Unlocking Specialty Drug Access: Pharmacy Strategy Meets AI Automation

Summary

Becker’s Healthcare Podcast – Episode Summary

Episode Title: Unlocking Specialty Drug Access: Pharmacy Strategy Meets AI Automation
Date: December 8, 2025
Host: Erica Spicer Mason (Becker's Healthcare)
Guest: Will Yin, CEO of Mandolin

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Overview

This episode explores the intersection of specialty drug access, pharmacy strategy, and the role of AI automation in transforming complex healthcare workflows. Will Yin shares the origin story of Mandolin and provides in-depth insights into the current challenges in specialty pharmacy—including administrative bottlenecks and payer-driven complexity—and discusses how advanced AI-driven automation can alleviate these pain points. The conversation also touches on practical strategies for adoption, change management, and the future direction of specialty pharmacy operations.

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Key Discussion Points & Insights

1. Mandolin’s Origin & Focus in Healthcare

• Personal Motivation: Will Yin was inspired by his family’s history with Alzheimer’s. Initially intending to pursue academic research, he turned his focus to resolving systemic barriers preventing patient access to breakthrough therapies.
• Industry Problem:

  "The bottleneck to real patient impact is not in more science...The bottleneck is in a broken American healthcare system." (Will Yin – 01:17)

• Mandolin’s Mission:
  Focused on automating the repetitive administrative work that delays lifesaving therapies, Mandolin partners with large healthcare organizations (over $10B annual drug spend) to close gaps between patients and innovative science.
• Complexity of Specialty Pharmacy:
  Unlike other industries, payers in specialty drugs benefit from complexity, making true automation both more challenging and more impactful.

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2. Major Administrative & Operational Bottlenecks

(Timestamp: 04:00)

• Staffing Difficulties: Rapid industry growth makes it hard to hire and retain skilled workers—errors become costly as paperwork demands increase.
• Evolving Site of Care Requirements: Policy and payment reforms create new hurdles for processing specialty drugs.
• Inconsistent Processes & Documentation:

  "...there's little consistency across the entire organization on the right process for them to follow in processing paperwork." (Will Yin – 04:44)

• Technology Fragmentation: A patchwork of platforms (EHRs, ePortals, PA portals) forces staff to juggle multiple systems, increasing error rates and inefficiency.
• Expertise Silos: Only workers with decades of experience have a full grasp of the complex system, limiting scalability and standardization.

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3. Strategic Implications of AI Automation in Specialty Pharmacy

(Timestamp: 06:20)

• Near-Term Impact:
  • Automates simple, repetitive tasks (e.g., data entry, processing).
  • Reduces claims denial rates and speeds up turnaround times.
  • Prevents costly mistakes; a single error with high-cost drugs can result in losses of hundreds of thousands of dollars.
  • Allows health systems to handle increasing patient volumes without linear increases in staffing.

  "...with high cost specialty drugs, we've seen single errors costing hundreds of thousands of dollars on a denial." (Will Yin – 07:18)

• Long-Term Vision:
  • As AI becomes the norm, operations will fundamentally change (comparable to the adoption of self-driving cars).
  • Shift from reactive paperwork correction to automated, robust, error-proof workflows.

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4. Change Management & Adoption Challenges

(Timestamp: 09:10)

• Historical Skepticism:
  Tech companies have often overpromised and underdelivered, leading to "enormous amounts of pain and scar tissue."
• Organizational Complexity:
  Slow-moving decision processes, competing priorities (e.g., budgeting season), and coordination hurdles are common in health systems.
• Keys to Success:
  • Well-documented SOPs lead to faster AI adoption and ROI.
  • Consistent answers and processes across teams reduce friction during implementation.

  "...the teams that get the most value the fastest are those with well documented SOPs for their patient access workflows." (Will Yin – 10:24)

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5. Future Directions & Value Opportunities

(Timestamp: 11:41)

• Process Documentation is Foundational:
  Solving denial and prior auth issues starts with clear, codified workflows that enable scalable automation.
• Bad Debt Reduction:
  • Hospitals are writing off significant revenue (often around 3% of net revenue) due to preventable errors and denied claims.
  • Example: One health system lost $750,000 on a single therapy due to missed prior authorization.

  "These numbers add up to tens of millions of dollars in preventable bad debt write offs." (Will Yin – 12:55)

• Central Command Opportunity:
  Mandolin aims to operate as a "central command" on every script, optimizing not just for revenue but for optimal patient care and site selection.

