Capital Rx Launches Program for Self-Funded Employers

Capital Rx, a pharmacy benefit manager/administrator, has unveiled a new solution for large, self-funded employer groups. The new program, called Never Move Again, provides companies with more than 50,000 employees with access to its technology platform, JUDI. The platform provides underwriting, implementation, claim adjudication, data integration, prior authorization, patient communication, client reporting, invoicing, and reimbursement.

AJ Loiacono

“Large employers are essentially mini health plans,” AJ Loiacono, co-founder and CEO of Capital Rx, said in an interview. “They have similar responsibilities and liabilities under ERISA (Employee Retirement Income Security Act), yet they face significant challenges when it comes to managing their health benefits efficiently. With our platform, we’re giving them the flexibility to manage their benefits as health plans do, without the need for constant changes and administrative burdens.”

Loiacono said the JUDI platform also can help employers navigate the complex regulatory environment created by the Consolidated Appropriations Act of 2021, which amended ERISA to require greater transparency around prescription drug and healthcare spending. “The Consolidated Appropriations Act has made a lot of people nervous,” he said.

These changes to ERISA have led to lawsuits for breach of fiduciary duty. Earlier this year, for example, a class action suit was filed against Johnson & Johnson for mismanaging prescription drug benefits. The suit alleges that this has led to higher premiums, higher deductibles, and higher coinsurance and copays.

The lawsuit claims that J&J’s PBM Express Scripts has shown a pattern of unreasonable mark ups on prescription drugs. “No prudent fiduciary would agree to make its plan and beneficiaries pay a price that is two-hundred-and-fifty times higher than the price available to any individual who just walks into a pharmacy and pays out-of-pocket,” the suit said.

In July 2024, a similar lawsuit was filed against Wells Fargo for breaching its fiduciary duty for the mismanagement of prescription drug benefits, which also used Express Scripts as its PBM.

Loiacono said the JUDI platform can help clients to extract detailed formulary data on an NDC level. “Many of these larger companies have their own physicians, nurse practitioners, directors of pharmacy and formulary managers,” he said. “They have opinions and may want to make adjustments.”

The new offering allows employers to customize their benefits offerings without having to switch administrators or undergo costly implementations. Traditionally, employer groups must go through a bidding process to change PBMs or make significant adjustments to their health plans. This often involves changing networks, issuing new ID cards, and educating employees on new systems.

“Whether they want to switch rebate partners, add new mail facilities, or introduce direct-to-consumer drug programs, we can provide a way to do this without the need for full implementation changes,” Loiacono said.

So far, several large employers already are in the process of signing up. While Loiacono was not able to name specific clients, he said announcements are expected in the new year.