CVS Health's Agentic Enterprise gives Caremark members answers without the wait

Caremark, CVS Health's pharmacy services business, serves 87 million members and fields a high volume of routine member questions, with order status the single highest-volume request. Its existing voice and chat channels pointed members toward answers rather than delivering them directly. Questions that went beyond routine support created a second problem. Reaching the right expertise on a case like specialty medication coverage meant placing the member on hold and looping in a senior care rep, which roughly tripled the cost of the call.

To give members a real answer in the moment, Caremark built an order status agent with Agentforce. Members ask on the Caremark website and app or by phone, and the agent calls Caremark's experience APIs and returns the next shipment date. The agent reasons across more than 150 fulfillment substatuses to explain what a status means and what to expect next, such as an order that requires a prior authorization. For request types not yet built, like address changes, an orchestrator agent routes members to the existing experience, letting Caremark replace one high-volume request at a time.

When a question needs deeper expertise, a care rep asks for help without leaving Compass, their service console built on Agentforce Health. That request opens a swarm in Slack, a channel created for that single question. The right specialists join with the member's case history, and the rep stays on the line with the member while the group works the question. The conversation is then attached to the case in Agentforce Health, so the work becomes documentation other reps can find and learn from later.