The Astonishing Healthcare Podcast

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 sposnsors. 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.

...

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...

In this episode of the Astonishing Healthcare podcast, Mike Tate, one of the newest members of Capital Rx's commercial team, joins Justin Venneri in the studio to discuss the latest challenges and innovations in the healthcare market, and how he's approaching growth opportunities "west of the Mississippi." Mike explains why his region has been relatively slow to adopt self-funding strategies compared to the rest of the country (despite the great work of innovative brokers and consultants), how plan members - who are more informed than ever before - are pushing their employers' benefits teams to think creatively about their...

This episode of the Astonishing Healthcare podcast with Dr. Sunil Budhrani (Chief Innovation & Medical Officer) highlights the transformative potential of Judi Health™, the first Unified Claims Processing™ platform offering a combined medical and pharmacy benefit experience (with vision and dental soon to follow)! Why is unifying claim administration necessary to reach a value-based world? Well, everyone has been talking about VBC for years, and it's proved to be an elusive target. On Episode 7, Dr. Budhrani explained why pharmacy must be included in the equation along with providers, patients, and payers, and today we go a level deeper, explaining why "ever...

This Astonishing Healthcare podcast episode features Bridget Mulvenna, who joins us in the studio again for an insightful discussion about addressing data access hurdles and utilizing pharmacy claims data. Building on her previous episodes, we dig into the "how" here - how can plan sponsors get their data, analyze it, and use it to make more informed decisions. It's encouraging that things are getting a little better out there, but data transparency and sharing remain top concerns for channel partners and plan fiduciaries alike; everyone is trying to understand what's driving costs higher within their plans (aside from GLP-1...

In this episode of the Astonishing Healthcare podcast, we welcome Jessin Joseph, PharmD, MBA, back to the studio. Jessin's focus on the pharmacy benefit administration side of the business and experience at Kentucky Medicaid and working with health plan clients inform the discussion about the impact the new administration and appointments in Washington, D.C., may have on health plan partners, MPPP (M3P), various models of Pharmacy Benefit Management (PBM) for Medicaid, including the single PBM and carve-out/unbundling approaches, and how the drug price benchmark can influence access to medication for plan members.

In Episode 16...

This encore episode of the Astonishing Healthcare podcast highlights the transformative potential of Judi Health™, the first unified claims processing platform that integrates medical and pharmacy claim administrative workflows and data to create a seamless experience for stakeholders, including patients, providers, and employers. Judi Health garnered much attention during our second annual Partner Summit, as Unified Claims Processing™ has the potential to help reduce up to $1 trillion of administrative waste and empower the provider-patient relationship.

AJ Loiacono (Co-Founder & CEO of Capital Rx) and Dr. Sunil Budhrani (Chief Innovation & Medical Officer) emphasize the limitations of the traditional fee-for-service mode...

In this episode of the Astonishing Healthcare podcast, Spencer Kramer, Director, Client Services at Capital Rx, joins us in the studio to discuss an important aspect of plan sponsors' annual reporting requirements: Prescription Drug Data Collection - aka RxDC. We review key dates and where plan fiduciaries can find important data and updates, and Spencer shares his experience working with Capital Rx's clients and some suggestions to a) yield a smooth RxDC submission process and b) make use of the detailed data that plan sponsors are entitled to!

As a requirement of the Consolidated Appropriations Act of 2021...

On this episode of the Astonishing Healthcare podcast, we discuss how modern technology - Judi® - brings efficiency to the labor union market with Capital Rx's Mike Miele, FSA, MAAA (Senior Vice President of Insured Services), Christie Peperato (Manager, Payment & Operations), and Kelly Smith (Product Manager). Who knew that Capital Rx has an hours banking system? Why did we build one? Well, every hour a union worker works may be tracked and "banked" for benefits eligibility purposes. So, those hours and the accuracy of the reporting matter... a lot. And as Christie describes, it's been a manual, "painful" process f...

For this special episode of the Astonishing Healthcare podcast, Andrew Barnell, CEO of Geneoscopy, joins Justin Venneri in the studio for an insightful discussion about colorectal cancer (CRC) screening in observance of National CRC Awareness Month! Andrew explains how he and his "very talented" sister, Erica Barnell, MD, PhD, co-founded Geneoscopy to develop diagnostic tests using RNA biomarkers extracted from stool samples. Their newly FDA-approved test, ColoSense™, provides a non-invasive alternative to traditional colonoscopies.

Barnell highlights the rising incidence of CRC in younger adults, which prompted guideline changes to lower the recommended screening age to 45. He stresses th...

On this episode of the Astonishing Healthcare podcast, Bloomberg Intelligence's Jonathan Palmer (Sr. Equity Analyst & Team Lead, Healthcare) joins us in the studio for a discussion about the work his team does and the evolving landscape of health tech. Palmer notes interest in Hinge Health's potential IPO and how the market's receptivity to tech-enabled healthcare companies has improved recently. While these companies face pressure to demonstrate profitability amid evolving market dynamics, there's optimism about innovation on several fronts. He also explains the impact of health policy uncertainty and questions about what the FDA, FTC, DOJ, and CMS will do...

