Carly Rodriguez, Pharm.D. | 2026 MHE Emerging Leaders in Healthcare

I grew up in a suburb of Seattle, Washington, where my passion for helping others was sparked by my first job at a retirement home. I completed my prepharmacy studies at the University of Portland, where an early mentor in biochemistry helped shape my interest in pharmacy and its impact on patient outcomes. I earned my Pharm.D. degree from the University of Washington, along with a certificate in biomedical and regulatory affairs.

I credit the Academy of Managed Care Pharmacy (AMCP) with providing formative opportunities that shaped my career in health plan pharmacy. I was named a fellow of AMCP in 2019 for sustained contributions and excellence in managed care pharmacy and currently serve as immediate past president.

As vice president and chief pharmacy officer for Moda Health, I provide strategic direction for pharmacy programs and oversee medication spend and utilization across both medical and pharmacy benefits. I also serve as an innovation leader for the organization, advancing Moda’s care delivery model to incorporate personalized medicine.

In addition to my professional roles, I serve on the board of directors for Albertina Kerr, an Oregon nonprofit dedicated to empowering individuals with intellectual and developmental disabilities to lead self-determined lives in their communities. I live in Portland, Oregon, with my family.

Turning point in your career

A pivotal turning point in my career was my decision to take a risk and pursue the role of pharmacy director, clinical innovation, at Moda Health. Prior to joining Moda, I spent my entire postgraduate career with one organization, including completing an internship there during pharmacy school. It was a comfortable and familiar environment, and as someone who historically viewed herself as risk averse, leaving that setting represented a significant step outside my comfort zone.

This decision proved transformative. Transitioning into a higher-level leadership role at Moda allowed me to collaborate closely with leaders across disciplines beyond pharmacy and to contribute to innovation at an organization level. It also expanded my understanding of the broader healthcare landscape, including new exposure to Medicaid, and reinforced the value of applying pharmacy expertise in nontraditional ways.

I am fortunate to have benefited from many great mentors throughout my career, but the most impactful advice has centered on not limiting myself. Early on, I defined my professional identity narrowly, viewing my growth trajectory through a pharmacy‑only lens and assuming that chief pharmacy officer represented the natural ceiling. Encouragement from others who recognized my capabilities beyond pharmacy helped me reframe that perspective. I now see myself as a healthcare leader who happens to be a pharmacist, which is a mindset that continues to shape my growth and guide my professional aspirations.

Biggest day-to-day challenges

One of the greatest challenges I face in my daily role is navigating the pace and complexity of regulatory change in the pharmacy and broader healthcare space while continuing to ensure patient access to safe, effective and affordable medications. New federal and state regulations, particularly around drug pricing, reporting and coverage, often require rapid operational adjustments, cross-functional coordination, technology investments and change management. The Inflation Reduction Act (IRA) is a great example.

At the same time, rising prescription drug costs continue to put financial pressure on both healthcare organization budgets and patients. Balancing cost containment with clinical appropriateness requires constant evaluation of our drug formulary, negotiation with manufacturers and vendor partners, and close collaboration with clinicians to support evidence-based prescribing. The daily challenge is making thoughtful, compliant decisions that manage financial impact without compromising quality of care or patient experience.

Use of AI

We were early adopters of AI [artificial intelligence] to enhance operational efficiency, selecting an electronic prior authorization platform in 2023 that integrates AI across multiple workflows. One capability uses AI in a HIPAA [Health Insurance Portability and Accountability Act]-compliant manner to extract relevant data from clinical documentation (e.g., diagnoses, lab results) and align them with coverage requirements, thereby streamlining clinical review. AI does not make coverage determinations, but it supports clinical reviewers by efficiently gathering required information.

The platform also employs AI to convert plain language coverage criteria into structured decision trees that enable real-time electronic prior authorization. This process, which can take hours when performed manually, is completed in seconds and validated by human reviewers.

