Lucille Accetta on the Distance Between Diagnosis and First Dose

Melanie Marcus: What if the hardest part of a serious diagnosis isn’t the therapy, but everything standing between you and the first dose? If you’re prescribed something for high blood pressure, you can usually pick it up at the pharmacy the same day. But if you’re diagnosed with a chronic condition like multiple sclerosis or cancer, the prescription doesn’t go to the pharmacy shelf. It goes into a process built for complexity that includes benefit verification, prior authorization, financial assistance and nursing coordination. Our guest calls closing that gap her North Star, because in specialty pharmacy, getting someone started on therapy can mean running through a series of clinical interactions, prior authorizations and paperwork before anything reaches the patient.

Lucille Accetta is Senior Vice President, Chief Pharmacy Officer and Head of Specialty Operations at CVS Health, where she leads a specialty pharmacy business supporting more than 2 million patients managing complex and chronic conditions. But her connection to this work started at home. She watched her grandmother live with diabetes, and that made the concept of accessible healthcare personal long before it was professional.

Lucille began her career as a community pharmacist, and during her more than 30-year career she’s worked in community and hospital pharmacy, at pharmacy benefit managers and within life sciences companies—experience she now brings to her advocacy for pharmacists as essential members of the care team. Today, we talk about what it takes to move 2 million people through the most complicated corner of American healthcare, and why she believes the answer to helping patients is using technology to advance care and strengthen human touchpoints.

Welcome, Lucille. Thanks so much for joining us on There’s a Better Way.

Lucille Accetta: Thank you, Melanie. Excited to be here.

Marcus: First, a quick note before we dive in. Lucille sits on Surescripts’ Board of Directors, though this conversation really isn’t about either of our companies. Our focus is on the patient. So, Lucille, you started in community pharmacy in Westchester County, and your grandmother’s brittle Type 1 diabetes pulled you toward this work. How did your early experience as a community pharmacist, including your family connection to diabetes care, shape how you think about specialty pharmacy and patient support today?

Accetta: Thank you for this question, Melanie.

If I think back, my father’s mother, my grandmother, was a brittle diabetic, and I watched her journey as a child and growing up. It really was personal for me to watch how her healthcare was managed. So, when I started early in my career in community pharmacy, I learned how important it is to get accessible healthcare—you could walk in, talk to the pharmacist and get so much advice. I carried that lesson into all the different roles I’ve had, in hospital pharmacy, in the pharmacy benefit manager industry, working with patients on a larger scale, and in pharma, working with patient assistance programs. Even now in specialty pharmacy, how important it is to really connect with our patients and help them with their complicated needs using similar technologies and processes: educating them, providing them access to care and support, and giving them confidence in their diagnosis, their condition and their therapy.

The philosophy my leadership drives is being able to use technology to scale. I’ve watched over 30 years how technology can really advance the practice of pharmacy but never lose that human touch we give patients to take good care of themselves and understand their therapy.

Marcus: I love that. Technology done right actually frees you up so you can spend more time with patients.

Accetta: Exactly.

Marcus: As we’ve said, you lead specialty pharmacy operations at CVS Health, and that’s where we’re going to zero in on the patient experience. Could you explain what you mean by specialty pharmacy? What patients are served, and what’s different about the medications a specialty pharmacy dispenses?

Accetta: Specialty pharmacy is really different from what you typically see in your community pharmacy. It’s supporting patients with complicated chronic conditions like multiple sclerosis, rheumatoid arthritis, cancer, pulmonary hypertension and hemophilia. 

These are therapies that require a lot of complexity in the support they need, from nursing to different types of supplies. Most often they’re extremely high cost and, in most cases, very temperature sensitive. And in specialty pharmacy, it goes well beyond dispensing, and even beyond providing advice and counsel. It’s benefit verification. It’s financial assistance. It’s prior authorization work. In certain therapies, it’s extensive clinical education, and a lot of work around supporting adverse events and adherence. As you mentioned earlier, Melanie, just serving these 2 million patients in these complexities requires a lot of unique capabilities.

Success, for me, is this: How can we get patients started quickly and keep them on therapy so they can achieve their clinical outcomes?

