by Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, for a timely discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, but, as Josh describes, there are some "tectonic shifts" happening as plan sponsors demand to see more options (i.e., transparent PBMs) and benefits brokers and consultants upgrade the questions and...

Episode 83 of the Astonishing Healthcare podcast features returning guest, Bridget Mulvenna (VP, National Business Development at Capital Rx)! We discuss specialty drugs, pharmaceutical manufacturer rebates, and the shift to biosimilars. Yes, GLP-1s come up as well (how could they not?), and Bridget explains how employer plan sponsors can consider opportunities to provide access to these medications while not ignoring their inflationary potential and the economic impact on the plan - i.e., how to pivot from a rebate-driven models to a net-cost approach, facilitating more accurate cost management and budgeting.

Highlights

In this episode of the Astonishing Healthcare podcast, Tracey Rollins, CPM (Sr. Director, Client Implementations) and Kristen Morgan (Director, Health Plan Implementations) join Justin Venneri in the studio for a discussion about pharmacy benefit implementations and how switching to an aligned, transparent partner can be efficient and a pleasant experience, despite the complexities involved.

Tracey and Kristen explain how employers and health plans can prepare for and manage the transition to a new pharmacy benefits partner, emphasizing the role that the PBM should play and the importance of making strategic decisions early in the process to build tru...

This special episode of the Astonishing Healthcare podcast features Congressman Jake Auchincloss, who discusses his efforts to reform pharmacy benefit managers (PBMs) and address systemic issues in the U.S. healthcare system to bring down costs. Representing Massachusetts' 4th district and growing up in a family of medical professionals and scientists, Rep. Auchincloss draws on his experience to advocate for policies that promote competition, innovation, and improved access to affordable care. He highlights his Pharmacists Fight Back Act (H.R.9096), noting that he looks forward to reintroducing the widely supported, bipartisan bill that aims to protect independent pharmacies, employers, and...

Episode 80 of the Astonishing Healthcare podcast focuses on care navigation! Our guest, Andy Kageleiry (VP, Judi Care), explains the role of care navigation in helping health plan members (i.e., healthcare consumers) find care and navigate the complex U.S. healthcare system. He also discusses the importance of care navigation from the perspective of a plan sponsor. While everyone in the healthcare industry talks about patient-centered care and controlling costs, patients are left to navigate fragmented systems that work against them. Andy cuts through this contradiction and explains how care navigation can help as a core piece of the hea...

In this episode of the Astonishing Healthcare podcast, Mike Miele, FSA, MAAA (SVP of Insured Services), joins us again for a lively discussion about a new product and the growth of level-funded pharmacy plans. What are level-funded plans? How does Capital Rx's "Capital Equilibrium" work? Listen in to hear how these plans, positioned between self-funded and fully insured models, offer employers budget certainty while maintaining flexibility and transparency. Mike highlights the scenarios where a level-funded plan can truly help - e.g., a municipality with a fixed budget and the role stop-loss plays (building on Episode 55), and he also not...

In this episode of the Astonishing Healthcare podcast, Capital Rx's Dr. Sunil Budhrani (Chief Innovation & Medical Officer) and Mike Tate (Vice President, National Business Development) discuss the questions they are fielding from channel partners and prospects interested in Judi Health™ - the first unified medical and pharmacy solution. We explore advancements in unified claims processing and how it helps address healthcare's fragmented nature by integrating pharmacy and medical benefits data with preferred vendors to tackle specific needs (e.g., for women's health or chronic condition management). Sunil also shares early, updated data revealing a ~5% per-employee-per-month (PEPM) reduction in costs YTD w...

In this episode of the Astonishing Healthcare podcast, host Justin Venneri sits down with Lauren Carroll, PharmD, a Senior Clinical Programs Manager at Capital Rx, to discuss Rx Retro, a pharmacist-led program that focuses on medication deprescribing to enhance patient safety, reduce adverse drug events, and improve healthcare outcomes. Lauren shares insights into how Rx Retro leverages Judi® - Capital Rx's enterprise health platform - to identify and address drug therapy concerns through a series of alerts and outreach designed to promote the safest and most effective treatments for plan members. The conversation also highlights the broader implications of de...

In this episode of the Astonishing Healthcare podcast, we discuss recent health policy news and how to bring greater transparency to health benefits programs with returning guest, Jeff Hogan, President of Upside Health Advisors. Building on our previous discussion with Jeff - How First-Movers are Taking Control of their Health Plans in 2025 - we shed more light on the “PBM boogeyman” narrative, explaining how opaque pricing structures and unhelpful provisions buried in contracts must be discovered. Jeff reviews attempts by states around the country to intervene and halt steering and other practices that negatively impact health plans and their memb...

In this episode of the Astonishing Healthcare podcast, host Justin Venneri speaks with Lindsey Butler, PharmD, Vice President & Clinical Pharmacy Consultant at Lockton, and Chris England, Vice President of National Business Development at Capital Rx. They discuss what health systems need from a pharmacy benefit management (PBM) partner, the challenges in today's market, and the opportunities for innovation and collaboration to advance care for the patients in the communities health systems serve. State-level regulatory changes are top of mind, and Lindsey explains what she's tracking and how she's approaching meeting her clients' unique requirements: How can the benefits program...

