Went through the CVS Health senior software engineer system design interview round twice in the last year (once in-person, once virtual) for two different roles on the digital health and pharmacy platform teams. Sharing what i actually saw because most advice online assumes a pure-tech-company context and CVS is different.
The setup. One 45-minute round, one or two interviewers, typically a senior IC and sometimes a tech lead. You'll get a whiteboard (physical or virtual Miro equivalent). They give you a prompt, you drive.
Prompt types I saw: Design a prescription refill notification system that needs to handle multiple channels (push, SMS, email) and be HIPAA-compliant Design an appointment scheduling API for CVS MinuteClinic locations Design a pharmacy order management system with inventory visibility across stores
All three are clearly domain-specific to CVS's actual product surface. They're not trying to trick you with abstract distributed systems puzzles. They want to see: can you break down a real healthcare-adjacent problem, think through the data model, identify the API boundaries, and say something coherent about reliability and compliance.
What moved the needle: Calling out PHI (protected health information) and what that means for logging, encryption, and retention early in the discussion Thinking aloud about failure modes and graceful degradation rather than happy-path only Asking clarifying questions before diving in: scale, SLAs, existing systems to integrate with
What didn't matter much: Exact Kafka vs. SQS debates at the margins Wildly specific throughput numbers (they're not building for Twitter scale) Fancy algorithms
This is a senior/L5 equivalent role so they want to see judgment over cleverness. If you come in deep on healthcare data flows and regulatory context, you're ahead of most candidates.