Leveraging Capital Rx’s spread-free, full pass-through pharmacy benefit model, Capital Equilibrium is bringing Rx cost savings and renewal stability to the self-funded municipality and commercial markets

Capital Rx, Judi Health’s transparent pharmacy benefit management (PBM) line of business, is powering a new level-funded product, Capital Equilibrium. Unlike legacy level-funded products, Capital Equilibrium leverages Capital Rx’s full pass-through model, clinical programs, and contact center for member care – all powered by modern enterprise health technology (Judi) – to offer clients a combination of cost savings, flexibility, and budgeting security.

“What I love about this new option for pharmacy benefits is that it’s powered by Capital Rx’s transparency and gives municipalities and employers an opportunity to shop for a better deal – one that works for their group.” – Mike Miele, FSA, MAAA

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“The skyrocketing health insurance premiums we’re seeing across the country are in no small part due to rising spend on the medicine people need,” said Justin Leader, President and Chief Executive Officer of BenefitsDNA, a Pennsylvania-based employee benefits advisory, brokerage and consulting firm. “This problem predates concerns about tax credits expiring. Municipalities and other entities with fixed budgets or an inability to assume the risk of extremely volatile benefits expenses have dealt with compounding costs for years. Now, New Jersey’s state benefit plans, for example, must worry about 30% – 60% rate increases for medical and pharmacy premiums, respectively? We’ve reached a breaking point.”

By partnering with an A-rated stop-loss carrier for reinsurance and Capital Rx for conflict-free pharmacy benefit administration, Capital Equilibrium can bend the curve for plan sponsors through its unique features across all 50 states and provide:

  • A fixed monthly payment plan covering expected claims, administrative fees, and stop-loss, with these monthly amounts often below market rates
  • Stop-loss insurance to back claims exceeding monthly amounts, offering cost control for claims covered by the policy
  • A fair pricing structure that eliminates the traditional PBM gameplay around discounts and rebates, which often results in overstated, unachievable savings expectations
  • Individualized client reporting
  • The option to participate in a risk-sharing program to share in any gains or losses related to stop loss coverage
  • An experience refund or rate credit after the end of the plan year if claims are better than expected
  • 24/7/365, U.S.-based, multilingual, award-winning call center support to plan members

“This is a very price-sensitive market, and we believe that Capital Equilibrium is the most competitive and flexible level-funded solution,” said Mike Miele, FSA, MAAA, Senior Vice President of Insured Services, who oversees the new product. “When we underwrite the program and quote the actual fees, we show people what they’re spending now, what we think the costs will be – including expected rebates, which are 100% passed-through – and the amount that they will pay every month. We essentially lock in savings with a stop-loss policy. And if the experience comes in better than expected, the employer receives a dividend, a refund, or a ‘credit’ toward the premium for the following year. There are so many ways we can craft this and work with employers – that’s a true benefit.”

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Source- businesswire