Judi Health
Judi Health unifies pharmacy and medical claims processing with transparent pricing.
Judi Health (Capital Rx) is a full-service health benefit management platform that unifies pharmacy, medical, vision, and dental claims processing on a single enterprise platform capable of handling 180 million lives in real-time. Built on a purpose-built Enterprise Health Platform called Judi®, it eliminates fragmented workflows by consolidating claims adjudication, prior authorization, patient communication, and rebate administration. The company differentiates through transparent, flat-fee pricing with 100% rebate pass-through and NADAC-based benchmarking, eliminating hidden fees and spread pricing common in traditional PBM models.
Problem solved
Health plans and employers lose millions to fragmented claims processing systems, opaque PBM pricing, rebate clawbacks, and lack of unified visibility across pharmacy and medical benefits.
Target customer
Self-insured employers, health plans, health systems, unions, Medicare/Medicaid plans, and Fortune 500 companies seeking transparent, unified health benefit administration.
Founders
A
Anthony J. Loiacono
CEO & Co-Founder
Serial entrepreneur with 20+ years in pharmacy benefits and healthcare IT; previously CEO of Truveris for 8 years and founder of SMS Partners and Victrix (acquired by Chrysalis Solutions in 2007).
R
Ryan Kelly
Chief Technology Officer & Co-Founder
Co-founder and CTO; technology architecture and platform leadership background.
Funding history
Series C
$106M
2022
Led by B Capital
· Unknown
Strategic Investment
$50M+
2023
Led by Atlantic Health System, Banner Health, Hawai'i Pacific Health, Inova Health System, Lehigh Valley Health Network, Memorial Hermann, Nebraska Medicine, Novant Health, Ochsner Health, WellSpan Health
· Major health systems
Series E
Unknown
March 2024
Led by Unknown
· Unknown
Series F
$252M
September 23, 2025
Led by Wellington Management, General Catalyst
· Generation Investment Management, Growth Equity at Goldman Sachs Alternatives, 9Yards Capital, B Capital, Edison Partners, Prime Health Investments, Transformation Capital
Total raised:
$607M
Industries
Pricing
For PBM services: $0.99 flat fee per claim with 100% rebate pass-through and no clawbacks. Platform SaaS pricing not publicly disclosed; enterprise pricing available upon request.
Notable customers
Vida Health, Capital District Physicians' Health Plan, XO Health, Teamsters Health & Welfare Funds of Philadelphia and Vicinity, Fortune 500 companies, leading unions, major health systems, academic institutions
Integrations
AWS, Cloudflare, Google Analytics, reCAPTCHA, Element UI, Webflow
Tech stack
Element UI
Google Tag Manager
Google Analytics
reCAPTCHA
Cloudflare Bot Management
Amazon Web Services
Cloudflare
HSTS
HTTP/3
Open Graph
Webflow
jQuery
Website
Competitors
CVS Health/Aetna
Vertically integrated pharmacy and health insurance with opaque pricing; Capital Rx offers transparent, flat-fee pricing with full rebate pass-through.
Optum/UnitedHealth
Large integrated health platform with complex pricing structures; Capital Rx specializes in unified claims processing with no hidden fees or clawbacks.
Humana
Traditional health plan with PBM services; Capital Rx offers independent, transparent technology-first claims administration.
Truveris
Founder's previous company focused on PBM benchmarking; Capital Rx expanded to full claims processing and administration.
Why this matters: Judi Health represents a significant disruption to the $200B+ PBM industry by making transparent pricing and unified claims administration the standard, attracting billions in venture funding and major health system participation. At $3.25B valuation with $607M raised, it demonstrates investor confidence in the shift away from traditional opaque PBM models toward technology-first, transparent health benefits administration.
Best for: Self-insured employers, health plans, and health systems seeking transparent, unified claims administration that eliminates PBM markup spreads and provides real-time visibility into drug costs.
Use cases
Transparent Pharmacy Cost Management for Self-Insured Employers
Large employers with self-insured health plans use Judi Health to replace traditional PBMs and gain transparency into drug pricing. The Teamsters Health & Welfare Funds achieved $3M in savings by switching to Judi's NADAC-based pricing with 100% rebate pass-through, eliminating spread pricing and clawbacks that traditionally hide tens of millions from employers.
Unified Medical and Pharmacy Claims for Health Systems
Health systems integrate medical and pharmacy claims on a single platform to streamline prior authorization, reduce administrative overhead, and improve patient access to medications. Real-time claims processing across all benefit types enables coordinated care decisions and eliminates data silos between departments.
Real-Time Claims Processing at Scale for Health Plans
Medicare, Medicaid, and commercial health plans use Judi's platform to process millions of claims daily with a unified workflow. The enterprise platform scales to 180 million lives on a single instance, enabling plans to consolidate multiple legacy systems and reduce operational complexity.
Patient Assistance and Adherence Programs
Health plans and employers deploy patient communication and assistance programs integrated directly into Judi's claims administration, improving medication adherence and identifying cost-saving opportunities like generic alternatives and manufacturer programs at point-of-service.
Alternatives
CVS Caremark
Integrated health insurance and pharmacy, but opaque pricing with built-in PBM spreads; Judi offers independent transparent pricing.
Optum Pharmacy Benefit Management
Part of larger integrated health system; Judi specializes in transparent, standalone claims administration with no hidden fees.
Humana Pharmacy Solutions
Health plan-integrated PBM; Judi provides independent platform accessible to employers and health systems regardless of insurance affiliation.
FAQ
What does Judi Health do? +
Judi Health (operating as Capital Rx) is a health benefit management platform that unifies real-time claims processing, formulary management, prior authorization, and rebate administration for pharmacy, medical, vision, and dental benefits. It eliminates fragmented systems and provides transparent pricing with 100% rebate pass-through to clients.
How much does Judi Health cost? +
Judi Health's PBM service charges a flat $0.99 per claim with 100% rebate pass-through and no clawbacks. Enterprise platform SaaS pricing is not publicly disclosed and requires custom quoting based on volume and use case.
What are alternatives to Judi Health? +
Main alternatives include CVS Caremark and Optum, which are vertically integrated health insurers with pharmacy services but operate with opaque, spread-based pricing. Humana offers similar integrated PBM services. Traditional standalone PBMs like Express Scripts offer claims processing but without unified medical/pharmacy administration.
Who uses Judi Health? +
Target customers include self-insured employers (especially Fortune 500), health plans (Medicare, Medicaid, commercial), health systems, unions, and academic institutions. Notable customers include Teamsters Health & Welfare Funds, Vida Health, and major health systems like Banner, Novant, and WellSpan.
How does Judi Health compare to traditional PBMs? +
Traditional PBMs like CVS Caremark and Optum use opaque spread pricing and clawback mechanisms that hide margin extraction from employers and health plans. Judi Health eliminates this by charging a flat $0.99 fee with guaranteed fair dispensing fees and 100% rebate pass-through, using NADAC-based benchmarking for pricing transparency. Additionally, Judi unifies pharmacy and medical claims on one platform, while traditional PBMs operate separately from medical claim systems.
Tags
pharmacy benefits
claims processing
PBM
transparent pricing
health plans
rebate management
medical-pharmacy integration
healthcare administration