On this episode of the Astonishing Healthcare podcast, host Justin Venneri speaks with 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™. They dive into several recent updates to the Judi® platform, highlighting Judi's overall agility and how it aids in the administration of benefit plans for Capital Rx's clients. During the discussion, they also explore:

On Episode 57 of the Astonishing Healthcare podcast, host Justin Venneri welcomes Jeff Hogan, President of Upside Health Advisors, back to the show to discuss the major trends he observed in healthcare procurement and plan management in 2024 and areas of focus in 2025. Jeff highlights the evolving role of employer fiduciaries under the Consolidated Appropriations Act of 2021 (CAA), building on Episode 30 and re-emphasizing the necessity of real-time data access and process-driven strategic decision-making. He explains how employers must take greater accountability for healthcare spending, moving beyond reliance on traditional insurance networks (BUCAHs) and considering alternative care delivery models; and adds that...

On this episode of the Astonishing Healthcare podcast, Justin Venneri chats with Angela Kalantarova, PharmD, a senior clinical programs manager at Capital Rx, about recent updates to Medicare's star ratings. Angela shares her path to Capital Rx and experience working in managed care and on clinical programs, and she explains what's new for 2025: star measures for polypharmacy and concurrent use of opioids and benzodiazepines.

The conversation highlights the positive impact early interventions can have and how innovative enterprise health technology like Judi® allows for real-time insights. As CMS proposes changes, such as possibly removing the MTM - m...

On this episode of the Astonishing Healthcare podcast, we explore the nuances of stop-loss insurance with Capital Rx's Mike Miele, FSA, MAAA (Senior Vice President of Insured Services). With premiums on the rise due to high-cost claims reaching levels actuaries never thought possible, self-insured plan sponsors need new options and better tools to monitor their costs. Mike, who is a healthcare actuary by training, discusses everything from "What is stop-loss?" and who it's for to what's driving high-cost claims to new heights, the rise of a pharmacy-only stop-loss option, and options plan sponsors have to mitigate risk when "it's...

This episode of the Astonishing Healthcare podcast highlights the transformative potential of Judi Health™, the first unified claims processing platform that integrates medical and pharmacy claim administrative workflows and data to create a seamless experience for stakeholders, including patients, providers, and employers. Guests AJ Loiacono (Co-Founder & CEO of Capital Rx) and Dr. Sunil Budhrani (Chief Innovation & Medical Officer) emphasize the limitations of the traditional fee-for-service model and legacy infrastructure in U.S. healthcare, which incentivizes reactive rather than proactive care and can't handle the evolution and complexities of value-based care, respectively.

Building on Episode 7 (with Sunil) and Ep...

On Episode 53 of the Astonishing Healthcare podcast, Bridget Mulvenne, VP of Business Development, joins Justin Venneri in the studio again to share highlights of her first full year of selling pharmacy benefit solutions ahead of her webinar on February 13: 5 Ways to Improve your PBM Procurement Process in 2025 (click here to learn more and register). They discuss the evolving healthcare landscape, regulatory pressures, expanding indications for GLP-1s, and the need for transparency in pharmacy benefits. Bridget shares stories from the field, explaining why focusing on drug manufacturer revenue and breaking the industry’s dependence on rebates are so important an...

In this episode of the Astonishing Healthcare podcast, Nick Welle, Partner & Chair of the Health Benefits Practice at Foley & Lardner LLP, joins host Justin Venneri in the studio for a discussion about ERISA and how employer plan fiduciaries can navigate a relatively complex set of responsibilities. With the recent developments around the J&J lawsuit and interest in how that may progress following the dismissal of the allegations, and questions swirling about i) what the Trump administration will do regarding the ACA and ii) CAA compliance and reporting, the timing couldn't be better to publish Episode 52.

They...

For Episode 51 of the Astonishing Healthcare podcast, we spoke with Nick Opalich, CEO of HospiceChoice Rx. We learned about how end-of-life care is evolving in the U.S., including the roles pharmacy and technology play in the hospice industry. Nick and host Justin Venneri discuss some similarities between the hospice pharmacy benefit management (PBM) and commercial PBM spaces, such as the importance of a great pharmacy network and independent pharmacies, why the drug price index matters (NADAC vs. AWP), medication access, and disconnected systems.

A former pharmacy owner himself, Nick explains the importance of helping hospice providers...

On this 50th episode of the Astonishing Healthcare podcast, Capital Rx Vice President of Business Development Hope Nakazato, PharmD, joins Justin Venneri to discuss her observations, based on diverse industry experience, about the three most common friction points between plan sponsors and pharmacy benefit managers (PBMs): lack of execution, poor communication, and inflexibility. So, why have plan sponsors dealt with the status quo and rising costs for so long? Great question.

Hope uses the book, "Who Moved My Cheese?", by Dr. Spencer Johnson, to explain the fear of change, as well as three things people can look...

