Digital Pharmacy Is Booming. Its Infrastructure Is Falling Behind.

As consumer demand surges, the next wave of innovation will be architectural—not just another app.

The Front-End Boom, Back-End Strain

For millions of Americans, digital pharmacy has moved from convenience to expectation. Home delivery, automated refills, and digital affordability programs are now part of everyday healthcare. Health plans, PBMs, digital pharmacies, and health systems have invested heavily to meet this demand, often with slick mobile experiences and rapid go-to-market launches.

But behind the smooth consumer experience, many platforms are straining under the weight of their own success. Outages, delayed prior authorizations, brittle integrations, and manual workarounds are early warning signs of infrastructure that was never designed to operate as national, mission-critical healthcare plumbing.

The challenge is no longer whether digital pharmacy will scale—it already has. The question is whether the underlying architecture can keep up while protecting patients, meeting regulatory expectations, and supporting sustainable business models for payers and providers.

Why Scaling Digital Pharmacy Is Harder Than It Looks

On the surface, digital pharmacy appears straightforward: a prescription is ordered, filled, and delivered. In reality, every transaction touches multiple systems and regulatory checkpoints. Eligibility verification, pricing, clinical safety checks, prior authorizations, payment processing, dispensing coordination, cold-chain logistics, and real-time tracking must all work together without failure.

Each of these steps may involve different vendors, standards, and payer-specific rules. When platforms are built as isolated solutions, scaling becomes fragile. Every new payer, state requirement, accreditation standard, or clinical rule introduces complexity that legacy architectures were never designed to absorb.

One expert whose experience closely mirrors these challenges is Reshma Thakkallapelly, a digital health and enterprise architecture leader with more than 15 years of experience designing cloud-native platforms that operate at national scale across healthcare and other mission-critical industries.

“Digital pharmacy systems are no longer niche applications,” she explains. “They function as national infrastructure. If the architecture is not reusable, interoperable, and auditable, scaling exposes risk instead of reducing cost.”

Interoperability as Infrastructure, Not an Add-On

Interoperability has been a long-standing goal in U.S. healthcare, but it has now become a defining requirement for digital pharmacy. Standards such as FHIR and NCPDP are essential for connecting payers, pharmacies, and clinical systems in a way that supports growth rather than fragmentation.

According to Thakkallapelly, the issue is not whether organizations adopt standards, but how deeply they design around them.

“When interoperability is treated as an add-on, platforms become rigid,” she says. “When it is foundational, systems can evolve without being rebuilt every time something changes.”

That means thinking of interoperability not as a single interface project, but as core infrastructure: shared services, canonical data models, and configurable payer adapters that reduce re-engineering when onboarding new insurers or benefit designs.

What Modern Digital Pharmacy Platforms Must Handle

Today’s digital pharmacy platforms are expected to do far more than process prescriptions. They must coordinate complex clinical and financial workflows while protecting sensitive patient data at every step and providing real-time transparency for patients, clinicians, and payers.

That includes operating within HIPAA-aligned, privacy-by-design frameworks; enforcing least-privilege access; segmenting protected health information; and maintaining full auditability across microservices and partners. At national scale, even small architectural weaknesses can quickly translate into operational disruption, compliance risk, or reputational damage.

A recent example of this infrastructure-first approach is Elevance Health’s launch of a new digital pharmacy through its pharmacy benefit manager, CarelonRx. Announced in late 2023 and rolling out nationally in 2024, the platform is designed to let members track prescriptions end to end, compare medication costs, and engage with pharmacists 24/7 via text, chat, or phone, all while integrating tightly with plan benefits and clinical programs.

Serving as the lead architect and engineering lead for this platform, Reshma Thakkallapelly focused on building a scalable, event-driven architecture that can securely orchestrate high-volume transactions across FHIR, NCPDP, and payer systems, with deep observability and privacy controls built in. Platforms engineered with this level of rigor have been associated in industry analyses with measurable medical cost reductions, improved medication adherence, and significant affordability gains across large member populations. By contrast, solutions that depend on manual workflows and opaque integrations often struggle to scale, prove value, or manage risk as digital pharmacy volumes grow.