Marcus: And when you say get them started quickly, that isn’t as easy as it sounds, is it? Compared to an antibiotic prescription you pick up at your local pharmacy.

Accetta: That is very true, and you’re going right into my North Star. Many times, I think: If I was diagnosed with hypertension, I could pretty much get my prescription that very same day from my local community pharmacy. In specialty, sometimes that’s not the case. It runs through a series of clinical interactions, prior authorizations, all this paperwork up front. And that’s the North Star—trying to make it easier and faster for patients to get started on therapy when they’re diagnosed with these complex conditions.

It really requires a lot of technical enhancements and data connectivity to take away that friction and personalize the entire experience. I think technology is going to make this a lot easier—it already has started—but we continue with that human touch.

Marcus: It’s amazing how science has come up with so many incredible ways to address these diseases, and yet we still need to get it to the patients. So, what is your better way in healthcare, and how does it show up for these patients, especially when they’re in a real-life situation needing specialty medication?

Accetta: Again, it’s really getting them started as fast as possible, making it easier to help them understand the entire process, and interacting with them. We have a lot of digital capabilities to keep them knowledgeable about the process, engage them in understanding their clinical needs, make sure they’re staying adherent with clinical interactions throughout certain times in their therapy, and then navigate all of the different needs they have.

Some folks need help with financial assistance. Some individuals need help with nursing care and coordinating all of that. It takes a very personalized effort around the type of patient and the type of therapy.

Marcus: That makes sense. Specialty pharmacy handles some of the most complex chronic diseases and costly medications, and patients are dealing with very difficult conditions like cancer and multiple sclerosis. It’s a different world. When a patient receives a serious diagnosis, what tools and strategies are most important to preventing the specialty journey from breaking down between diagnosis, prescribing and actually filling that first prescription—and then continuing on?

Accetta: I would look at it in three phases, Melanie. First, we want that very first interaction to be simple, and we use a lot of techniques and tools to make it easier. I’ll use the word omnichannel—leveraging data from across the enterprise. We can start a patient pretty quickly by looking at all the data we already have on that individual: their benefit, their plan design and so on.

Then we look at what therapies they’re being placed on, and how we can make it simple through technology—interactions with the prescriber, the clinical interactions, connectivity with their electronic health record, completing the prior authorization, managing all the pieces we need from the doctor’s office to complete the clinical component of the drug itself.

And then it’s the technology to interact with the patient. How do you want it delivered? Where do you want it delivered? How can I help you with financial assistance? In some cases, we even go as far as social-needs support. All of these pieces connect them with our colleagues to make sure they’re getting the interactions they need with our pharmacists and nurses and coordinating it all so that when the patient is ready to start, they’ll have either that nurse visit at home or the directions on how to self-inject.

So, all those pieces come together as part of starting, and then there’s the interaction we have through the digital component. A good 98% of our patients are already digitally engaged, so we can chat with them and connect with them digitally to keep them on their journey of care. And if there’s a need to change, or an issue the patient may have, it allows us to interact with them and connect back with their prescriber. So, technology is helping us create a better experience, but still with that personalized touch.

Marcus: That’s so important—personalized touch. How do you scale a high-touch human experience to 2 million patients without it becoming impersonal?

Accetta: The most important part is the connectivity we have with them. It’s amazing to watch how people are leveraging the interaction with us, either through chat, through calls or through digital. This omnichannel approach, and the fact that we can personalize it based on the patient’s diagnosis and therapy, is really important. And we have care teams wrapped around these patients to help with the expertise.

So, we have to make sure our care teams are set up in ways that understand these complex treatments, in certain cases, in centers of excellence that really understand the therapeutic area, and that they’re able to connect with prescribers to help them understand the challenges the patient might be having, or the paperwork we need to get through.

A lot of this scaling and ability to handle a human experience has to do with tech, but also with the ability to be connected to our colleagues on the care teams.

Marcus: I’m envisioning a patient who’s had a diagnosis today, in 2026, being able to chat in the middle of the night. You wake up in the middle of the night, and you can chat, and then if things get to be more than that, someone calls them the next day, or maybe even then.

Accetta: Yes. I recently did an interview with a patient whose mom called us at 3 a.m.

Marcus: Wow.

