Podcast Summary: Becker’s Healthcare Podcast

Guest: Roya Tran, PharmD, MS, 340B ACE, Associate Chief Pharmacy Officer for Pharmacy Finance and Supply Chain, Duke Health
Host: Ella Jeffries, Beckers Healthcare
Date: January 24, 2026
Episode Theme:
A look inside Duke Health’s pharmacy initiatives, strategic priorities for 2026, regulatory headwinds, and the mission-driven opportunities guiding organizational growth. Roya Tran shares operational insights and personal motivation as a pharmacy leader navigating finance, supply chain, and care access challenges.

Episode Overview

The episode explores the recent advances and ongoing challenges in health system pharmacy, as discussed by Roya Tran. With a focus on Duke Health’s ambitious expansion, operational initiatives like purchasing analytics, and national issues such as the future of 340B and gene therapies, Tran offers a blend of practical case studies and mission-driven leadership philosophy.

Key Discussion Points and Insights

1. Introduction & Role at Duke Health (00:30–03:11)

• Roya Tran’s Background:
  • Oversees pharmacy finance and supply chain at Duke Health—covering four hospitals, 250+ clinics, with expansion into Charlotte and plans for two more hospitals.
  • Career progression from Houston’s Texas Medical Center, through leadership of UNC’s 340B program, and rural health experience at Maine Health.
• System Growth:
  • Duke is integrating new hospitals and ambulatory sites, including a significant joint venture with UNC for a 500-bed hospital.
  • Tran’s combination of health system ops, financial & regulatory knowledge underpins her leadership approach.

2. Most Important Initiative of the Past Year (03:37–06:55)

• Key Initiative: Purchasing Analytics Platform
  • Adoption of a new platform for purchasing analytics, contract management, and product selection.
  • Results:
    • Realized $1 million in drug expense savings within six months.
    • Created new roles and cross-functional teams combining supply chain, clinical, and operations to oversee and communicate changes.
    • Shift to “proactive and strategic” data use instead of reactive decision-making.
• Other Highlights:
  • Expansion of pharmacotherapy clinics, particularly in ambulatory care, to support patient access.
  • Focus on developing a scalable financial structure that enables broader patient service access.

“We beat our target within six months. I think we've already saved a million dollars worth on that we've seen realized in drug expense savings. But I think what's more important is that we were able to build a group ... to be the decision maker and also the folks that help to escalate or also share out the changes with the operational areas.” —Roya Tran (05:04)

3. Major Headwinds and Strategic Priorities for 2026 (07:17–09:53)

• Regulatory Volatility:
  • 340B program is at a critical juncture, with current court wins delaying a new rebate model but ongoing uncertainty (“changes overnight” can happen).
  • Maximum Fair Price (MFP) rebates are another urgent focus.
• Financial Resilience:
  • Emphasis on “defense strategy” to weather payer and payment changes, but also an “offensive side” balancing investment in cell & gene therapies.
  • Duke’s specialty in high-complexity therapies requires robust financial/operational preparation.

“I expect that you wouldn't be able to go without a single interview with a pharmacy leader without hearing about the word 340B... all the work that we did leading up to it still continues to ensure that we are ready for if that time comes.” —Roya Tran (07:18)

“Every single time when I hear our last zildjunsma baby come through the door ... and you hear the story about how three months later they have improved quality of life, those are the things that you can speak to.” —Roya Tran (09:24)

4. Hardest Choices Leaders Face (10:09–12:43)

• Complex Medication Reimbursement & Revenue Cycle:
  • “All the low hanging fruit has been plucked”—now optimization is complex, multidisciplinary, affecting both clinicians and finance.
  • Biosimilar adoption is being pushed, but alignment across inpatient, clinic, and retail is tough due to payer variability.
  • Resource Challenges:
    • Aligning limited resources and leveraging technology to keep pace.
    • Importance of “getting to a point where we can put ourselves in a spot of leverage to work with what's best for the patients and the health system.”
• Vision:
  • Faith in health system mission sustains teams through uncertainty and helps align financial realities with patient care needs.

“What I've learned over time, with all the uncertainties of 340B, is that we have to have faith in the mission of health systems.” —Roya Tran (11:15)

5. Preparing the Team for Headwinds (12:58–15:17)

• Growth Areas:
  • Specialty pharmacy is a priority; better patient outcomes when care stays within the health system.
  • Facility and tech limitations are the main bottlenecks; active search for new specialty space and centralized distribution efficiency.
• Tech & AI:
  • Piloting both homegrown and market AI solutions, with an eye on choosing fit-for-purpose tools for supply chain and operations.
  • Openness to strategic partnerships; upcoming Becker’s Conference seen as a forum for learning and collaboration.

“We know patients get better care when everything is within the health system, within one electronic medical record, when they get to see their own pharmacists and their own technicians...” —Roya Tran (13:19)

“There is no one technology that fits all. But we've got to figure out which pockets exist for what tool.” —Roya Tran (14:37)

6. Personal Motivation and Vision for Pharmacy Leadership (15:30–16:54)

• Mission-Driven Leadership:
  • Personal story: inspired by helping her health-illiterate, chronically ill father navigate the US system as a first-generation American.
  • Deep commitment to expanding pharmacy access, patient education, and operational models that share learning with other health systems.
  • Finds Duke supportive of her vision; sees system-level leadership as a lever for broad impact.

“At heart, I always was in the mission to improve access to pharmaceutical care... This really gives me the opportunity to do that for the region that I am residing in, but also the larger level of the states...” —Roya Tran (15:32)

“It's very corny, but it is the mission of what I do and my belief. And I think that's where I'm lucky to be in a spot where the leadership and the organization is supporting that shared vision.” —Roya Tran (16:33)

Notable Quotes & Moments

• On confronting the complexity of pharmacy reimbursement and biosimilar adoption:
  “I think all the low hanging fruit has been plucked.” —Roya Tran (10:11)

• On the shifting technology landscape:
  “This is the great race in the AI world, where there are so many technologies out there. And I do truly think there's no one technology that fits all. But we've got to figure out which pockets exist for what tool.” —Roya Tran (14:26)

• On personal mission in pharmacy:
  “I wanted to be able to scale up pharmaceutical access, improve medications use and education to patients. This really gives me the opportunity to do that for the region that I am residing in, but also the larger level of the states...” —Roya Tran (15:32)

Timestamps for Key Segments

• 00:30–03:11 — Roya Tran’s background and pharmacy organization at Duke Health
• 03:37–06:55 — Biggest initiative: Purchasing analytics, financial savings, and team building
• 07:17–09:53 — 340B and regulatory headwinds, specialty care financial strategies
• 10:09–12:43 — Hardest pharmacy leadership decisions for 2026: revenue optimization, biosimilars, resources
• 12:58–15:17 — Team preparation, specialty and ambulatory expansion, technology adoption, conference goals
• 15:30–16:54 — Personal motivation, leadership vision, and Duke’s culture of mission-driven growth

Summary

Roya Tran provides a comprehensive insider’s view into pharmacy leadership at a major academic health system. She details Duke’s proactive stance on technology, culture, and regulatory adaptation, focusing on the centrality of mission-driven work. The conversation foregrounds the interplay between cost-saving innovation, complex regulatory shifts (notably 340B and cell/gene therapy), and operational growth. Tran’s insights are punctuated by personal motivation, emphasizing the deep connections between healthcare leadership, patient access, and professional fulfillment.