Latest / Becker’s Healthcare Podcast / Roya Tran, PharmD, MS, 340B ACE, Associate Chief Pharmacy Officer for Pharmacy Finance and Supply Chain at Duke Health

Transcript

Roya Tran, PharmD, MS, 340B ACE, Associate Chief Pharmacy Officer for Pharmacy Finance and Supply Chain at Duke Health · Becker’s Healthcare Podcast

• 0:00
  Welcome to the Becker's pharmacy leadership podcast. I'm
• 0:03
  Ella Jeffries, pharmacy reporter with Becker's healthcare. Today,
• 0:06
  I'm joined by Roya Tran, associate chief pharmacy
• 0:09
  officer
• 0:10
  at Duke Health. In this episode, we'll be
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  talking about key pharmacy initiatives from the past
• 0:14
  year, the priorities and headwinds leaders are navigating
• 0:17
  as they plan for 2026,
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  and more opportunities for organizational growth are emerging.
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  Roya, thank you so much for joining me
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  today. To start us off, can you please
• 0:25
  introduce yourself and share a bit more about
• 0:27
  your role in Duke Health Pharmacy Organization?
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  Yeah. Sure. Thank you, Ella, for having me.
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  It's a great way to start off the
• 0:36
  new year.
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  But my name is Roya Tran.
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  I'm a the associate chief pharmacy officer,
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  for overseeing pharmacy
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  finance, and supply chain at Duke Health.
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  At Duke Health, we are a,
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  four hospital health system with over two fifty
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  clinics
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  based generally in the Raleigh Durham Triangle area
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  of the state of North Carolina.
• 1:00
  But we all are also spread out across
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  the state. Our most recent integration of Lake
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  Norman has been, in that Charlotte area, and
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  we're looking to build,
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  and stand up two more hospitals in the
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  next five years one in a community site.
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  And then we're working with a joint partnership
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  with UNC to build the only freestanding hospital
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  in the state of North Carolina that's looking
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  to be a 500 bed
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  hospital site along with a number of ambulatory
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  clinics. So there's a lot of exciting growth
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  coming to our health system. I actually joined
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  Duke about a year ago. I'm coming up
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  in my one year mark.
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  Prior to Duke,
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  I was lucky to start my
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  early,
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  years in health systems management, but with a
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  residency
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  in the Houston program in the Texas Medical
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  Center, which
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  about ten years ago, that was one of
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  the largest academic
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  or largest medical center in the world. And
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  so it was great to get a broad
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  view of health systems,
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  in such a small,
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  densely populated area.
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  And that really gave me the ability to
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  kind of jump onto opportunities to continue to
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  grow. And I was lucky when I was
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  looking to relocate to North Carolina to have
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  the opportunity
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  to work with 340B
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  programs.
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  At UNC, I was able to grow and
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  establish their system three forty b program,
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  from one hospital service to nine hospital service,
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  corporate service and took that opportunity and that
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  structure
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  with me when I was able to support
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  Maine health, which. Was a very rural state,
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  so a totally different.
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  Climate of of of or diversity of hospitals
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  from
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  rural to more critical access type hospitals in
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  addition to the disproportionate share of hospitals.
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  And most recently when I joined,
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  Duke, it really has been like a culmination
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  of all my experiences that allows me to
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  align
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  that that very health system operations background with
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  the complexities and financial,
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  and regulatory complexities of three forty b into
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  a supply chain and finance role. So it's
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  been a great year, and I'm excited for
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  what's to come.
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  Great. Thank you so much for that context,
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  and congratulations
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  on completing a year. You have some great
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  experience under your belt, and I know Duke
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  is lucky to have you leading their pharmacy
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  team. And really exciting to hear about all
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  those opportunities coming up for Duke. And we'll
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  get into that later. But first, I'd love
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  to hear, you know, looking back over the
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  past year, what was the most important initiative
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  that you led? What did you focus on,
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  and what was results did you see?