Accetta: It’s definitely scalable if a patient needs us. And to your point, the chat function is very secure—I just want to make sure of that. At the same time, it’s interesting how people have gotten used to chatting on so many different forums. For us it was a great experience seeing patients take to chatting as well.

Marcus: Always on, always there. As you know by the name of this podcast, we believe there is a better way, and that’s what we’re always searching for. In that search, specialty pharmacy depends on both technology and people working together. Where do technology and connected data make the most difference for patients, prescribers and care teams? And where does the human connection remain irreplaceable?

Accetta: Technology really is strengthening that human touch when we use it well. One example that’s near and dear to us is connectivity with the electronic health record. If I look at our data, we can help address prior authorization requests for more than 80% of our patients.

Can you imagine that?

We can take care of that in supporting the doctor’s office, really trying to reduce the administrative burden that’s on physicians’ plates today. They want to spend time with their patients, not with paperwork. So, beyond the human connection, it’s the technology to remove this burden from the doctor’s team, and from the pharmacy team, of having to find these answers in a lot of the paperwork we have to do. And as I look further at whether technology is truly going to help us continue to reduce the administrative burden for our pharmacy teams, I still think there’s more we will continue to do.

Marcus: That’s great. Like you said, you put technology into the picture, and it gives you more time with people, one-on-one. As you’ve said, you’re an advocate for pharmacists to be recognized as integral members of the care team. What must change in technology, or in how care teams work together, for that to be a reality? And is it already a reality in some ways?

Accetta: I currently lead the pharmacy for specialty, but I also love being the chief pharmacy officer for CVS Health. What I’ve seen in a lot of the work we’re doing, even in our community pharmacies, is technology innovation—looking at how we can help our pharmacists and technicians work at the top of their education and training.

A lot of the work is trying to take out the administrative burden that sits behind what we do as pharmacists. We know the pharmacist is considered an integral member of the care team, and we really want to see us make a bigger impact on the outcomes patients have.

So, across all our businesses, what’s exciting is continuing to innovate and using technology to give that time back to the pharmacist for more of that patient-pharmacist connection. That’s what’s really important to our pharmacists, too. They’re trained to be clinical in nature, they want to care for patients and they want to have the time.

You’re trying to navigate them out of this administrative burden. A lot of it is through AI. A lot of it is through predictive analytics. And obviously, the electronic health record connectivity I just shared. Then there’s the workflow: If you think about the pharmacy process, can we take out routine tasks? Can we make it easier for pharmacists to see clinical interactions and insights about a patient in a personalized way, and give them the opportunity to focus on counseling, interventions and improving outcomes? For me, that’s the important part of this role of being chief pharmacy officer and advocating on behalf of pharmacists as integral members of a care team.

Marcus: I love that. Very exciting progress. Can you take us into a day in the life of a pharmacist? What does it look like now when a patient comes in? What’s the best experience a pharmacist might have with a patient because this technology exists?

Accetta: If you think about the number of clinical interactions that come up on the screen when a new therapy is started, it sometimes causes what we used to call alert fatigue. Now that we can make it more personalized, it’s a unique message for the pharmacist for that particular patient’s therapy. And we try not to repeat all the same things over and over again at every refill, so we’re very conscious of the important clinical intervention. That’s one way to simplify it for the pharmacist.

The other way is looking at all the rejections that happen behind the scenes—plan designs, refill-too-soons—things that come up that cause the pharmacist to have to deal with an interaction that is so administrative. Simplifying that has been another great way to reduce the burden.

Another great thing CVS Health has done is look at regionality. If our pharmacy is heavily weighted on filling scripts and another pharmacy down the road isn’t carrying the same load, they can help each other out by pulling in some of that work, even though they’re not right there in that particular pharmacy. This geographic sharing, cloud sharing of work has really been game changing for our pharmacists.

Another area—and I don’t know if you’ve experienced this—is the phone calls. Imagine in the past, as a pharmacist, you’re trying to fill prescriptions, look at the interactions for that patient, and the phone is ringing and you have to pick it up. Nowadays the phone is not ringing unless it’s an urgent issue. The message is transcribed for the pharmacist and lands right in their queue of work, and they can answer that patient back within about 60 minutes. But the way they’re answering is different now: they have an answer. They don’t have to put the person on hold to research it while they’re still trying to fill a prescription or take care of a patient at the counter.

