Judi Health, a health technology company and benefits administrator, launched a new Medicare Part D plan on Tuesday called Judi Rx Retire.
New York-based Judi Health, previously known as Capital Rx, offers solutions for employers, unions, health plans and government entities. Judi Rx Retire is an Employer Group Waiver Plan (EGWP), meaning it’s able to provide prescription drug coverage to employer groups and their Medicare-eligible retirees.
With the plan, Judi Health seeks to provide an offering that is transparent and without conflicts of interest. The company stated in its announcement that traditional EGWPs frequently “obscure” the cost of medications with complex rebate arrangements and opaque pricing.
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“I often say, our roadmap and innovation is driven by my frustration and sometimes disgust at how things operate. We have existing customers where we are the PBM that is managing the active employees, and up to this point, there’s always been a separate entity that manages the EGWP program, and I started to ask some questions about these programs, and a lot of times the answers didn’t make sense,” said AJ Loiacono, CEO of Judi Health, in an interview.
Judi Rx Retire includes standard Part D components, such as pharmacy networks, cost sharing, deductibles and the Medicare Prescription Payment Program. The plan holds its own CMS contract and coordinates directly with the agency, consolidating compliance, enrollment and claims administration in one system rather than distributing these functions across multiple vendors, as is common in traditional EGWP arrangements.
It also offers 24/7 customer care and real-time alerts for fraud, waste and abuse. Clients have access to “one unified system” for eligibility, claims, network, formulary, prior authorization and reporting.
The Part D plan is something that Judi Health’s clients were asking for.
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“Leveraging what we’ve done today for our existing regulated markets, and naturally building this PDP offering, just made sense and was really synergistic for us, but also for our clients because they get to benefit from the efficiencies, those savings, and quite frankly, now they get visibility to something they’ve never had visibility to,” said Jason Barretto, SVP of government programs at Judi Health, in an interview.
The announcement comes shortly after CMS announced a proposed rule that seeks to enact reforms for Medicare Advantage and Part D. These reforms would require plans to verify and update their provider directory information regularly, and would enact transparency and reporting requirements for PBMs.
Loiacono noted that with the proposed rule, Judi Health won’t have to change anything because the company started with these principles.
“[These policies] weren’t popular. Go back seven, eight years ago. People thought we were insane,” he said. “They’re like, ‘You’re leaving so much money on the table. How could you operate at these levels?’ And I’m like, first of all, there’s plenty of administrative fees to cover your costs if you’re efficient in using modern frameworks. Second of all, transparency should have been here from the start.”
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