- Innovation enables tags to account for potential changes to
data structures, thereby minimizing or eliminating the need to
reprogram application programs
NEW
YORK, July 23, 2024 /PRNewswire/ -- Capital Rx,
the full-service pharmacy benefit manager (PBM) and pharmacy
benefit administrator (PBA) advancing our nation's healthcare
infrastructure to improve drug price visibility and patient
outcomes, has been awarded a U.S. Patent for its novel data tagging
system used in JUDI®, the company's proprietary enterprise health
platform. This patented tagging system enables users to configure
custom rule sets without programming to dictate any desired
outcome, thereby eliminating many technological difficulties users
often encounter in legacy claims processing systems.
"Smart tags and overrides" allow Capital
Rx's team to be agile and responsive in meeting clients' diverse
needs.
"We are committed to investing in and upgrading JUDI's
capabilities and the workflows that create efficiencies in the
deployment and management of pharmacy benefit programs," said
Ryan Kelly, Co-Founder and Chief
Technology Officer. "The fact that many legacy systems rely on
hardcoded data structures and are difficult and time-consuming to
alter is something we have and will continue to address through
innovation."
How Tags and Overrides Work in a Modern Enterprise Health
Platform
"Smart tags and overrides, as we refer to them, are
among our favorite JUDI features because they allow our teams to be
incredibly nimble and responsive to our clients' needs," said
A.J. Loiacono, Co-Founder & CEO of Capital Rx. "There's
no need for 'ruleset prioritization' or additional hours of
overhead cost associated with programming to make simple, intuitive
changes in minutes. With JUDI, our clients can respond
appropriately to anything from new regulatory guidance to a natural
disaster or be creative around meeting members' unique needs."
Illustrative use cases for the patented tagging system
include:
- Enabling a prior authorization (PA) bypass. For example, if a
continuous glucose monitor is prescribed for a patient with a
history of insulin use, if there's a specific diagnosis code, or
when a particular physician writes the prescription (i.e., Gold
Carding).
- Informing the PA process and allowing for determinations about
whether the claim is an administrative denial (i.e., not covered by
a plan) or if it should go through the full review.
- Allowing for the reasons for approval or rejection to appear on
the outcome of a claim, enabling faster research and better
communication with members, providers, and pharmacies.
- Controlling utilization or preventing fraud,
waste, and abuse with multi-product "refill too soon" overrides for
medications like opioids or glucagon-like peptide-1s (GLP-1s).
- Setting a zero-dollar cost share for test strips when a patient
has a history of insulin use.
Capital Rx's JUDI is purpose-built to redefine the
administration of Medicare, Medicaid, and Commercial pharmacy
programs. Originally designed to consolidate all pharmacy
benefit-related workflows in one system and improve costs and
service levels in the commercial market, JUDI's adaptability and
modular framework allowed for the expansion to serve Medicare and
Medicaid plans and enables the rapid development and deployment of
new products to meet clients' needs.
For more news and content related to Capital Rx's full-service
PBM solution and JUDI, please visit Capital Rx Insights.
About Capital Rx
Capital Rx is a full-service
pharmacy benefit manager (PBM) and pharmacy benefit administrator
(PBA), advancing our nation's electronic healthcare infrastructure
to improve drug price visibility and patient outcomes. As a
Certified B Corp™, Capital Rx is executing its mission through the
deployment of JUDI®, the company's cloud-native enterprise health
platform, and a Single-Ledger Model™, which increases visibility
and reduces variability in drug prices. JUDI connects every aspect
of the pharmacy ecosystem in one efficient, scalable platform,
servicing millions of members for Medicare, Medicaid, and
commercial plans. Together with its clients, Capital Rx is
reimagining the administration of pharmacy benefits and rebuilding
trust in healthcare. To learn more,
visit www.capitalrx.com.
Media Contacts
Michael
Passanante, SVP, Marketing & Communications
Justin Venneri, Director,
Communications
marketing@cap-rx.com
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SOURCE Capital Rx