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Becker’s Healthcare Podcast
Roya Tran, PharmD, MS, 340B ACE, Associate Chief Pharmacy Officer for Pharmacy Finance and Supply Chain at Duke Health
00:17:32
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- [00:00]
A
Welcome to the Becker's Pharmacy Leadership Podcast. I'm Ella Jeffries, Pharmacy reporter with Beckers Healthcare. Today I'm joined by Roya Tran, Associate Chief Pharmacy Officer at Duke Health. In this episode, we'll be talking about key pharmacy initiatives from the past year. The priorities and headwinds leaders are navigating as they plan for 2026 and where opportunities for organizational growth are emerging. Roya, thank you so much for joining me today. To start us off, can you please introduce yourself and share a bit more about your role in Duke Health pharmacy organization?
- [00:31]
B
Yeah, sure. Thank you, Ella, for having me. It's a great way to start off the new year, but my name is Roya Tran. I'm the associate Chief Pharmacy Officer for overseeing pharmacy finance and supply chain at Duke Health. At Duke Health, we are a four hospital health system with over 250 clinics based generally in the Raleigh, Durham Triangle area of the state of North Carolina. But we are also spread out across the state. Our most recent integration of Lake Norman has been in that Charlotte area. And we're looking to build and stand up two more hospitals in the next five years. One in a community site and then we're working with a joint partnership with UNC to build the only freestanding hospital in the state of North Carolina. And that's looking to be a 500 bed hospital site along with a number of ambulatory clinics. So there's a lot of exciting growth coming to our health system. I actually joined Duke about a year ago. I'm coming up in my one year mark. Prior to Duke, I was lucky to start my early years in health systems management, but with a residency in the Houston program in the Texas Medical center, which about 10 years ago that was one of the largest academic or largest medical center in the world. It was great to get a broad view of health systems in such a small, densely populated area. And that really gave me the ability to kind of jump onto opportunities to continue to grow. And I was lucky. When I was looking to relocate to North Carolina to have the opportunity to work with 340B programs at UNC, I was able to grow and establish their system. 340B program from one hospital service to a nine hospital service, corporate service, and took that opportunity and that structure with me. When I was able to support Maine Health, which was a very rural state, so a totally different climate or diversity of hospitals from rural to more critical access type hospitals, in addition to the disproportionate share hospitals. And most recently when I joined Duke, it really has been like A culmination of all my experiences that allows me to align that very health system operations background with the complexities and financial and regulatory complexities of 340B into a supply chain and finance role. So it's been a great year and I'm excited for what's to come.
- [03:12]
A
Great. Thank you so much for that context and congratulations on completing a year. You have some great experience under your belt and I know Duke is lucky to have you leading their pharmacy team. And really exciting to hear about all those opportunities coming up for Duke. And we'll get into that later. But first, I'd love to hear, you know, looking back over the past year, what was the most important initiative that you led? What did you focus on and what results did you see?
- [03:38]
B
Yeah, there were definitely many as I was thinking about this. But I think when thinking about what is really important to me in my leadership style and in creating a new whole, a whole new division within pharmacy, it's important to be able to establish and empower a culture that allows us to collaborate in a time where there is so much change and requires so much discipline to maintain the execution and at the same time, the agility, the flexibility to be able to respond to all of the changes in all of our regulatory spaces and the financial headwinds that we see, the pressures that we see from payers. So it was important to me to be able to kind of establish a culture and build talent, an aligned talent, where we can respond to this change. And I think one of the things that comes to mind specifically was about six months ago, we adopted a new technology platform around purchasing analytics. When it comes to product selection, contract management gave us a great line of sight to what we were purchasing and how we can optimize our purchases and make sure that our contracts were lined up appropriately. And I think when you look at the numbers, sure, 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 around having the appropriate new role, if we needed a new role, to establish some type of oversight in this process, bringing in supply chain clinical team members as well as operational team members to really be a core group, to be the decision maker and also the folks that help to escalate or also share out the changes with the operational areas. So I think we are at a point where we've been able to develop a lot of efficiencies on the process and now are able to work on scaling up some of the changes that we're seeing in more of our sites. And as we continue to grow as a health system, it's great to have a tool as well as a team that can effectively look at data and be able to respond to it in a more proactive and also strategic manner, as opposed to some of the reactivity that we were looking at previously. So I think that has been a highlight. But there's been just at Duke, we've also expanded our pharmacotherapy clinics, and that's a part of some of the work that. There's some parts of that that all sorts of team members were involved in. And I'm excited to see where we're able to expand in the ambulatory space and support our pharmacists to increase access to patient care. And those are the things when I think about how do we develop a financial structure to support more patient services, it really keeps the mission going for me and makes it exciting to be at Duke where we can do some of this work.
- [06:55]
A
Definitely, those are great examples. Thank you so much for sharing. And I agree, you know, now it's more important time than ever to maintain that strong financial structure. And kind of leading into my next question, you know, looking ahead, what are the big headwinds and priorities that you focused on as you plan for 2026, and how are those headwinds shaping your strategy right now?