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  Yeah. There were definitely many,
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  as I was thinking about this, but I
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  think when thinking about what is really important
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  to me,
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  in my leadership style and in creating a
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  new
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  a whole a whole new division within pharmacy,
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  it's important to be able
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  to establish
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  and empower a culture that allows us to
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  collaborate
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  in a time where there is so much
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  change
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  and requires so much discipline
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  to maintain
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  the execution
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  and at the same time, the agility, the
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  flexibility to main to be able to respond
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  to all of the changes in the,
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  all of our regulatory spaces and the financial
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  headwinds that we see, the pressures that we
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  see from payers. So it was important to
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  me to be able to kind of establish
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  a culture and build a talent
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  and align talent where we can respond to
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  this change. And I think one of the
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  things that comes to mind,
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  specifically was it about six months ago, we
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  adopted,
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  a new technology platform
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  around purchasing analytics,
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  when it comes to product selection,
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  contract
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  management,
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  gave us a great line of sight to
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  what we were purchasing and how we can
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  optimize,
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  our purchases and make sure that our contracts
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  were lined up appropriately.
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  And I think with you when you look
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  at the numbers,
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  sure, we beat our target within six months.
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  I think we've already saved a million dollars
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  worth on that we've seen,
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  realize in in drug expense savings.
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  But I think what's more important is that
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  we were able to build a group around
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  the having the appropriate,
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  new role if we needed a new role
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  to establish,
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  some type of oversight in this process, bringing
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  in supply chain,
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  clinical team members as well as operational team
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  members
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  to really be a core group,
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  to be the decision maker then and also
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  the folks that help to escalate
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  or,
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  also share out the changes with the operational
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  areas.
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  So I think we are at a point
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  where we've been able to develop a lot
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  of efficiencies on the process,
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  and now are able to work on scaling
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  up some of the changes that we're seeing
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  in more of our sites. And as we
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  continue to grow as a health system,
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  it's great to have a tool as well
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  as a team that can effectively look at
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  data
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  and be able to respond to it in
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  a more proactive and also strategic manner, as
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  opposed to some of the reaction that reactivity
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  that we were looking at previously. So I
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  think that has been a highlight, but there's
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  been, just at Duke, we've also expanded our
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  pharmacotherapy
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  clinics, and that's a part of some of
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  the work that there are some parts of
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  that that all sorts of team members were
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  involved in. And I'm excited to see where,
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  we're able to expand in the ambulatory space
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  and
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  support our pharmacists to increase access to patient
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  care.
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  And that, that those are the things when
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  I think about how do we develop a
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  financial structure to support more patient services,
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  it really keeps the mission going for me
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  and,
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  makes it exciting to be at Duke where
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  we can do some of this work.
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  Definitely. Those are great examples. Thank you so
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  much for sharing, and I agree. You know,
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  now is more important time than ever to
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  maintain that strong financial structure. And kind of
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  leading into my next question,
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  you know, looking ahead, what are the big
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  headwinds and priorities that you focused on as
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  you plan for 2026,
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  and how are those headwinds shaping your strategy
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  right now?
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  Yeah. I I,
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  expect that you wouldn't be able to go
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  without a single interview with a pharmacy leader
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  without hearing about the word three forty b.
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  And I'm in a spot where
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  this week, we,
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  we're still celebrating some wins, with the recent
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  court rulings that's sustaining
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  the appeal of the three forty b rebate
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  model from taking place in on 01/01. So,
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  we are super excited that
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  that has that is still under review and
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  on for an indefinite period of time.
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  I've done three four to be long enough
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  to know there's gonna be changes overnight and,
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  though some things may,
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  take a while to proceed. I think as
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  this works through the courts,
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  we still have to be prepared to respond.
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  Right? So all the work that we did
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  leading up to it still continues to ensure
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  that we are are ready,
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  for if that time comes.
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  And
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  the other piece to this is the MFP
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  rebate, the maximum fair price rebate that,
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  is also the second rebate that we were
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  working through against this one one deadline. So
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  we are working on executing,
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  the rebates for those. So I would say
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  some of that is a the defense strategy
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  that we're working through to make sure that
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  we're responsive to all these pay
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  payer changes and,
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  payment changes.