Platforms designed with these principles have been associated in industry analyses with measurable medical cost reductions, improved medication adherence, and significant affordability outcomes across large member populations. Conversely, platforms that rely on manual processes and opaque integrations often struggle to prove value and manage risk as volumes grow.

Architectural Patterns That Separate Growth From Risk

From an engineering perspective, scaling digital pharmacy is not about adding more servers or signing another integration agreement. It is about designing systems that can adapt to continual change.

Thakkallapelly points to several architectural patterns that are becoming essential for national-scale digital pharmacy:

• Configurable payer adapters that abstract plan- and PBM-specific rules so new payers can be onboarded with configuration rather than custom code.
• Saga-based workflow orchestration to ensure complex, multi-step transactions remain consistent, auditable, and recoverable when something fails midstream.
• Privacy-by-design patterns that minimize unnecessary PHI propagation, apply strong data segmentation, and support dynamic consent and access controls.
• Observability built into every service—real-time telemetry, service-level objectives, error budgets, and distributed tracing to detect issues before they affect patients.

“At scale, you don’t guess what’s happening,” she notes. “You instrument everything.”

These capabilities give operators the confidence to grow: to support new drug classes, benefit designs, channels, and partner models without rewriting the core platform each time.

Lessons from Other Mission-Critical Industries

While digital pharmacy has unique clinical and regulatory constraints, many of its technical challenges are familiar to other mission-critical sectors. Thakkallapelly’s background includes enterprise platforms supporting thousands of retail locations, as well as systems in aviation, manufacturing, and global supply chains.

Across these environments, the same patterns repeat. Systems that prioritize automation, cloud-native design, security, and observability scale more predictably and recover faster when issues occur. Those that grow through one-off integrations and manual interventions tend to hit a ceiling—sometimes abruptly.

Retail and logistics have already lived through this transition, moving from siloed systems to integrated, event-driven architectures that can support omnichannel demand. Digital pharmacy is now at a similar inflection point, with consumer expectations rising and regulators paying closer attention to reliability, data protection, and equity.

The Strategic Imperative for Payers, PBMs, and Health Systems

For health plans, PBMs, and health systems, digital pharmacy is no longer a side initiative. It is a front door to member experience, a lever for medical cost management, and a visible indicator of how modern—or brittle—the organization’s broader technology stack really is.

The next wave of differentiation will not come from one more app or enrollment campaign. It will come from the ability to operate digital pharmacy as resilient infrastructure: interoperable by default, architected for privacy, observable in real time, and adaptable to new care models and payment structures.

Leaders who treat digital pharmacy as infrastructure will ask different questions: How quickly can we onboard a new payer or partner? How confidently can we support new clinical programs? How transparent is our system when something goes wrong—and how fast can we recover without harming patients?

Answering those questions requires architectural investment, not just feature roadmaps. But for organizations that get it right, digital pharmacy can become more than a convenience channel. It can be a strategic asset that improves outcomes, strengthens member trust, and supports sustainable growth.

About Reshma Thakkallapelly

Reshma Thakkallapelly is a Senior Software Engineering Leader and Enterprise Architect with more than 15 years of experience designing and delivering large-scale, cloud-native, microservices-based platforms across digital healthcare, retail, aviation, and manufacturing. She is recognized for architecting secure, highly available, standards-based systems that operate at national scale and support millions of users in regulated environments, including the design of a payer-agnostic digital pharmacy fulfillment platform supporting nationwide home delivery and affordability programs within a HIPAA-aligned, privacy-by-design framework.

Her experience also includes enterprise-scale cloud modernization supporting more than 9,000 retail locations across North America, along with DevOps and CI/CD transformations for mission-critical systems in aviation, supply chain, and product lifecycle management. Reshma holds a Bachelor of Engineering in Computer Science from Kakatiya Institute of Technology and Sciences (KITS), Warangal, completed in June 2009, and holds AWS Certified Developer – Associate, AWS Solutions Architect, and TOGAF credentials. She is an IEEE Senior Member, holds SCRS Fellow Membership, serves on a technical advisory board, and contributes through Taproot.