The Astonishing Healthcare Podcast

Judi Health
  • 5.0 (16)
  • MEDICINE
  • UPDATED WEEKLY

If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Judi Health (Capital Rx) is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Judi Health, visit https://www.judi.health.

  1. MAR 6

    AH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd Fiorini

    On this episode of Astonishing Healthcare, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Judi Health, returns to the studio for a discussion about the barrage of regulatory changes shaping the pharmacy benefit manager (PBM) landscape in early 2026. Within just two weeks, the Department of Labor announced new proposed rules, the Consolidated Appropriations Act of 2026 became law, and the FTC's announced a settlement with Express Scripts. Then, to top it all off, TrumpRx went live. Lloyd offers clear, helpful explanations of the key takeaways from each of these concurrent reforms aimed at improving transparency and how PBMs operate and interact with the other stakeholders in the supply chain, from independent pharmacies to patients and plan sponsors (employers). Whether you're responsible for a self-funded plan or overseeing a Medicare Part D plan, this episode provides the detail and insights about where the puck is going that you need. As Lloyd said, "I think we've made a great step forward, but the work isn't done." It's also worth giving a shoutout to previous guest Jim Winkler, as "Change is Imminent" is in the title of AH090! Episode Highlights The Department of Labor’s historic proposed rules on PBM disclosures fills a gap left by the CAA of 2021The Consolidated Appropriations Act of 2026 redefines the financial alignment of pharmacy benefits beyond just Medicare Part Patient/plan member protection seems to be what the FTC’s recent settlement was all aboutTrumpRx signals a broader shift toward transparent, cost-plus pricing models, but it's just for cash-paying customers, at least for nowDelinking and efforts to block vertical integration are hotly contested Related Content AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHow to obtain Rx data and what to do with itAH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason BarrettoSigns it is time to change your PBM vendor, and how to overcome common hesitations Reference Links US Department of Labor proposes historic pharmacy benefit manager fee disclosure rule (January 29)PBM Reforms Signed Into Law, Reshaping Medicare Part D Drug Pricing Transparency (February 3)FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients (February 4)TrumpRx Launches (February 6) For more information about Judi Health and this episode, please visit Judi Health - Insights.

    14 min

  2. FEB 20

    AH101 - Health Benefits 101: What's a Third-Party Administrator (TPA)?

    On this episode of Astonishing Healthcare, Judi Health's Mike Tate (VP, National Business Development) and Mark Pearce (Director, TPA Operations) join us in the studio to discuss the role of Third-Party Administrators (TPAs) in the self-funded employer market. As Mike explains, TPAs act as the "enforcers" of an employer's plan document, responsible for pulling everything together and ensuring claims accuracy, network access, and financial stewardship. Mark dives into the distinction between carrier-owned (ASO) and independent TPAs, explaining how independent models offer greater flexibility in plan design. And of course, they highlight a significant industry challenge: legacy technology. Many administrators rely on antiquated systems that limit customization and data visibility. In contrast, modern platforms empower plan sponsors to integrate point solutions effectively, customize networks for high-value care (e.g., through centers of excellence), and drive better member engagement. If you've ever asked yourself, "What does a TPA really do?" or "Should I look at different TPAs?" this episode will be worth your time to listen to. Ultimately, successful healthcare administration relies on managing "hundreds of little things" correctly for each benefit (Rx, medical, vision, and dental) - from provider payments to member support. That's how you create positive financial and clinical outcomes. Related Content AH080 - Health Benefits 101: The Importance of "Smart" Care Navigation, with Andy KageleiryReplay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better OutcomesAH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmDJudi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards Program For more information about Judi Health and this episode, please visit Judi Health - Insights.