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Notable Quotes

• On Healthcare’s True Bottleneck:

  "The bottleneck to real patient impact is not in more science...The bottleneck is in a broken American healthcare system."
  (Will Yin – 01:17)

• On the Complexity of Specialty Drug Infrastructure:

  "For [payers], the complexity and confusion in the system is a feature, not a bug."
  (Will Yin – 02:19)

• On Automating for Financial & Patient Impact:

  “Most of the bad debt increases that we've seen at health systems are driven by denials caused by preventable errors with claims.”
  (Will Yin – 07:03)

• On Implementation Reality:

  "There's been frankly pretty shameful history of tech companies swaggering into the healthcare space and making outrageous claims."
  (Will Yin – 09:39)

• On the Impact of Documentation:

  "...the teams that get the most value the fastest are those with well documented SOPs for their patient access workflows."
  (Will Yin – 10:24)

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Important Timestamps

• 00:50 – 03:14: Will Yin’s background and Mandolin’s mission
• 04:00 – 05:48: Specialty pharmacy’s biggest operational bottlenecks
• 06:20 – 08:45: Strategic implications of automation (immediate and future state)
• 09:10 – 10:50: Change management hurdles and adoption advice
• 11:41 – 13:36: Next frontier for AI in specialty pharmacy and operational priorities
• 13:59 – 14:34: Closing thoughts on the future of specialty drug access

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Tone and Style

The discussion is frank, forward-thinking, and solution-focused, marked by Will Yin’s candid critique of industry pain points and pragmatic optimism about what AI-driven automation can achieve for health systems and, ultimately, patient care.

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Takeaways

• Specialty Pharmacy’s complexity requires a thoughtfully tailored approach to AI—one that recognizes payer incentives and workflow realities.
• Clear, unified processes and documentation are foundational for successful automation.
• AI holds significant promise for reducing bad debt, improving patient access, and enabling scalable operations amidst rising drug costs and administrative demands.
• Change management and realistic implementation strategies are critical, particularly given the industry's history with tech overpromising.

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Listeners are encouraged to tune in to the next episode for a deeper dive into driving revenue and access in specialty pharmacy.

Transcript

[A]

Hello everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series today. So today I'm joined by Will Yin, the CEO of Mandolin. And Will is going to talk to us about unlocking specialty drug access and where pharmacy strategy is intersecting with AI automation. Will, welcome to the podcast. I'm excited to have this conversation today.

[B]

Thanks, Erica. Happy to be here. I also, as an avid reader of Becker's newsletters, it's awesome to be on the podcast.

[A]

Oh, well, we're so happy to have you and thanks for being a reader as well. But to get our conversation started, I thought we could start a little bit high level here. So can you share us share with us a little bit about Mandolin's origin and your work in healthcare and particularly how you came to focus on specialty drug workflows and automation.

[B]

Yeah, sure. So a family history of Alzheimer's was my initial introduction to healthcare. And because of that, I spent my entire early life thinking that I was going to go into academia doing research around these incredibly exciting and life changing therapies for neurologic disease, for autoimmune conditions, for cancer. Very quickly though, what I realized, and ultimately what was incredibly disheartening, was that the bottleneck to real patient impact is not in more science. There's a wealth of incredibly accomplished and incredibly smart individuals doing great, groundbreaking science on important diseases in academia. The bottleneck is in a broken American healthcare system. And so that's what led me to swing the other way, drop out of Stanford undergrad and start Mandolin. The fact is that so much of what slows down patient access are these repetitive, mundane administrative tasks that lead to errors and mistakes, lead to building up of bad debt for systems and health care providers, and ultimately lead to patients not receiving therapies that could change and save their lives. At the same time. I was seeing this incredibly exciting convergence of large language models and agents. And that was exactly the premise on which we started Mandolin. I mean, we only started the company about a year and a half ago, but in that time we've grown to partner with some of the largest healthcare organizations in the U.S. totaling $10 billion a year of annual drug spend to close the gap between patients and groundbreaking science that could change and save their lives. The last thing that I'll say here, by the way, is that most industries that benefit from automation are not as complex as the infrastructure to deliver specialty drugs specifically. That's because most industries market participants the system to work more efficiently, right? They're just limited by the challenges of clunky systems of record, or maybe data fragmentation. But in the specialty drug market specifically, you've got a much more broken process, which means far more opportunity, frankly, because that's one of the most, or rather one of the most important market participants. In other words, payers, they actually benefit from the complexity. For them, the complexity and confusion in the system is a feature, not a bug. So the system itself has much more upside around agentic automation and ultimately empowering healthcare providers and their patients than many other industries.

