PBMs Are Evolving to Simplify Care and Reduce Costs

The below conversation between Managed Healthcare Executive and Kristin Begley, Pharm.D., chief commercial officer of Judi Health/Capital Rx, has been edited for length and clarity.

MHE: Judi Health is now valued at $3.25 billion—more than double what it was last year. What does this say about how investors view the future of PBMs and health benefits overall?

Kristin: I think it’s a very exciting time, not only for us, but for advancing healthcare in America. This valuation of Judi Health really reflects a broader investment belief that the future of healthcare benefits lies in transparency, integration and technology-driven efficiency—areas where healthcare has historically lagged.

We’re witnessing the end of the dinosaurs in healthcare. It’s been far too long since infrastructure was modernized to deliver the healthcare future we all deserve while reducing costs. Strong valuations like this signal that the traditional PBM model is under pressure, and platforms using unified AI-powered solutions are poised for the next wave of transformation.

MHE: How can companies operate effectively without full transparency and leveraging technology, whether that be AI or other forms, in their operations?

Begley, Pharm.D.

Kristin: I think this is probably the most bipartisan moment in our country right now: both sides agree that healthcare costs too much. Would you walk into a grocery store and not know the price of a soda, then get billed afterward? That’s essentially what happens across pharmacy and medical benefits. Regarding Judi Health, we’re no longer just a PBM. We have a strong foothold in the PBM market but have positioned ourselves as a full-service health benefits technology company. Our enterprise platform, Judi, aims to unify and streamline benefit administration across multiple domains, reflecting the broader trend that employers want integrated solutions and everyone wants lower costs and simpler experiences.

MHE: Where does the name “Judi” come from?

Kristin: Judi is short for adjudication. Internally, we sometimes call it “Judge Judy” for adjudication.

MHE: Will Capital Rx eventually be phased out, or does it remain part of your identity?

Kristin: Capital Rx will always remain part of our identity. It continues to operate as an industry-leading transparent PBM, recognized for our flat-fee, member-centric pricing model and operational efficiency. Judi is the platform that everything runs on—it’s purpose-built for enterprise health benefits and can operate in software-only environments serving health systems, Medicare, and Medicaid. The Judi Health rebrand reflects a broader vision to integrate and unify medical, dental, vision and pharmacy workflows, reducing administrative burden and costs in the U.S.

MHE: Healthcare costs are expected to rise nearly 9% in 2026. How can technology-based PBMs help employers control costs while still delivering quality care?

Kristin: That 9% increase is the sharpest we’ve seen in over a decade, and health outcomes for Americans are worsening. Pharmacy alone accounts for 24% of employer healthcare costs. Employers face massive administrative waste from duplicate claim processing across medical, dental and pharmacy. Judi can reduce these inefficiencies. In our own claims data, we saw costs drop 11% due to administrative efficiencies, alongside improvements in member experience. Our technology also uses natural human language in call centers, making interactions easier for members regardless of their background, instead of relying on outdated codes.

MHE: From a patient perspective, it must be reassuring to be understood and not lost in technical jargon. Transparency is critical, especially for PBMs. How does Judi Health’s approach differ from traditional PBMs?

Kristin: We’ve re-engineered the PBM financial model to eliminate hidden fees, remove conflicts of interest and deliver a transparent, member-focused experience. Employers and patients—not intermediaries—are our priority. Capital Rx and Judi Health use a flat-fee approach, so payers see actual drug costs along with disclosed admin fees. We leverage NADAC—the National Average Drug Acquisition Cost—so the price is based on government surveys of what pharmacies pay wholesalers. This ensures transparency without manipulation, unlike some PBMs that blend traditional and “transparent” deals.

MHE: Regarding the big three PBMs, what role do you see companies such as Judi Health playing in transforming benefits management?

Kristin: Judi Health is building the infrastructure for a more transparent U.S. healthcare system. Legacy technologies and misaligned incentives have left patient experiences inconsistent and opaque. Our platform unifies medical, dental, vision and pharmacy, reducing inefficiencies, improving member experience and enabling value-based care. One call center can access a member’s full history—pharmacy, medical, dental—without transferring to multiple departments, improving both care and financial efficiency.

MHE: So is consolidating all benefits into one platform the future of benefits administration?

Kristin: Absolutely. Fear of the unknown has kept many with the big three PBMs, but plan sponsors shouldn’t let that block opportunities to save money and improve employee healthcare. Platforms like Judi offer real-time data transparency and automation, allowing employers to track performance more precisely and align metrics with business goals and employee needs.

MHE: How can employers measure whether platforms such as Judi Health deliver better value than the traditional system?

Kristin: Look at return on investment: compare total delivered cost, outcomes and satisfaction against platform fees. Employers can benchmark against previous years or other populations. Judi’s unified platform allows side-by-side comparisons of networks and services, making it easier to determine who provides the best value.

MHE: That’s very helpful. Any final thoughts for our audience?

Kristin: The future is bright. Technology will enable the healthcare system we all deserve, and it’s time to invest in employees.