- [07:17]
B
Yeah, I expect that you wouldn't be able to go without a single interview with a pharmacy leader without hearing about the word 340B. And I'm in a spot where this week we're still celebrating some wins with the recent court rulings that sustaining the appeal of the 340B rebate model from taking place on 1:1. So we are super excited that is still under review and for an indefinite period of time. I've done three, four to be long enough to know there's going to be changes overnight. And though some things may take a while to proceed, I think as this works through the courts, we still have to be prepared to respond. Right. So all the work that we did leading up to it still continues to ensure that we are ready for if that time comes. And the other piece to this is the MFP rebate, the maximum fair price rebate. That is also the second rebate that we were working through against this 1:1 deadline. So we are working on executing the rebates for those. So I would say some of that is the defense strategy that we're working through to make sure that we're responsive to all these payer changes and payment changes. But on the offensive side, I would say more so just making sure that we continue to work through balancing the needs of the high dollar sell and gene therapies, which is a big portion of what Duke does. We specialize in very clinically complex care and we lead in some of these areas. And so making sure that we're at the forefront of, of the models related to cell and gene therapy. Space is an exciting time there for us to kind of sort of position ourselves to be strong while the cost can be very high to maintain those therapies. But every single time when I hear our last zildjunsma baby come through the door and we were able to administer something that's life saving, 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. And we really try to make sure that we position ourselves financially to be successful and to be able to scale up to meet the needs of our population.
- [09:54]
A
Definitely. Definitely. Now, along with those priorities do come some tough decisions. What do you say is the hardest thing that you're going to have to tackle or decide in the coming year as a pharmacy leader?
- [10:09]
B
There are so many hard things at this point. I think all the low hanging fruit has been plucked. But we are at a point where there's only a lot of opportunity to optimize medication reimbursement and tightly manage our revenue cycle. And that's not just one aspect of the process. It requires a multidisciplinary involvement. And some of that requires changes with our clinicians and our prescribing practice. And sometimes it requires someone who understands our payers and having that ongoing conversation at the clinical, the financial level to align the need and the utilization appropriately. So I'd say when there are so many different complexities, it's trying to make sure that we can focus on what is truly the most important and helpful. I would say in this year, given everything that's going on with MFP rebates, 340B rebates, we're seeing a push for really biosimilar adoption. 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. Because when we do come together to align the needs of patient care and the need to reduce all these complexities for the viability of health systems, I think we're going to be able to get to a place where we as a health system can be able to have leverage to be able to maintain, if we were to, say, a biosimilar formulary that is aligned across multiple settings, whether it's inpatient, inpatient, clinic, or retail, and not have to react to all of these specific payers. Right. So I think that that may not be the best choice for all, but we need to get 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. So I'd say that's probably one of the hardest. And in tandem, it's just making sure that we align our resources and our talent appropriately to respond to this. So, you know, we don't have the ability add more resources all the time. So how do we look at our resource pool and whether we have technology that can help support us is going to be a big piece in making sure we can execute faster than we have in the past.
- [12:43]
A
Definitely. And speaking of coming together, I'm curious, with all these headwinds and challenges, how are you preparing your team to not only embrace them, but also to overcome them as well?
- [12:59]
B
Great question. I think we are at a point where we are looking more towards the how do we again, look at our offensive strategy and grow where we need to grow for the. For our patients? And I think one of that area, one of those areas is continuing to support our specialty pharmacy business. 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 to support them through getting their prescription approved and refilled and go through the whole prior auth process. Right. So that's a big business area for us where we're looking to grow that. And we're at a point where we're hitting our cap on space. And without the space, we won't have the right technology. We can't grow. So we are actively looking for the appropriate facility to grow our specialty space. And with that, I'm also looking for the appropriate alignment on the acute care and the ambulatory side to support sort of that centralized distribution model where efficiencies can be gained with the right technology. So there's strategic planning that's involved in our teams to kind of develop that structure and what that future might look like. And at the same time, I think it goes back to where 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. So we have a number of our own homegrown AI tools as well as looking at other vendors that are out there in the market that have already practice and optimize that other health systems. So we're also open to partnering strategically with the right partner. So I think with the upcoming Beckers Conference, it's a great time to kind of go out there and see and learn from other health systems as well as looking to see what other solutions exist in the marketplace.
- [15:18]
A
Definitely. And throughout this whole conversation, you talked a lot about growth and all these exciting new opportunities for Duke. Specifically, I'm curious just what excites you most about these opportunities?
- [15:31]
B
For me, I'm going to be kind of corny and at heart. I always was in the mission to improve access to pharmaceutical care that I grew up with a father who was always sick. He was a second, I guess I was a first generation American. He was health illiterate. I was the one who had to navigate the entire health system process with my father at the heart of it. 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 and everything that we do where we could be the leader for a health system in different Pockets, whether it's 340B or specialty or ambulatory, really, we get to share that with other health systems so that they can also improve their work. That's what drives me. 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.
- [16:54]
A
Definitely. No, it's great to hear that you're in a place where you're able to do that well, Roya, this has been such a great conversation. Thank you so much for sharing your perspective and insights with us. That's all for today's episode of the Becker's Pharmacy Leadership Podcast. A big thank you again to Roya Tran for joining us to discuss pharmacy priorities, challenges and opportunities at Duke Health. Thanks for listening and we'll see you next time.