PBM Capital Rx Plans to Accelerate Growth with $50 Million Investment

Capital Rx recently closed a $50 million series B funding round. The round was led by Transformation Capital and also included investment from Edison Partners, who led the PBM’s series A round. Capital Rx serves hundreds of thousands of members and processes millions of prescriptions.

Capital Rx, launched in 2018, is redefining the way prescriptions are priced and administered in the U.S. Capital Rx is a next generation pharmacy benefit manager, overseeing prescription benefit plans on behalf of employers, unions, and members. Capital Rx is one of a number of transparent PBMs that offer an alternative business model that passes through rebates on behalf of consumers.

Through its Clearinghouse Model, Capital Rx unlocks the pharmacy supply chain and reduces prescription costs for employer groups. By establishing a competitive marketplace for drug pricing, Capital Rx focuses its resources on deploying actionable strategies that improve plan performance and patient outcomes.

Capital Rx’s Clearinghouse pricing model is inspired by the stock exchange. By removing the artificial wall between pharmacies and plan sponsors, the company takes the mystery out of prescription drug pricing. The result is a fairer, more efficient system with the ability to deliver untapped value from the supply chain by ensuring everyone knows exactly what they’re getting and exactly what it costs.

Capital Rx’s Clearinghouse Model deploys the National Average Drug Acquisition Cost (NADAC), which is maintained by the CMS based on surveys of actual acquisition costs among retail pharmacies. With a NADAC benchmark, Capital Rx utilizes on an unbiased source that also ensures price consistency because NADAC prices only update when changes of +/-2% occur.

In addition, Capital Rx ‘s contracts with employers offer an industry first- actual unit costs for all drugs, that are the same for all customers. In comparison, typical PBM agreements are over 50 pages but do not include a single prescription price.

Capital Rx also recently announced the launch of JUDI℠, the industry’s first Enterprise Pharmacy Platform (EPP), to significantly reduce administrative overhead, advance clinical management, and radically improve customer experience in healthcare.

JUDI ℠ was architected to unify all pharmacy benefit management (PBM) operations – from underwriting, implementation, claim adjudication, data integration, prior authorization, patient communication, client reporting, invoicing, and reimbursement – to deliver on the promise of a better care delivery system.

Capital Rx joined forces with Walmart last summer to bring transparency of unit prices across specialty and mail order prescriptions through its Clearinghouse Model^SM in order to combat rising cost of prescription drugs. 

Walmart Specialty Pharmacy is a URAC accredited, provider with a focus on patient-centered care, helping patients manage specialty medication therapies for a wide variety of complex and chronic diseases. Walmart Specialty Pharmacy coordinates care between patients, caregivers and insurance companies to ensure that patients receive necessary medications and supplies whenever and wherever they are needed.

Takeaway: Capital Rx’s new investment will help to continue the company’s rapid growth and market acceptance of its Clearinghouse Model