[A]

Well, it's great to learn a little bit more about your background, what led you to where you are today. And you're in a very exciting space right now, the specialty pharmacy space. And you've already touched on really how we're seeing not only the spend of this industry grow, but complexity. To your point about the payer piece, complexity is continuing to accelerate as well. And you also touched on some of those administrative and operational hurdles. So I'd love to go there next and talk a little bit more about some of those barriers. So what are you seeing as the biggest admin or ops bottlenecks in hospitals and health system pharmacies right now? Especially when it comes to those key areas like access, benefits, prior auths and revenue cycle?

[B]

Sure. Well, in a system as broken and inefficient as the specialty medication space, there's actually several bottlenecks. So first, staffing is one huge bottleneck. The industry is growing incredibly quickly, and as the cost of screwing up the paperwork grows, the risk of mistakes grows. It's just enormously challenging to hire, train and retain diligent workers. Of course, changes to site of care requirements, that's another big bottleneck with site neutral payment reforms and so on and so forth. And documentation is another massive bottleneck. I mean, the way that the system continues to evolve has led to a wide range of expertise at the customers that we work with where there's little consistency across the entire organization on the right process for them to follow in processing paperwork. It often takes us months of effort for us or our customers to excavate the process that back offices are using. And it's always a deep surprise when leadership sees the actual steps that are being taken. The last big bottleneck that I'll mention is the proliferation and profusion of technologies, portals and SOPs. On the technology side, you've got faxes to ePortals, different EHRs, specialty specific EHRs, separate logins for PA portals or bridge program enrollments, RCM data. Living in alternate systems than the EHR itself. And then you've got rapidly evolving policies and protocols for every payer. In short, you've got this massive body of expert expertise that's impossible for anyone to master without having worked in the industry for decades. All of these bottlenecks lead to real pains and challenges, not just for the hospital system, but also all of its employees and ultimately for their patients, which I hope we'll get a chance to talk about more.

[A]

Yeah, absolutely. And I appreciate you outlining so clearly some of those bottlenecks, staffing, documentation, just the sheer proliferation of technology and platforms sounds like a really challenging environment. And I understand to address that, Mandolin is using AI agents to help automate tasks like intake benefit checks, prior auths, claim statusing. So in your view, what are the strategic implications for health system pharmacies of adopting this kind of automation? We'd love to know more about that.

[B]

Great question. I think that we can start to think about implications for AI based changes in perhaps two different timescales. The first is in the near term where the market is heterogeneously adopting AI and the comparison is often between an AI powered workforce performing against how work has historically been done. The second is going to be once AI is the norm. So I live in San Francisco. Most people here take self driving cars as our taxis. Basically that's only happened over the past few years. On the one hand, you have the near term change where we're in these cars comparing the experience to say an Uber ride with a human driver. But then there's of course also the deeper implications of long term what the world can look like when all the vehicles are self driving and you don't need things like say traffic lights anymore. So I'll talk about the near term first. So in the near term, the biggest implications of AI are on those simple, repetitive, mundane processes. So these are for example, data entry processing tasks. And the benefit of AI in those regimes is that we end up seeing significantly lower denial rates and faster turnaround times. Most of the bad debt increases that we've seen at health systems are driven by denials caused by preventable errors with claims. As an example, with high cost specialty drugs, we've seen single errors costing hundreds of thousands of dollars on a denial. And keep in mind that the more expensive the drug is, the higher the scrutiny from the payer side. These are clinical requirements, side of care requirements. These requirements change all the time. As you extrapolate this across a system and factor in the explosive increase in biologics, you're looking at tens of billions of dollars in losses attributable to paperwork errors. Of course, there's ultimately massive impact on patient care, which is the most important. Studies have shown that patients benefit significantly from having continuity of care when they stay within the four walls of an idn. Longer term staffing remains a big challenge. Patient volumes are only going to continue to scale. What is, what does that mean to grow capacity quickly without needing to spend time and resources? Hiring pharmacy techs, that's what AI enables us to do to scale operations like software.