On this episode of the Astonishing Healthcare podcast, Carrie Liken (now with Snowflake) returns to the show to discuss the exceptionally rapidly evolving search landscape and Google's new AI Mode. Are websites dying as AI-powered search ascends in popularity? According to Carrie, it looks that way. She and host Justin Venneri discuss the transformative impact of AI on healthcare search and patient journeys. They explore how tools like Google’s new AI Mode and ChatGPT are reshaping how consumers find healthcare information, reducing reliance on traditional websites. Carrie shares insights from her "mini research studies," highlighting the challenges and de...

The latest episode of the Astonishing Healthcare podcast dives into the functionalities and real-world impact of Rx Smart Save, a low-cost alternative program designed to reduce medication costs for both patients and plan sponsors. Jackie Lolos, PharmD, and Haleh (Halls) Campbell, PharmD, join Justin Venneri in the studio for a discussion highlighting the innovation and care behind this clinical program.

Jackie and Halls outline how the two levels of Rx Smart Save work, with Level 1 empowering members to independently switch to lower-cost, clinically equivalent medications via notifications on the Capital Rx app or web portal. Level 2 increases...

On Episode 72 of the Astonishing Healthcare podcast, Marsha Perry, Capital Rx's Head of Benefits and Compensation, joins host Justin Venneri in the studio for a conversation about the intricacies of employee benefits, beyond pharmacy benefits! At a high level, she shares her thoughts on setting up a "well-rounded and affordable" benefits package, what should be in the benefits guide, and how to drive app usage and engagement in underutilized programs (a little humor and sharing personal stories almost always helps 😀).

Additionally, Marsha offers some specific examples of "benefits people [often] forget they have," and she dives into the...

This episode of the Astonishing Healthcare podcast features Michael Kleinrock, Director, Research Development at the IQVIA Institute for Human Data Science. We explore key highlights from their most recent annual report - Understanding the Use of Medicines in the U.S. 2025 - with an eye toward implications for plan sponsors and the health benefits market. What are the key drivers of higher drug spend beyond GLP-1s? At what cost do consumers abandon prescriptions at the counter? How is biosimilar adoption going, and what impact is it having on trend? We answer these questions and many more, including how...

This "Best of '25!" episode of the Astonishing Healthcare podcast highlights Episode 58, which featured Liya Lomsadze (Director, Product Management) at Capital Rx. Liya highlights her journey from data analytics on the provider side to leading the product development of Capital Rx's Unified Claims Processing™ product, Judi Health™. We'll be back with a fresh new episode next week, but given the acquisition of Amino Health and launch of Judi Care, a unified "front end" pharmacy and medical care navigation solution, we think having an understanding of what the back end - or "chassis" - is capable of helps paint a pict...

In this special episode of the Astonishing Healthcare podcast, Capital Rx Co-Founder and CEO, AJ Loiacono, and John Asalone, Executive Vice President of the newly formed Judi Care (former CEO of Amino Health), join Justin Venneri in the studio for a discussion about Capital Rx's acquisition of Amino, a unique care navigation company. The conversation covers everything from the background on how AJ and John met to "What is care navigation?" and how Judi Care offers 1) health plan members (i.e., healthcare consumers) a differentiated way to take control of their individual healthcare journeys, and 2) plan sponsors and other pay...

This episode of the Astonishing Healthcare podcast highlights two recent posters presented by Zachary Brunko, PharmD (PGY1 Managed Care Pharmacy Resident), and Nash Albadarin, PharmD, MBA (Associate Director, Clinical Programs Business Development), at AMCP 2025 and the 2025 PQA Annual Meeting, respectively.

We won't give away the conclusions, but Zach explains the team's research on International Classification of Diseases (ICD) codes and how they evaluated the accuracy and reliability of ICD codes submitted on pharmacy claims. Additionally, they sought to identify patterns in ICD code submissions across client types, drug classes, disease states, pharmacy networks, and regions.

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This episode of the Astonishing Healthcare podcast is all about Pharmacogenomics (PGx), a critical component of precision medicine that ensures the medications prescribed to patients align with their genetic makeup.. To explain everything from what PGx is and barriers to broader adoption to the future state of integrated care, Burns Blaxall, PhD (Senior Vice President of Precision Medicine at Aranscia), and Caitlin Munro, PharmD (Sr. Clinical Programs Manager at Capital Rx), joined Justin Venneri in the studio.

Burns and Caitlin discuss the growth of biomarkers on drug labels and use cases where PGx has been most helpful to date (e.g., behavioral health), the cost of testing, lack of insurance coverage and appropria...

In this episode of the Astonishing Healthcare podcast, Justin Venneri speaks with Kristin Begley, PharmD, Chief Commercial Officer at Capital Rx, about the evolving role of Pharmacy Benefit Managers (PBMs) and the rapidly accelerating shift in demand for an "unbundled," agnostic model. But what does unbundling mean? How does this approach help to avoid conflicts of interest? What parts of a pharmacy program can be carved out or unbundled to allow plan sponsors the freedom to design a plan that meets their unique populations' needs? Kristin answers these questions and more during the conversation, and she also explains what's so astonishing about the Trump administration's executive order aimed at addressing global drug pri...