Capital Rx Receives a US Utility Patent Covering its Enterprise Health Platform - Judi®

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.

"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 Ju®di, 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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