It’s a game changing difference to walk into the day feeling like the technology is helping you simplify your workflow.

Marcus: That’s amazing. I hadn’t paid as much attention to the fact that I didn’t see the phone on a pharmacist’s shoulder all the time. Now I’m going to have to pay attention, because I’m sure that’s what I'm witnessing. I just hadn’t noticed.

Accetta: You are. And what a difference, if you think about the noise factor and the ability to be in a more calming experience for taking care of patients.

Marcus: Including for the patients.

Accetta: Exactly.

Marcus: The specialty work you’re doing is so interesting. Maybe you could help crystallize it for us and talk about a patient’s experience with specialty medication and a specialty pharmacy. What might it have looked like, say, five years ago, versus what does it look like today?

Accetta: There are a lot of differences nowadays versus five years back. I can think of several. First, starting on therapy: getting all the information about a patient’s benefit, the copay assistance process, their ability to understand whether it’s a medical or a pharmacy benefit. Just the complexity of the benefit has gotten a lot easier. We have the technology to see that patient’s entire benefit design. That’s key number one, because sometimes specialty pharmacy drugs go through the pharmacy benefit and sometimes the medical benefit. That’s a complexity itself that we’ve simplified.

Second is getting a patient on copay assistance. That was tedious for patients, and today it’s a lot easier digitally. You can get a patient to click a link, go in, navigate them through the copay card and help them get some assistance with their copay. That’s another game changer.

Third is the prescriber work. Think about prior authorization and the number of clinical questions in certain therapies that you must get answers to. Today we can pull from the electronic health record and populate a lot of that data from the record. Super easy today, versus years back.

Last, which I love too, is the patient who’s digitally engaged with us, meaning they have the app or they’re on the website. They can track their therapy: “We’ve got your script. It’s working through prior auth. It’s in process. It's about to be delivered. I’m scheduling it. It’s on its way. It’s been delivered.” All those little notes are tracked today, and patients can see them. Before, they may not have always known where it was, and they’d be calling in: “Is my drug approved? Has it shipped yet? When will I get it?” Now it’s all very visible to them. We call it the pizza tracker, but it’s a very similar model, where I can watch it all the way through if I’ve got a digital connection. We wouldn’t have been able to do that years back, and the progress of that whole simplification, making this easier, is really where the technology has come into play. Couldn’t do that without the tech.

Marcus: For sure. I love that story, because it’s really a story of how technology is starting to get to a tipping point where patients are actually having an easier time.

Accetta: Absolutely. And even for doctors, if I take away the burden on our prescribers, that’s an easy lift for them. We’ve had prescribers say to us, “Help me understand where all my patients are in the process at your pharmacy.” So, we’ve even given them a portal: connect in, and here’s where every one of your patients is in the process. There’s so much out there now to help navigate and simplify, so we’re not all calling each other trying to figure out what’s happening with Mary Jones’ prescription.

Marcus: Thanks for that explanation and example. Let’s wrap up our conversation where we started: at the patient, and our search for a better way. So, let’s return to a variation of our signature question. If every leader in healthcare focused on one change that would keep complex patient care on track, what should that be?

Accetta: At CVS Health we have this ambition to be America’s most trusted healthcare company. To do that, we have to focus on simplifying this healthcare process, and our goal is one person, one family and one community at a time. You can hear already from what I've shared—the innovations, the technology—that we’re trying to simplify this complicated process.

I know it’s easier said than done, and we know it’s a challenge. Healthcare is not simple. So, our focus has really been on the experience of the patient: listening to our customers, listening to our patients, listening to our pharmacy teams and our prescribers, and making sure we’re navigating the process as easily as possible to get, at the end of the day, superior clinical outcomes.

One thing I enjoy at CVS Health is the focus on constantly improving our processes, prioritizing the innovations we feel are market leading, and putting the patient at the center of everything we do. That’s what I enjoy most about the work we do. We have the patient at the table as we look at how we’re processing and getting feedback.

Marcus: Lucille, I just want to thank you for your time here today. It was great to be with you.

Accetta: Same here, Melanie. Thank you for the opportunity.