How Clinical Expertise and Technology Are Transforming Specialty Pharmacy Care at CVS Health

Specialty pharmacy sits at the intersection of clinical complexities and logistical challenges and at the AXS2026 summit, 4 CVS Specialty leaders offered a detailed look at how their organization is addressing both sides of that equation through a patient-centered care model backed by real-world outcomes data and a forward-looking technology strategy.

Building Clinical Depth Around the Patient

Maria Klecha, assistant vice president of specialty therapy operations, spoke about the scope and specificity of CVS Specialty's therapeutic expertise. "Our team supports some of the most complex, rare, and emerging therapies on the market today, and we have very intentionally organized that expertise around the conditions and the therapies that our patients actually live with," she said.

Klecha explains that the organization has built more than 30 centers of excellence, each staffed by clinicians with disease-specific training. For example, within the pulmonary arterial hypertension (PAH) program alone, more than 100 pharmacists have completed specialized PAH training. A national network of more than 450 nurses credentialed in complex therapies maintains a 97% patient satisfaction rate. Data from research studies also shows that in PAH, integrated specialty pharmacy models, where pharmacists are embedded in disease-specific care teams, are well positioned to mitigate adherence barriers.¹

Beyond adherence metrics, Klecha cited quality-of-life improvements among patients with short bowel syndrome. In an internal review of more than 2500 clinician-led patient assessments, over 85% of patients reported improvements in quality of life within the first 2 months of therapy.

"These insights do not replace controlled clinical studies," she acknowledged, "but they do provide that valuable real-world understanding that helps our teams anticipate needs and deliver more personalized care sooner."

Technology as a Force Multiplier

Lucille Accetta, RPh, MPH, MBA, senior vice president and chief pharmacy officer, was deliberate in framing the role of technology within the broader care model. "We never lose sight of the fact that we deliver care to patients led by people," she said. "Our pharmacists, our nurses, our clinicians—they're all doing this, but they're really strengthened by technology."

A notable patient-facing tool highlighted was secure live-chat access to clinical staff. Accetta noted that when the feature first launched, pharmacists reported receiving more information from patients through chat than they had historically gathered over the phone. The observation speaks to a broader principle of meeting patients where they are, in the format that works for them. Over 98% of CVS Specialty patients are now engaged digitally, and this approach allows patients to manage nearly their entire pharmacy experience through digital touchpoints, while still maintaining direct clinician access when needed.

Klecha reinforced that the technology infrastructure supports clinical judgement, rather than supplants it. "This is not about technology alone," she said. "It's really about empowering our teams to deliver that personalized, compassionate care that our patients deserve."

Streamlining Benefits Verification and Prior Authorization

Amber Lorenzon, executive director of benefits verification, described how her team is overhauling benefits verification and prior authorization which has historically been one of the most friction-heavy parts of the specialty pharmacy experience. Using enterprise data assets and electronic health record (EHR) connectivity, her team is moving toward what she termed predictive claims intelligence, which is the ability to anticipate a patient's therapy needs and proactively manage insurance benefits before gaps arise.

"What has historically been a pretty manual process for our colleagues, we're able to simplify by leveraging, with patient permission, enterprise data and assets, as well as our expansive EHR," Lorenzon explained. The goal is an interconnected workflow that replaces the traditional stepwise approach with a process that resolves benefits issues proactively, provides patients with real-time cost transparency, and reduces administrative burden across the board.

EHR Connectivity and the Prescriber Experience

Danielle Blackman, executive director of innovation strategy, built on Lorenzon's discussion by describing how deep EHR integration is changing the prescriber relationship. CVS Specialty is currently connected to more than 94,000 prescribers, giving the pharmacy EHR data access for over 80% of their specialty patients. That connectivity allows clinicians to complete prior authorization submissions using chart data already in the system. In more than half of cases, those prior authorizations are sent directly to the patient's plan without requiring any follow-up contact with the prescriber's office.

"That really allows us to give the doctors minutes and hours back for them to be able to focus on the clinical care of the patient, especially in a specialty situation where the care is more complex," Blackman said.

Blackman also highlighted proactive formulary change messaging, noting that CVS Specialty has already sent over 7000 alerts to prescribers for formulary changes. Prescribers working within this connected system report am approximate 94% satisfaction rate.

A North Star for the Industry

Accetta said the organization's goal is to reduce the time from diagnosis to therapy start for specialty medications to mirror the speed of a community pharmacy fill. Over the past 3 years, process improvements have already cut time-to-therapy by more than 43%, and the vision is for most therapies to reach a 24-hour start goal.

"You cannot grow specialty pharmacy today without innovation," Accetta said. "And we are an innovation engine here."

REFERENCE

1. Shah NB, Mitchell RE, Proctor ST, et al. High rates of medication adherence in patients with pulmonary arterial hypertension: an integrated specialty pharmacy approach. PLoS One. 2019;14(6):e0217798. doi:10.1371/journal.pone.0217798