Does cache get cleared automatically in Align or does the Veeva Support team need to initiate it every time?
Cache is cleared every time stale cache is detected on every page load.
There is a system object in Vault: vault_component__v.
After every page load, a query is executed to see if anything has changed since cache is last populated:
SELECT id, component_name__v, modified_date__v, component_type__v, checksum__v FROM vault_component__v WHERE component_type__v CONTAINS ('Object', 'Pagelayout', 'Picklist', 'Securityprofile', 'Permissionset') AND modified_date__v >= '2018-07-18T19:54:08.908Z' ORDER BY modified_date__v DESC, id
In order to force a clearing of cache please open a ticket with Veeva Align Support.