The following is a guest article by Raj Ramaswamy, Chief Technology Officer at Buzz Health and Board Member
Pharmacy claim processing has become significantly faster and far more demanding. The timeframe benchmark for adjudicating claims has steadily narrowed, dropping from approximately 16 seconds to a target of just two seconds. That narrowing window now sits at the center of pharmacy infrastructure design.
Inside it, pharmacies, health plans, pharmacy benefit managers (PBMs), and consumers expect answers that older systems were never designed to produce.
Several forces are converging at once. Federal transparency rules, Centers for Medicare and Medicaid Services (CMS) prior authorization deadlines, and the growth of cash-pay and direct-to-patient programs have moved real-time accuracy from a competitive edge to a baseline requirement.
These trends shift the pressure point to infrastructure. The way that infrastructure is structured today will determine which organizations can deliver real-time accuracy inside that two-second window for the next decade or more.
A Piecemeal Architecture
The current prescription ecosystem was assembled over decades around point-to-point feeds, Health Level Seven Version 2 (HL7 v2) push messaging, batch reconciliation, and fax-and-portal workflows. Each component solved a real problem when it was introduced.
It worked for the era in which it was built. Consider what that era ran on: one-to-one connections between named partners, push-based events that fired when something happened, and end-of-day reconciliation that served as the audit trail. For a world where claims could be reconciled overnight, and patients first saw the price at the register, this was sufficient.
Today, that piecemeal architecture is no longer sustainable. Pressure on prescription infrastructure now arrives from multiple directions, regulatory and commercial alike.
For example, federal regulators are moving on two tracks. CMS interoperability mandates are establishing real-time data access as a federal standard, while a parallel set of rules dictates how quickly prior authorizations must be resolved. A 2026 CMS proposed rule would extend and harmonize the existing drug prior authorization timeframes, 24 hours for an expedited request and 72 hours for a standard one, across more payers.
More consequentially, it would require prior authorization for real-time electronic exchange, using the Prior Authorization API for medical-benefit drugs and NCPDP standards for pharmacy-benefit drugs, with compliance proposed for October 1, 2027. On top of these federal pressures, state-level price transparency laws are layering additional disclosure requirements at the pharmacy counter.
Commercial forces compound those regulatory pressures. Employers and plan sponsors are demanding auditability of every transaction. At the same time, cash-pay and direct-to-consumer growth is operating entirely outside the traditional benefit rails, creating a parallel ecosystem that older infrastructure was never positioned to support.
Each of these forces packs more work into the same fixed window. What used to be reconciled overnight must be addressed within the claim window. Information that used to flow through batch files at the end of the day now needs to be returned in milliseconds.
The gap between what the industry was built to do and what it is now expected to do narrows at the underlying architecture layer, where actual response times and data flows are determined.
What Real-Time Demands in Production
The crux of the challenge is that every claim demands real-time orchestration across multiple systems. The production system must query external sources in parallel, assembling eligibility, pricing, prior authorization, and benefit data from systems that have historically returned results asynchronously. The pharmacy counter cannot wait for those systems to take turns.
That orchestration runs against a hard clock. The two-second ceiling forces every design decision to bend around it. The system has to respond to external sources that slow down or fail, decide what to do when a response does not come back in time, and still return a clean answer to the pharmacist. The engineering challenge sits in that combination of constraints rather than in any single one of them.
Beyond speed, the architecture has to absorb constant change. Benefit designs, regulatory requirements, and pricing rules change continuously, and every routing decision encoded in compiled software becomes a future bottleneck. The architecture’s responsiveness to that change has become as important as its responsiveness to a single claim.
The system must also validate its work. For example, a patient’s decision to compare pricing and select an alternative off-benefit option must hold throughout downstream processing, and the system must be able to demonstrate that on demand. Most marketplace and adjudication systems leave that loop open, surfacing a price at the point of selection and trusting it will reappear at the point of dispensing.
How the New Architecture Responds
The architecture that meets these demands rests on three principles: speed at the moment of decision, configurability as the business rules change, and verification once the claim executes. Each one addresses a specific challenge described above.
Speed lives at the surface of the architecture. Inside the two-second window, the system has to query external sources in parallel, manage the ones that slow down or fail, and still return a clean answer to the pharmacist. Concurrency design, timeout handling, and failover logic have moved from specialized engineering disciplines into baseline architectural requirements for any platform that processes claims at scale. When that engineering holds, latency stops being the binding constraint. Over 90% of transactions clear well below the two-second threshold, with most processed in as little as one second.
Configurability operates one layer underneath. Pricing rules, benefit designs, and regulatory parameters change too quickly for compiled software to keep up. A configuration-driven layer enables business analysts to adjust routing logic directly, compressing the cycle between market signal and production behavior from quarters to days.
Verification runs across the full path. The price selected at the point of comparison has to match the price delivered at the point of dispensing, and the system must demonstrate that match on demand. Closing that loop catches price discrepancies, data staleness, or downstream errors before they reach the patient.
All three principles depend on one foundational design choice: API-first, contract-driven architecture. Standardized, well-documented interfaces reduce integration complexity for partners and support real-time access patterns at scale, with production volumes reaching upward of 145 million API calls per month. Partners that build to that standard will likely find their integrations adopted faster and replaced less often.
There is also an upstream dimension. Moving real-time pricing and benefit data to the point of prescribing, before the script is written, brings cost and coverage into the original treatment conversation. That is where adherence outcomes begin to improve, ahead of the pharmacy counter rather than at it.
What the Industry Builds Next
All of these improvements directly address the prescription experience itself. Inside that two-second window, the patient, prescriber, pharmacist, and payer all interact with the same infrastructure.
For decades, that experience was constrained by what legacy systems could deliver. Patients learned prices at the register, pharmacists confirmed coverage by phone, and prescribers wrote scripts without visibility into affordability. The transparency era reframes those defaults as friction that the industry can no longer accept.
Those three principles, speed, configurability, and verification, produce a new kind of experience: speed at the point of decision, configurability at the point of change, and verification at the point of execution. The organizations that treat infrastructure as experience design, not as a compliance project, will set the standard that the rest of the industry is forced to follow.
About Raj Ramaswamy
Raj Ramaswamy is a technology leader and Buzz Health Board Member with more than 25 years of experience in enterprise technology, including 15 years in the prescription healthcare industry. His expertise spans platform architecture, system design, digital commerce, process automation, cybersecurity, compliance, and large-scale healthcare operations. At Buzz Health, Raj has played a foundational role in scaling the company’s core technology infrastructure, leading the development of key innovations such as the dynamic pricing API, RxCompare platform, and proprietary real-time adjudication capabilities. He is also a co-inventor on a patent-pending innovation that advances Buzz Health’s technology-driven prescription savings solutions.
He brings deep expertise in prescription benefit management, high-volume transaction processing, and the design of secure, scalable systems that enable modular, data-driven healthcare solutions.