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  But on the offensive side, I would say
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  more so,
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  just making sure that we continue to work
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  through balancing the needs of the
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  high dollar cell and gene
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  therapies, which is a big portion of what
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  Duke does. You know, we we specialize
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  in in very clinically complex care and we
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  lead in some of these areas and so
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  making sure that we're at the forefront
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  of of the models related to cell and
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  gene therapy space,
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  is an exciting time there for us to
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  kind of,
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  sort of put position ourselves to be strong.
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  While the cost can be very high to
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  maintain those therapies. But,
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  every single time when I hear, you know,
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  our last little gems, my baby
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  come through the door and we were able
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  to administer something that's life saving and you
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  hear the story about how,
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  three months later, you know, they have improved
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  quality of life.
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  Those are the things that you can speak
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  to and we really try to make sure
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  that we,
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  Position ourselves financially
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  to be successful and to be able to,
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  scale up to to meet the needs of
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  our population.
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  Definitely. Definitely.
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  Now along with those priorities do come some
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  tough decisions. What do you say is the
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  hardest thing that you're gonna have to tackle
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  or decide in the coming year as a
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  pharmacy leader?
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  There are so many hard things at this
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  point.
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  I think all the low hanging fruit has
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  been thought,
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  but we are at a point where,
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  there's only a lot of opportunity to optimize
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  medication reimbursement
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  and tightly manage our revenue cycle. And that's
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  not just,
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  one aspect
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  of of of the process. It it requires
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  a multidisciplinary
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  involvement.
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  And some of that requires
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  changes with,
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  our clinicians and our prescribing practice. And sometimes
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  it requires
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  someone who understands our payers and having that
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  ongoing conversation
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  at the clinical, the financial level
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  to align the need and the utilization
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  appropriately.
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  So I'd say when it when there are
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  so many different complexities, it's trying to make
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  sure that we can focus on what is
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  truly
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  the most important and and helpful. Like, I
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  would say in this year, given everything that's
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  going on with MFP,
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  rebates, three forty b rebates, we're seeing a
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  push for really biosimilar adoption.
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  And
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  in the what I've learned over the time
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  with all the uncertainties of 340B
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  is that we have to have faith in
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  the mission of health systems because when we
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  do come together
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  to align
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  the needs of patient care
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  and the need to reduce all these complexities
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  for
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  the viability of health systems, I think we're
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  gonna be able to get to a place
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  where we as a health system
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  can be able to have leverage
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  to be able to,
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  maintain
• 11:47
  if we were to say a biosimilar formulary
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  that is aligned,
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  across
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  multiple,
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  settings, whether it's inpatient inpatient, clinic, or, retail,
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  and not have to react to all of
• 12:00
  these specific
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  payers. Right? So I think, that that may
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  not be the best choice for all, but
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  we need to get to a point where
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  we can put ourselves in a spot of
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  leverage to work with, what's best for the
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  patients in the health system. So I'd say
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  that's probably one of the hardest and in
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  tandem, it's just making sure
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  that we align our resources and our talent
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  appropriately to respond to this.
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  So, you know, we we don't have the
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  ability to add more resources all the time.
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  So how do we look at our our
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  resource pool,
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  and whether,
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  we have technology that can help support us
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  is gonna be a big piece in making
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  sure we can execute faster than,
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  we have in the past.
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  Definitely. And, you know, speaking of coming together,
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  I'm curious,
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  with all these headwinds and challenges, how are
• 12:50
  you preparing your team to
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  not only embrace them, but also to overcome
• 12:55
  them as well?
• 12:59
  Great question.
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  I think we are at a point where
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  we are looking more towards,
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  the how do we, again, look at our
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  offensive strategy
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  and grow where we need to grow for
• 13:12
  the for our patients. And I think one
• 13:13
  of that area one of those areas is
• 13:16
  continue to support our specialty
• 13:18
  pharmacy business.
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  We know patients get better care when everything
• 13:23
  is within the health system within one electronic
• 13:26
  medical record when they get to see their
• 13:28
  own pharmacists and their own technicians to support
• 13:31
  them through getting their prescription
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  approved and,
• 13:36
  refilled
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  and go through the whole prior auth process.
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  Right? So,
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  that's a big business area for us where
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  we're looking to grow that.
