Capital Rx, a Financial District-based pharmacy benefit manager firm, raised a $115 million Series D funding round earlier this month, Chief Executive A. J. Loiacono confirmed Wednesday.
Capital Rx manages prescription drug benefits for hospitals, unions and health plans using an artificial intelligence-based claims software platform called Judi. The platform oversees patients’ eligibility for certain plans, processes claims electronically and handles payments and reimbursements, Loiacono said, to automate the process to drive down costs for Capital Rx clients.
Judi is what drew Prime Therapeutics, another pharmacy benefit manager company that is collectively owned by 19 Blue Cross and Blue Shield health plans across the country, to invest in Capital Rx, Loiacono said. The plans serve 50 million members across the country but Prime had been using outdated technology to administer its claims for more than two decades. The firm has invested $115 million into Capital Rx in exchange for a minority interest in the organization and access to Judi, according to Loiacono.
The deal will allow Prime to use Judi and Capital Rx to scale the platform, according to the company. The firms first announced their deal on March 13 but Prime’s specific investment was previously unreported.
Capital Rx will also use the funding round to invest in research and development, Judi and new services, Loiacono added. The firm will look to optimize its own services, which include a pricing model to make drug costs more transparent for employers and members and a Medicare prescription payment plan.
Capital Rx was founded in 2017 and has raised more than $250 million to date, including a $50 million funding round in October 2023.
Jacqueline Neber , 2024-03-28 10:33:03
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