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Prime Therapeutics and Capital Rx Create Tech Alliance

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The new collaboration gives Prime access to Capital Rx’s claims system; Prime has become a minority investor in Capital Rx.

Prime Therapeutics will now have access to Capital Rx’s technology platform through a new alliance between the two PBMs. As part of the strategic alliance, Prime has become a minority investor in Capital Rx.

Capital Rx’s technology, JUDI, unifies pharmacy benefit management operations — from underwriting, implementation, claim adjudication, data integration, prior authorization, patient communication, client reporting, invoicing, and reimbursement.

Prime executives said the collaboration will augment Prime’s scale, financial management, clinical expertise and allow for data and systems that can be connected and integrated more efficiently. This alliance with Capital Rx enables Prime to enhance core capabilities and ensure security, Mostafa Kamal, president and CEO, Prime, said in a press release.

Ryan Kelly

Ryan Kelly

Older PBMs are using legacy systems that may not be as efficient, cost-effective or able to evolve and adapt. “Modern approaches to architecture and infrastructure allow for an enhanced security posture compared with legacy practices,” Ryan Kelly, Capital Rx’s chief technology officer, said.

Healthcare in the United States requires fundamental change and a shift to modern and distributed solutions, much like those that power and secure the Internet, Kelly said. “Legacy platforms and technological approaches and decades of consolidation have created single points of failure. This change will not come from within. Legislators should consider strategies to force healthcare entities to adopt more resilient solutions and more rigorous security frameworks.”

Change Healthcare, a UnitedHealth company that provides claims processing, is still dealing with the effects of ransomware attack on its systems. Change was hacked on Feb. 21, 2024, which created huge disruption to pharmacy services, including electronic prescribing, claim submission and payment transmission. UnitedHealth said in a statement its payment platforms would be functional beginning March 15 and its medical claims system would begin testing on March 18, with service restored that week. UnitedHealthcare and its PBM Optum launched a temporary funding solutions for providers and partners who were affected by the hack.

Kelly said Capital Rx has leveraged AWS, the on-demand cloud computing platform of Amazon, and its suite of security tools and security experience. “By designing our platform using AWS’ Reference Architecture, in particular AWS Lambda, we are doing our part in the shared responsibility model to deliver on security and scalability. AWS Lambda has only one disclosed malware attack variant, ever, another proof point in the security of the solutions we leverage.”

Additionally, he said Capital Rx is SOC 2 Type 2 certified (which assesses compliance related to security and internal controls), URAC accredited (which assures a company is using best practices), and HIPAA compliant (for rules on patient privacy). The company bases its compliance process and methods on National Institute of Standards and Technology NIST 800-53 framework, which provides guidance on security and privacy controls.

This story first appeared on Formulary Watch.

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