Capital Rx Releases First Unified Claims Administration Platform

Capital Rx, a pharmacy benefit manager and administrator, has announced Judi Health, the first centralized claims processing platform that combines pharmacy and medical claims workflows, according to a news release published today. Judi Health is powered by JUDI, Capital Rx’s cloud-based health platform.

"Solving some of the major challenges in healthcare will require us to address foundational issues with technology. Nobody planned to create two separate systems to manage pharmacy and medical claims, but an entire ecosystem has been cobbled together to maintain and capitalize on preserving inefficiency rather than advancing our nation's care delivery," AJ Loiacono, founder & CEO, Capital Rx, said in the news release. "The root cause of our nation's failing infrastructure is massive underinvestment and inability for legacy companies to develop a unified platform for claims administration."

In 2021, $4.3 trillion was spent on healthcare in the United States, which equals about $12,900 per person, according to research funded by the Peter G. Peterson Foundation, a nonpartisan fiscal awareness organization. About a quarter of that spending is considered “wasteful” - money spent on managing the system rather than actual medical care. This includes losses due to fraud, prior authorizations and administrative complexity.

The United States currently has the highest administrative costs per capita of any Organization for Economic Co-operation and Development (OEDC) country at $1,055. Germany has the next highest amount, at $306 per capita, according to the Peter G. Peterson Foundation research.

Judi Health features include:

• Real time plan management for pharmacy and medical benefits
• Centralized operational, administrative and financial services
• Use of value-based care and contracting models
• Removal of third-party dependency that can lead to inaccurate data and billing errors

Capital Rx was founded in 2017. In August 2024, they unveiled Never Move Again, which gives JUDI access to self-funded employers with more than 50,000 employees, allowing them to customize their health plans without switching administrators. Employers traditionally go through a bidding process to change PBMs or make significant adjustments to their health plans. This may require employers to hand out new ID cards or change networks, which can be costly.

Capital Rx currently serves millions of members from Medicare, Medicaid and commercial plans.

“With Judi Health, payers will be better able to anticipate members' needs, eliminate delays in processing and decision making to speed time to treatment for patients, and leverage the full power of gen AI to improve the patient and provider experience," Ryan Kelly, CTO, Capital Rx, said in the news release.