How Technology is Bringing ‘Humanity’ Back to Pharmacy Benefits

Over the years, I’ve had the privilege of building products at the intersection of complex tech and human need. Whether developing autonomous vehicles or digital mental health platforms, the through-line of my career has remained the same. Technology should make life fundamentally better for humans.

In healthcare, “better” requires a radical infusion of empathy. It’s easy to view technology simply as an optimization engine to push business goals, but at SmithRx, we believe innovation without empathy is a missed opportunity. To my team, AI and platform architecture are not just buzzwords. They are frontline tools for solving the very human crisis of healthcare fragmentation and rising costs.

We do not build tech for the sake of our own egos; we build it for the common good.

This philosophy is what makes our platform a true differentiator. By bringing humanity back into pharmacy benefits, SmithRx is proving that a pharmacy benefit manager (PBM) can offer exceptional savings and scalability without losing sight of the patient experience.

Empowering Our Teams to Be “More Human”

AI is inescapable in the public consciousness today. This evolution has real meaning and impact in our day-to-day work at SmithRx, even beyond our technical teams. I view artificial intelligence as a strategic enabler, not a replacement for human judgment. Our AI strategy is built on three integrated pillars: 

• AI Assistants to empower our internal teams and the clients and members we serve.

• AI-Powered Platforms to embed predictive intelligence into core PBM workflows.

• AI-Enabled Teams to accelerate our software development lifecycle. 

By embedding intelligence into our core business functions, we’re going beyond simply adopting a new tool. We are evolving our entire operating model. 

AI Assistants: Augmenting the Human Touch

The first pillar is designed to augment the internal teams that interact directly with our members and partners. In the world of pharmacy benefits, speed is critical for patient outcomes and experience. Since leveraging AI assistants to consolidate information and simplify complex claims data, we’ve seen a 21% reduction in support call duration and a 15% faster turnaround on prior authorization (PA) reviews. 

These aren't just efficiency metrics; every minute saved is a minute less a member spends in uncertainty. By using AI to handle the information sourcing, we free our people to provide the human empathy that healthcare requires. We temper this unparalleled speed with a commitment to privacy, security, and compliance. All SmithRx team interactions with these tools occur within secure environments, ensuring that privacy is never compromised while still maintaining human oversight as the final decision authority. With the confidence in these tools seen by internal teams, the natural progression is to bring that simplicity and ease of AI assistants to members and partners.  

AI-Powered Platforms: Market-Leading Differentiation

Our second AI pillar embeds intelligence directly into our core Drug Pathways Engine to drive automation and optimization. This is where our technology truly differentiates us from any other PBM on the market. It’s continuously improving to get the right drug at the right price into the hands of patients.

Our platform shifts our role as the PBM from reactive processing to predictive intelligence. By integrating Drug Pathway Recommendations, we optimize drugs and pharmacies in real-time for both clinical efficacy and cost. Our AI initiatives include Claims Processing Optimization, which streamlines workflows and reduces avoidable rejections through smarter claim processing. Real-time Eligibility Anomaly Detection proactively catches mismatches to ensure seamless onboarding. Finally, Plan Build Auto-Correction leverages machine learning (ML) to automate and recommend benefit plan designs based on past claims and goals, automatically resolving discrepancies. 

This intelligent core ensures we deliver a continuously optimizing experience that lowers costs and improves member experiences.

AI-Enabled Teams: Leading a Cultural Shift

The final pillar is about the people building the product. We believe that an AI-powered shift is a change management challenge at its core, not just a technology overhaul. To achieve 100% adoption of AI tools within our tech team, we created an environment where innovation was contagious through shared learning sessions. 

Seeing a peer achieve measurable task time reduction is more motivating than any top-down mandate. Today, 100% of our engineers use AI for code generation. Over 30% of our total code is AI-suggested or generated. By making the use of AI “muscle memory” for our team, we’ve accelerated our software development lifecycle, allowing us to ship solutions to our customers at an unprecedented pace.

Fostering Excellence with Intentional Leadership

If technology is the blueprint for success, then leading with intention is the architect. To scale a modern PBM, I’ve always leaned on a core philosophy: you need the alignment of people, process, and product. As a company grows, what you’ve done before won’t necessarily scale you to the next level. You have to be willing to evolve your structure to dictate the behavior you want to see. Ultimately, the technology you build can’t run with empathy and ‘humanity’ unless you also infuse your culture with those same values. 

• People: We’ve set an intentionally high bar for our team, recruiting leading minds from both established tech giants and agile startups. The goal is to align individual career aspirations with our mission as we hire. When your team is personally invested in leaving the healthcare world better than they found it, the quality of work shifts to an exceptionally high level.

• Process: As we’ve matured, we moved from a monolithic scrum team to specialized “squads” focused on specific personas (members, partners, eligibility etc). This clarity of ownership allows us to orchestrate massive, complex programs with precision. By creating clear lanes, we’ve empowered our teams to move fast without breaking the things that matter.

• Product: Our North Star is a platform that is agile yet stable. We maintain a rigorous focus on the platform level, ensuring that every piece of code serves our long-term vision of a seamless healthcare experience. By applying data-driven decision-making at every turn and going deep to understand customer workflows and problems, we ensure our product isn't just a collection of features, but a cohesive solution to an age-old industry problem.

Building a Framework for Empathy at Scale

The technology transformation we’ve executed at SmithRx isn't just about code; it’s about intentional change management. I’ve always believed that structure dictates behavior. This framework fosters empathy and provides structural support for innovation, enabling our teams to change what it means to be a PBM for good, and we're just getting started.

Whether sharing our path to 100% AI adoption or navigating complex system migrations, we know that when we learn together, the entire industry moves forward. At SmithRx, our goal remains clear: use the machine to handle the data, so our humans can handle the care.

This is only the beginning. We’ll continue to have our technology leaders share more about our journey and dive deep into the technical "legs" of our platform. We are building the future of healthcare, and we’re excited to show you how.