Judi Health gets a CMS contract for its own employer retiree Part D plan

Judi Health said Oct 20 that the Centers for Medicare & Medicaid Services (CMS) granted a contract to Judi Rx Retire, a new Medicare Part D plan. It is sold as an employer group waiver plan (EGWP), the kind of Part D plan that employers and unions sponsor for their Medicare-eligible retirees.

What is different

In Judi’s model, Judi Rx Retire owns the CMS contract and handles CMS coordination itself. The company says traditional EGWP setups split compliance, enrollment and claims across several vendors. Eligibility, claims, the pharmacy network, the formulary, prior authorization and reporting all run on Judi’s own platform.

Coverage follows a CMS-compliant formulary with the standard Part D pieces: pharmacy networks, cost sharing and deductibles. Employers can add coverage beyond standard Part D.

Judi’s pitch is transparency. It says traditional EGWPs hide the real cost of drugs behind complex rebate deals and opaque pricing. It says plans on Judi can see their own claims data and verify the full value of the CMS subsidy. On service, the company claims 24/7 support based in the U.S., under 30 seconds to reach an advisor and 97% first-call resolution. Those figures are Judi’s own.

Jason Barretto, Judi’s senior vice president of government programs, told Fierce Healthcare that clients asked for the product. Until now, he said, they had to manage retirees through a separate vendor or skip Judi entirely. He said the company sees room for a Medicare Advantage drug plan later but is focused on Retire for now.

A first employer

Princeton University’s HR site says Judi Rx will replace OptumRx as the administrator of its retiree EGWP from Jan 1, 2027, and that enrolled retirees move over automatically. Princeton lists new 2027 retail copays for a 30-day supply of $15 for generics, $35 for preferred brands, $60 for non-preferred brands and $35 for specialty drugs. In 2026 those copays were $10 for generics, $30 for preferred brand or specialty drugs and $50 for non-preferred brands.

Why it matters

EGWPs are where employers carry retiree drug costs, and a plan that holds its own CMS contract and opens its claims data gives benefits buyers a direct way to check rebate and subsidy figures.