by JESSICA DAMASSA
What’s the larger information popping out of Capital Rx: that the next-gen PBM simply closed a $106 million greenback Collection C? Or, that the well being tech startup’s enterprise mannequin has expanded considerably over the previous 18 months, from PBM-only to PBM-plus-PBA, that means that as an alternative of simply servicing the pharmacy advantages administration wants of employer teams immediately, that now they’re additionally including to their enterprise by promoting THEIR TECH to different carriers and well being techniques to allow them to use it to administrate their advantages plans??
Capital Rx’s CEO AJ Loiacono takes these questions in stride, lets us in on which “aspect” of the enterprise fueled their 200% year-over-year development in 2021, and offers us the small print on that tech that his enterprise developed and why its standout in comparison with the inefficient infrastructure that presently exists to administrate and course of pharmacy claims.
The large deal right here is that AJ and workforce are tackling one of many largest friction factors in the price of pharmacy advantages: the price to manage a plan. They cut back that price, and the “internet price” of each drug is lowered. AJ says its on this approach that Capital Rx operates at one-seventh the price of his opponents, the “Huge Three PBMs” (CVS’s Caremark, Specific Scripts, and UnitedHealth’s OptumRx) and saves its clients a mean 27% on their prescription drug spend.
Now that Capital Rx has their slick enterprise software program, will the enterprise proceed to function a twin PBM-plus-PBA mannequin, or will they double-down on the PBA aspect? AJ lets us know what’s subsequent and (spoiler alert) it appears like issues would possibly go in a shocking course. If Capital Rx’s software program is so efficient at doing all of the issues it takes to handle pharmacy claims — underwriting sequences, implementation administration and onboarding, communication, affected person portals, community administration, reimbursement networks, eligibility checks, and many others. – what stops Capital Rx from processing other forms of healthcare claims? Is a step into the medical claims processing aspect of the healthcare world on the roadmap? Tune in and discover out!
