“One of the biggest challenges facing the U.S. healthcare system is not understanding actual or fair drug pricing,” said AJ Loiacono. Capital Rx, in an interview on Monday.
who is loacono Straight Talk About Problems in the Drug Pricing World, claims to be developing a fairer framework through his upstart pharmacy benefits management company, CapitalRx. The New York City-based company appears to have convinced investors of that vision. on Monday, capital receipt Completed a $106 million Series C round of financing financing round, increasing the total funding for pharmacy benefit management startups to $175 million. The round was led by B Capital, with participation from General Catalyst and existing investors Transformation Capital and Edison Partners.
When Loiacono and his team founded Capital Rx in 2017, he said they wanted to not only reduce costs in the prescription market, but also “define the electronic infrastructure to process claims over the next 50 years.”
Drug pricing is not just a supply chain issue, but also an infrastructure issue, Loiacono claims. Capital Rx is designed to efficiently process, manage and pay claims in a way that provides the best operational support with minimal overhead. So the startup built its platform, called JUDI, to do just that.
JUDI includes features such as claims adjudication, prior authorization, data exchange, claims reporting, and billing and reimbursement. It’s the first enterprise pharmacy platform to unify all of these businesses, Loiacono said.
The platform serves health plans, health systems, prescribers, third-party administrators and pharmacy benefit managers. It facilitates faster and more efficient prescription processing for its members by enabling real-time communication between physicians, pharmacies, patients, and plans.
To use JUDI, Capital Rx charges a fixed management fee. This can be a flat monthly fee based on the services selected, or a per-prescription or per-member monthly fee.
Loiacono said his startup doesn’t see any other company as a competitor because “all PBMs and health insurers can benefit from JUDI.” He said that Capital Rx can provide a kind of transparency by showing the pharmaceutical and healthcare industries differentiating itself through pricing models to reduce costs, improve service, and increase operational efficiency.Nonetheless, there are startups and more established companies across the pharmacy space that are also working to provide price transparency and reduce costs, such as good medicine, EmpiRx and Navitus.
Capital Rx’s latest funding round comes amid record growth. The company’s consumer membership has doubled over the past year and now serves 1.2 million members. The startup also recently added two major clients, heart rate variabilitywhich operates the world’s largest pharmacy benefit purchasing alliance, and CDPHPa major health program in New York.
The company expects to add 1 million patients in a planned year of 2023. Loiacono said it will use the funds raised on Monday primarily for research and development, but will also invest in growing its team and operating technology.
“The average person will write hundreds of prescriptions in their lifetime, which gives us a unique opportunity to positively impact everyone in this country,” he said.
Photo: cagkansayin, Getty Images