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  And we're at a point where
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  we're hitting our cap on space.
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  And without the space, we won't have the
• 13:53
  right technology.
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  We can't grow so we're
• 13:57
  actively looking for the appropriate facility to kind
• 14:00
  of grow our specialty
• 14:01
  space. And with that, I'm also looking for
• 14:04
  the appropriate,
• 14:06
  alignment on the acute care and the ambulatory
• 14:08
  side to support sort of sort of that
• 14:10
  centralized,
• 14:11
  distribution model where efficiencies can be gained with
• 14:14
  the right technology.
• 14:16
  So there's strategic planning that's involved in our
• 14:19
  teams to kind of develop that
• 14:21
  that structure and what that future might look
• 14:24
  like.
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  And at the same time, I think it
• 14:27
  goes back to where this is the great
• 14:29
  race and I I AI world where,
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  there are so many technologies out there. And
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  I do truly think there's no one technology
• 14:37
  that fits all, but we've got to figure
• 14:40
  out which pockets exist for what, what,
• 14:44
  tool. So we have a number of our
• 14:46
  own homegrown AI tools,
• 14:48
  as well as looking at, other vendors that
• 14:51
  are out there in the market that have
• 14:52
  already,
• 14:53
  practice and optimize with other health systems. So
• 14:57
  we're also,
• 14:59
  open to,
• 15:00
  partnering strategically,
• 15:02
  with the right partners. So I think with
• 15:05
  the upcoming Becker's conference, it's a great time
• 15:08
  to kind of,
• 15:09
  go out there and see and learn from
• 15:11
  other health systems as well as looking to
• 15:13
  see what other solutions exist in the marketplace.
• 15:17
  Definitely. And throughout this whole conversation, you talked
• 15:20
  a lot about growth and all these exciting
• 15:23
  new opportunities for Duke specifically.
• 15:25
  I'm curious just what excites you most about
• 15:27
  these opportunities?
• 15:30
  For me,
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  I'm gonna be kinda corny. And at heart,
• 15:35
  I always was in the mission to
• 15:38
  improve access to pharmaceutical care,
• 15:41
  that, you know, I grew up with a
• 15:44
  father who was always sick.
• 15:46
  We were he was a
• 15:48
  he he was a second, I guess I
• 15:50
  was a first generation American. He was health
• 15:53
  illiterate,
• 15:54
  and I was the one who had to
• 15:56
  navigate the health system process, the entire health
• 15:59
  system process with my father and,
• 16:03
  at the heart of it, I wanted to
• 16:04
  be able to scale up pharmaceutical access,
• 16:08
  improve medications,
• 16:09
  use and education to patients.
• 16:12
  And this really gives me the opportunity to
• 16:15
  do that
• 16:16
  for the region that I am residing in,
• 16:19
  but also the larger
• 16:21
  the larger level of the states and everything
• 16:23
  that we do where we could be the
• 16:26
  leader
• 16:26
  for a health system in different pockets, whether
• 16:29
  it's three forty b or specialty
• 16:31
  or ambulatory. Really, we get to share that
• 16:34
  with other
• 16:35
  health systems so that they can also improve
• 16:38
  their work. So that's where that's what drives
• 16:41
  me. It's it's very corny, but it is
• 16:43
  the mission of what I do and my
• 16:45
  belief. And I think that's where I'm lucky
• 16:47
  to be in a spot where the leadership
• 16:50
  and the organization is supporting sort of that
• 16:52
  shared vision.
• 16:54
  Definitely. No. It's great to hear that you're
• 16:56
  in a place where you're able to do
• 16:58
  that.
• 16:59
  Well, Royal, this has been such a great
• 17:01
  conversation. Thank you so much for sharing your
• 17:02
  perspective and insights with us. That's all for
• 17:05
  today's episode of the Becker's pharmacy leadership podcast.
• 17:08
  A big thank you again to Ria Tran
• 17:10
  for joining us to discuss pharmacy priorities, challenges,
• 17:12
  and opportunities at DeepHealth.
• 17:14
  Thanks for listening, and we'll see you next
• 17:16
  time.