Additionally, AI is used within our customer service operations to assess call sentiment. By analyzing call tone and content, AI categorizes interactions as positive, negative or neutral to support training, education and process improvement.

On a personal level, I use AI to support my daily work by developing presentations, capturing meeting notes, organizing data into a concise business plan and conducting policy research.

Top priority

A top priority for our pharmacy business in the coming years is advancing value‑based management of drug spend by aligning cost, outcomes and access. We are focused on ensuring coverage and payment for medications continue to be driven by clinical evidence and real‑world value, particularly as specialty and rare disease therapy categories continue to grow. This includes strengthening value-based arrangements, refining utilization management to support appropriate use and designing benefits that promote high‑value care while maintaining timely patient access.

At the same time, we are focused on sustainability through innovation. Using data, analytics and responsible automation, we can reduce administrative burden, improve transparency, and support better decision‑making across pharmacy and medical benefits. Through these efforts, we will evaluate how we can better leverage AI to improve our processes and reduce costs.

Lastly, as an organization, we are prioritizing wellness and prevention through care delivery to improve long‑term health outcomes and reduce downstream costs. This includes investing in integrated health and wellness, chronic condition management, and early intervention strategies that address physical, behavioral and social drivers of health. By advancing personalized wellness across the healthcare continuum, we aim to support healthier lifestyles, prevent avoidable complications and reinforce a sustainable healthcare model.

Recommended book, article, podcast, TV show or documentary

A book I recommend everyone working in healthcare read is “The Price We Pay: What Broke American Health Care — and How to Fix It” by Dr. Marty Makary [the current US Food and Drug Administration commissioner]. This is a quick and easy read that addresses many of the systemic frustrations and failures faced by clinicians, patients and healthcare leaders every day. It also offers a balanced perspective on potential paths to reform.

I like this book because it gives real-world examples of misaligned incentives across our healthcare continuum and effectively bridges the gap between frontline clinical experience and healthcare economics. The book is framed around patient experience, so corrective measures are centered on how policy and financial decisions can have meaningful consequences for patients.

To lead down a path of fixing our broken healthcare system, we must have a solid understanding of how and why it’s broken. “The Price We Pay” gives practical insight into some of the reasons.

Making U.S. healthcare less expensive

U.S. healthcare is expensive largely because incentives are misaligned and policy and regulatory frameworks add cost without reliably improving quality or outcomes. Most stakeholders are paid in ways that reward volume rather than value, driving more services, higher drug prices and layered administrative activity with little accountability for total cost of care. Patients are insulated from true prices, and no single stakeholder is responsible for overall value, which allows costs to escalate across the system.

At the same time, regulatory requirements continue to expand and change. While often well-intended, they are inconsistently implemented and can vary by payer and state, increasing administrative burden rather than driving standardization. Significant resources, including people, technology and vendors, are devoted to compliance with prior authorization regulations, cost share caps, coverage mandates and reporting requirements, with little evidence of improved affordability or outcomes. The system becomes optimized for compliance, not patient-centered outcomes.

Addressing these challenges requires realigning incentives and simplifying policy across the healthcare system. Accountability should shift toward total cost of care and clinical outcomes, rewarding providers and plans for measurable value rather than volume, while administrative requirements such as prior authorization and quality reporting should be standardized to reduce waste and friction. Policy should prioritize impact over process by sunsetting ineffective regulations instead of layering new ones onto outdated frameworks. At the same time, the responsible use of technology and data should be encouraged to automate manual work while preserving human clinical judgment. Greater transparency and alignment among patients, providers, payers and regulators are essential to ensure all stakeholders are working toward the same goal: better outcomes at a lower total cost of care.

Personal goal

This year, I want to spend more time outdoors and be more intentional about activities that help me recharge and enjoy the beautiful Pacific Northwest. I recently got back on a snowboard for the first time in 15 years, so I’d like to get out more consistently during the season and build my confidence on the mountain. This summer, I’m looking forward to developing a green thumb by starting an outdoor garden from scratch and growing my indoor plant collection.