AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing Healthcare

Episode 95 of Astonishing Healthcare (http://www.judi.health/podcast) features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that’s packed with insightful reflections and optimism about the future.


We won’t ruin it in the show notes, but based on what we saw in 2025:

• Everyone has finally had enough of the costs and opacity of the U.S. healthcare system – a $70k family premium is truly astonishing
• It’s surprising that, despite the lawsuits, warnings, and reform efforts, the proverbial hammer didn’t drop on anyone for not being a good health plan fiduciary
• The speed and impact of AI have broadly been more positive than expected
• The rise of cardio-diabesity
• How GLP-1s helped shift the balance of power in the pharmaceutical supply chain




And in 2026, we may see:

• Employers fight back – they take agency over their plans, and for first movers that started with transitioning to aligned PBMs, it’s “game on” for the rest of their health plans
• The cash price – or acquisition cost – of drugs in the U.S. becomes the baseline – i.e., we finally see a real change in how drugs are priced
• ICHRAs and other alternative models become more popular
• Employers look to new clinical programs and models that demonstrate a return on their spending
• AI become more important for clinical workflows (not decision-making, at least not yet)
• Pharmaceutical manufacturers find themselves with increasing bargaining power vs. traditional PBMs
• A new Stanley Cup champion, and a Super Bowl ring for…




Related Content

• Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform (https://www.judi.health/insights/judi...)
• Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness (https://www.judi.health/insights/repl...)
• AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency (https://www.judi.health/insights/ah09...)
• Health Benefits 101: The Importance of Clinical Programs (https://www.judi.health/insights/heal...)
• How to obtain Rx data and what to do with it (https://www.judi.health/insights/how-...)







For more information about Capital Rx and this episode, please visit Judi Health - Insights (https://www.judi.health/insights) .