    29 min

  3. FEB 6

    AH100 - The End of the Age of Confusion, It's Time for Acceptance, with AJ Loiacono

    For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had to endure an "age of confusion" to get here! AJ explains why traditional healthcare giants are facing a "BlackBerry moment" - trying to emulate a conflict-free challenger when "it’s already too late." The balance of power is shifting away from the traditional PBMs, as the industry now demands full transparency - buyers of health benefits today are smarter than ever before. We also discuss how and why the U.S. wastes [at least] a trillion dollars annually by trying to deliver care using inefficient, fragmented systems; we built the infrastructure to stop it. This episode isn't just a retrospective; it’s a blueprint of sorts, and we've got the cultural DNA required to bring about sustainable change (vs. just daydreaming about it). Related Content Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health’s Capital Rx Surpasses Five Million Contracted PBM Lives as America’s Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits StrategiesAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model For more information about Judi Health and this episode, please visit Judi Health - Insights.

    32 min

  4. JAN 30

    AH099 - Providing the Right Level of Guidance & Expertise in this Business is About as Hard as Driving Change, with Hannan Allen

    For Episode 99 of Astonishing Healthcare, we welcome Hannan Allen, SVP of Consultant Relations to the company and show! The discussion builds on Episodes 90 and 93, with Jim Winkler of Business Group on Health and Susana Villegas Spillman, respectively, by explaining why "pharmacy benefit consultants have a really tough job right now" and tackling some timely questions, including how has the role of the benefits broker or consultant evolved? What's making the job so complex lately? And, are plan sponsors' primary needs changing? We cover these questions and many more - including who will win Super Bowl LX. - with Hannan, so if you're working in the pharmacy and health benefits space, you won't want to miss this one. Tune in to hear about: Biosimilars - the big opportunity and challenges PBMs have createdThe push for transparency, and what it means for consultantsHow to weigh price/cost, and why drug mix is so importantPrioritizing member care and programs that benefit membersThe opportunity cost of sticking with the status quo (is astonishing) Related Content How employers can take back control of unnecessary pharmacy spendingJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformReplay: PBM Procurement Decoded: Insights from a Pharmacist and an ActuaryHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model For more information about Judi Health and this episode, please visit Judi Health - Insights.

    20 min

  5. JAN 23

    AH098 - Introducing The Judi Group: Mission-Driven Advocacy for Employers

    This episode of Astonishing Healthcare features three members of The Judi Group's leadership team: Jeff Hogan (Co-Founder & Managing Director), Chris Deacon (Director, Growth & Strategy), and Julie Selesnick (Director, Legal & Compliance). The Judi Group is a new venture - a premier advisory firm in healthcare on a mission to help companies evaluate the totality of their health vendors and contracts, deliver insights that lead to more responsible action, and ultimately improve the overall cost picture and health outcomes for their health plans and plan members, respectively. But why now? What steps can employer plan sponsors take to improve their contracting and access data? How do you set up a sustainable fiduciary process? For the answers to these and many more questions, like our guests' personal reasons for embarking on this journey, you'll have to listen in! Highlights We've reached a boiling point - everyone is tired of how the US healthcare system operates,, the misaligned incentives throughout the supply chain, and the unnecessary complexity of it all.There's a growing willingness among employers to challenge the status quo, embrace transparency, and create customized benefit plans that better serve their unique populations.Jeff is driven - in part - by his experience as a public servant, Julie tends to fight for the underdog, and Chris is inspired by the opportunity to make a tangible difference in healthcare.The RFP process must be redesigned for each employer, with their unique needs in mind.Access to claim-level data is critical if employers are to fulfill their fiduciary duties, make informed decisions, and ensure prudent use of employees' healthcare dollars. Related Content AH041 - ERISA Litigation Outlook and Meeting CAA Requirements: What Can Plan Fiduciaries Do?Health Benefits 101: The Importance of a Transparent PBM ModelReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform To learn more about the Judi Group, the team, and its mission and services, please visit www.judi.group. For more information about Judi Health and this episode, please visit Judi Health - Insights. Disclaimer This podcast is for informational and entertainment purposes only. The views expressed are those of our guests, do not constitute professional advice, and may not represent Judi Health's/Capital Rx's position on any matters discussed. We make no representations or warranties regarding the accuracy or completeness of the content; information is subject to change and may not be updated.