[A]

You just did a fantastic job outlining really three key strategic implications for health system pharmacies. I mean, you mentioned the ability to address some of those simple, repetitive, mundane tasks that staff have on their plates. It sounds like there are really huge financial implications of automating some of these features. And then of course that all trickles down into the patient care experience as well as staffing ability.

So again, appreciate you outlining all of that. And from your experience working with health systems, I'm sure you've seen them come across some adoption or change management hurdles as they're embracing automation in these ways despite knowing all of these value points. So I'd love to know how you've seen organizations get through those change management hurdles and how pharmacy leaders should really prepare to support their teams during that process.

[B]

Yeah, good question. So at core, I think that there's been frankly pretty shameful history of tech companies swaggering into the healthcare space and making outrageous claims. And also assuming that health systems have teams of eager world class software engineers with nothing else to do sitting around waiting to implement a software company's product. And that's just been a failure mode that has caused enormous amounts of pain and scar tissue that we as a young tech business have had to traverse. Secondly, of course health systems just tend to move far more slowly. There's complex orchestration challenges of having lots of stakeholders trying to make a big decision. And then of course there are also things like re verification season and budgeting season. So they end up moving more slowly relative to some of the private entities that we worked with on the aic, home infusion and independent specialty pharmacy side. In terms of preparation, something we've noticed with our clients is that the teams that get the most value the fastest are those with well documented SOPs for their patient access workflows. If we sit down with your team and hear say 10 different answers to the same question about how your team handles a specific edge case, that's something we need to spend time ironing out up front that leads to potentially longer time to value.

[A]

Fantastic. Well, thank you. And I know that we are winding down in our time together in this conversation, but since you are, you know, you mentioned you're in San Francisco, you're in the Silicon Valley area, you're at the forefront of innovation and ongoing advancements with AI automation, especially in the specialty pharmacy space. So as you look ahead, what do you see as the next frontier for specialty infusion or pharmacy? The operations when it comes to these AI driven workflows, analytics and value. And what do you think leaders should be thinking about right now?

[B]

I love this question. So when we look at where health systems want solutions, they always gravitate immediately towards automating prior auths on the pharmacy side or say reducing PA denials. And as much as these things feel like discrete problems, they're really a symptom of confusions, errors, ambiguities and inconsistent sops upstream all over the organization. I think that as intake and other processes get documented, codified and converted towards repeatable automated agentic processes, the opportunities for solving these hugely expensive and complex problems become much clearer and unlocks much more significant opportunities for value creation. One massive area of opportunity that we've seen is in bad debt reduction. We all know hospitals are in dire financial situations. I believe Kodiak reported earlier this year that found most hospitals are writing off something like 3% of net revenue in denials. That's nearly the same amount of margin they have. So it's ultimately just canceling out. As another example, we spoke with a large IDN in the Northwest that had massive write offs for just lack of prior author. Identifying that a prior auth was necessary could be upwards of 750k for a single therapy. And these are due to simple errors, ultimately an incorrect J code, lack of medical necessity. These numbers add up to tens of millions of dollars in preventable bad debt write offs. By operating as a central command on every script that runs through a health system, we can make sure that we're not only avoiding those missed revenue opportunities, but we also optimize for optimal site of care wherever possible, both for the system as well as ultimately for the patient. Hmm.

[A]

Fantastic. Well, it's been so great learning from you today where you see AI automation technology in the specialty pharmacy space headed where it's at right now, some hurdles that you're seeing organizations tackle when it comes to change management and adopting this tech. So again I just want to thank you for being part of the podcast today and for sharing your insights with us.

[B]

Of course. Thanks. Thanks for having me. I think the last thing that I'll say here is, you know, it's an incredibly exciting time for the industry, right? There's these groundbreaking life saving medications coming to market that again have the potential to change lives and save lives. But at the same time that means an ever.

Increasing pressure to ensure that all systems have a high degree of precision around navigating ever evolving payer requirements, especially as we look ahead to 2026.

[A]

Yeah, a really important note to leave our listeners with. So thank you Will and I know this isn't our last conversation together, wanted to flag for our listeners that Will will be joining us for a second episode, a part two where we'll talk about driving revenue and access and specialty pharmacy. We'll take a deeper dive there and really looking forward to that Will. And of course we'd like to also give a big thank you to Mandolin for sponsoring today's episode. So listeners be sure to have a great day and join us again on the Becker's Healthcare Podcast series soon.