On this Astonishing Healthcare podcast episode, return guests Heidi McKinnon, PharmD, CHC (Head of Compliance at Capital Rx), and Symara Schmidt, PharmD, PMP, CHC, BCGP (Director, Compliance Programs), join host Justin Venneri in the studio for another Pharmacy Benefits 101 discussion about Pharmacy Audits, including how pharmacy benefit managers (PBMs) and pharmacies can work together to avoid issues and improve compliance - it is possible!

They explain everything from common audit triggers and types of audits to how the audits work and resources pharmacies can leverage to improve compliance and reduce friction/errors. Why are compliance executives at...

What better way to kick off 2025 than having Dr. Eric Bricker join 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 discuss the issues of high-cost drugs and access to claims data - two topics he recently covered on AHealthcareZ - Healthcare Finance Explained - that should be top of mind for plan sponsors this year as pharmacy costs continue to rise.

Dr. Bricker shares several ways employers...

On this final encore episode of the Astonishing Healthcare podcast this year, we're replaying Episode 41, which featured three experts weighing in on rising litigation against employers and pharmacy benefit managers (PBMs) and was one of our most popular. We also want to take the opportunity to say, "Happy Holidays and New Year!" and thank our listeners and guests this year, including current and former colleagues; we couldn't have done it without you!

In Episode 41, we discussed what employers sponsoring ERISA-covered health and welfare plans can do to show they are making an effort to establish processes and...

Episode 20 of the Astonishing Healthcare podcast caught some folks' attention, as it featured Capital Rx Co-Founder and CEO AJ Loiacono and 3 Axis Advisors President/46brooklyn Research CEO Antonio Ciaccia. It's an episode you must listen to if your work or interests involve drug prices in any way. NADAC - national average drug acquisition cost - was the focus of our discussion on this episode, which was among the most downloaded and streamed episodes in 2024, and with PBM reform and drug prices top of mind, what better time to highlight it?

NADAC serves as a crucial price benchmark...

This Astonishing Healthcare podcast episode covers the potential future of US healthcare policy under the Trump administration, focusing on the business of healthcare services and possible changes to Medicare and Medicaid, support for telehealth, solving workforce issues, and managing chronic diseases. Our guest from Episode 13, Redefining Virtual Care: A Blueprint for Effective RPM, Robert Longyear, Co-Founder of Avenue Health, returns to the show and shares his view from K Street after reviewing Project 2025 and evaluating what RFK Jr. and Dr. Mehmet Oz could prioritize in their roles.

Robert shares the highlights of his analysis, including what he...

On this Astonishing Healthcare podcast episode, Tom Evegan, Principal, National Consulting Leader, Life Sciences at RSM, a leading provider of tax, assurance, and consulting services in the US, joins Justin Venneri for a discussion about topics ranging from health policy to drug pricing and how to provide equitable drug access. Tom shares his background and path to RSM, explaining how his experiences at a major pharmaceutical manufacturer, pharmacy benefit manager (PBM), and a biotech launching a new therapy shaped his experience and aided him in becoming a "gross-to-net expert."

Tom has helped hundreds of drug manufacturers launch...

Our first "Best of" Astonishing Healthcare podcast episode goes back to the beginning. For those who have been listening, "Thank you!" - we'll be back with a new episode next week. For new listeners, A LOT has happened since our co-founder and CEO AJ Loiacono kicked things off, including, but not limited to:

In this episode of the Astonishing Healthcare podcast, Nisha Bhide, PharmD, joins Justin Venneri in the studio to discuss an integral aspect of pharmacy benefit management (PBM) - the formulary. They explore everything from what a formulary is to how they are created and P&T committees, why and how often they change, the role JUDI® plays in managing a formulary efficiently, and the difference between open and closed formularies.*

Nisha also dives into how specialty drugs fit into the equation, utilization management tools like prior authorization (PA), the role of formularies in helping manage low-cost generic o...

On Episode 44 of the Astonishing Healthcare podcast, Andrew Gordon, LSW, joins host Justin Venneri for a discussion about the extensive primary research he's conducting on transparency and incentives in the U.S. Healthcare system. Gordon, who recently interviewed Capital Rx co-founder and CEO AJ Loiacono, explained how unexpected costs associated with an MRI sparked his curiosity, leading him to question why the healthcare system functions the way it does. He describes how he secured grants to explore - via 600+ interviews - what transparency means, where incentives are misaligned, fiduciary responsibility, and other factors that often contribute to patient confusion...

This episode of the Astonishing Healthcare podcast covers the ins and outs of two programs in the government sector - i.e., Medicare and Medicaid - and how modern technology JUDI® allows for more agility and flexibility in delivering care to Part D plan members and meeting CMS requirements. Capital Rx's Nash Albadarin, PharmD, explains changes to the Medication Therapy Management (MTM) criteria for 2025, which will increase membership, and provides an update on how MTM impacts Medicare star ratings. He also describes the purpose and structure of the Drug Management Program (DMP), which aims to help limit the risks a...