    31 min

  6. JAN 16

    AH097 - Stories from the Next Generation of Healthcare Disruptors, From Internship to Impactful Full-Time Work

    For Episode 97 of Astonishing Healthcare, we sat down with three team members who interned with Judi Health (Capital Rx) and recently joined our mission as full-time employees! Jakob Deel, Lisa Yu, and Bryan SebaRaj discuss their respective paths to Judi Health, from why they chose healthcare and how they found their internships to why they decided to join a newer, disruptive health tech company over larger "hyperscalers." So, this episode has something for every undergrad and graduate student. That said, Episode 97 isn't just about landing an internship or transitioning from an intern to full-time employee. The trio also discusses the engineering, development, and operations/policy work they are doing to help advance our industry. Our goal is really to raise awareness of the different paths the next generation of healthcare disruptors can take, how to prepare if you're on that path, and highlight the reward at the end of this first step in what will undoubtedly be long and successful careers! To learn more about life at Judi Health, check out our Careers Page, and keep an eye out for our 2026 summer internship program openings, which will be posted there soon. For more information about Judi Health and this episode, please visit Judi Health - Insights.

    18 min

  7. JAN 9

    AH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason Barretto

    For Episode 96 of Astonishing Healthcare, Jason Barretto, our SVP of Government Programs, returns to the show for a discussion about what's happening on the health plan side of the business. As a company, we spend a lot of time talking about and showing how modern technology streamlines benefit administration workflows and overall operating efficiency, solves longstanding problems, and helps clients stay nimble to meet the intent of new regulations. Well, Jason's experience managing PBM relationships at health plans helps him - and our team - add real value when working with our clients. And, thankfully, he loves to talk about it! During this episode, we discuss: Intensifying demand for transparency (beyond just price transparency)The Inflation Reduction Act (IRA) and the implementation of Maximum Fair Prices (MFP)Slow adoption of the Medicare Prescription Payment Plan (MPPP) and how CMS is removing barriersA streamlined approach to managing Dual Special Needs Programs (D-SNPs), something Jason "wanted to solve" when he started hereA really interesting observation about the popularity of GLP-1sCMS changing its audit approach and the importance of audit readiness in 2026 Related Content How Our Favorite New Judi® Features Aid Government ProgramsJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformJudi® is a Tech-Enabler – A Case StudyAH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya LomsadzePartnership & Collaboration: Why PBMs and Health Plans Should Sync on Regulatory Change Management For more information about Judi Health and this episode, please visit Judi Health - Insights.

    16 min

  8. JAN 2

    AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing Healthcare

    Episode 95 of Astonishing Healthcare features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that’s packed with insightful reflections and optimism about the future. We won’t ruin it in the show notes, but based on what we saw in 2025: Everyone has finally had enough of the costs and opacity of the U.S. healthcare system – a $70k family premium is truly astonishing It’s surprising that, despite the lawsuits, warnings, and reform efforts, the proverbial hammer didn’t drop on anyone for not being a good health plan fiduciary The speed and impact of AI have broadly been more positive than expected The rise of cardio-diabesity How GLP-1s helped shift the balance of power in the pharmaceutical supply chain And in 2026, we may see: Employers fight back – they take agency over their plans, and for first movers that started with transitioning to aligned PBMs, it’s “game on” for the rest of their health plans The cash price – or acquisition cost – of drugs in the U.S. becomes the baseline – i.e., we finally see a real change in how drugs are priced ICHRAs and other alternative models become more popular Employers look to new clinical programs and models that demonstrate a return on their spending AI become more important for clinical workflows (not decision-making, at least not yet) Pharmaceutical manufacturers find themselves with increasing bargaining power vs. traditional PBMs A new Stanley Cup champion, and a Super Bowl ring for… Related Content Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency Health Benefits 101: The Importance of Clinical Programs How to obtain Rx data and what to do with it For more information about Capital Rx and this episode, please visit Judi Health - Insights.

    30 min
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Ratings & Reviews

5
out of 5
16 Ratings

About

If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Judi Health (Capital Rx) is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Judi Health, visit https://www.judi.health.

Information

  • Creator
    Judi Health
  • Years Active
    2024 - 2026
  • Episodes
    110
  • Rating
    Clean

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