hi welcome everybody who is who are uh joining our webinar today we’re going to give it probably a couple minutes while
we have attendees join and um so we’ll
those that are on already thanks for already being on and we’ll give it just a couple more minutes
[Music]
that’s all right we’ll go ahead and get started
well welcome everybody to our webinar today uh my name is Curtis McIntyre I
lead the Trula team within spendmend um appreciate everybody for joining I think this is g to be a really exciting
discussion we’ve got really an awesome panel to really talk about Pharmacy procurement um I think there’s a lot of
transformation happening in Pharmacy procurement right now if you think about how you know we’ve been buying
medications from a hospital perspective it’s been the same for decades and we’ve seen you know I think the industry has
really seen a transformation of really more creative things um that people are going after to make sure to drive cost
savings drive you know standardization within the health system um Consolidated service centers obviously shortages have
have really played a part in it so we’re going to be hitting on a lot of these topics today and we have such an awesome
panel so we’ll we’ll introduce the panel but while we have a few more attendees uh kind of getting going we’re going to
start off with just some poll questions so it’ll be interesting just to see you know our audience and and what we have
here um and so the first question if you can answer this and and if you you know
if you’re not part of a health system don’t worry about replying but the first question is do you have a pharmacy Consolidated service center for your
health system so the three questions here yes no not yet but in planning or
implementation stages for one so if you want to answer that we’ll see see the
results here in a minute we’re gonna we’re definitely going to be talk about csc’s today um I
think it seems like you can’t go to a pharmacy conference these days without csc’s being a huge discussion um I think
there’s some un you know really great setups around the country I’ve had the opportunity to to visit and see and and
um we have a couple you know with a couple here on the call that have csc’s as well so 36% of you say yes uh 41% no
and 24% are not yet but in planning stages for one so looking I mean look at
that if you go you know 36 plus 24 you know 60 that
60% um of of everybody here all right let’s go to the next
question what is your top priority right now as it relates to Pharmacy procurement um we have NDC optimization
standardization csc’s more direct purchasing to manufacturers improved man management of
Clinic medication ordering or other the direct purchasing we’ll talk
about it a little bit I think you know shortages have definitely play a part in that um you know I think the wholesalers
are obviously strategic to all of our health systems right of your health systems and and um it seems like you
know some of some of the purchasing that happens is really a big result of you know just trying to make sure we have
Supply we have here wow yeah 77% NDC optimization
standardization 32% csc’s uh 17% uh direct purchasing to manufacturers 34%
improved management of Clinic medication ordering and 11% other the clinic medications too I mean it’s most health
systems right you guys have hundreds and hundreds of clinics sometimes that that are buying medications and a lot of
times for you know I know at the health system I worked out for a long time was kind of wild wild west you know is how
do you get your arms around it and uh and definitely I think there’s a big focus on on doing that with Health
Systems so great well thanks for that kind of help set the stage a little bit let’s dive in and if you want to go to
the next slide slide for the agenda we’ll do some introductions um and then we’ll hit on a
few topics here so current state of Pharmacy procurement for for our panelists we’ll talk about csc’s and
strategies there and their future priorities and Q&A so it’ll it really will be kind of an informal discussion I
wanted it to be that way this is not a scripted anything this is more we’re all learning from each other about what
different health systems are doing um and I I think that’s one of my favorite things about working with you know
various Health Systems around the country is you get to you you do you just kind of learn best practices from
each other and uh that’s really what we wanted the purpose of this uh this webinar to be so if we go to next
slide so I’ll be moderating the discussion um just for for those that
don’t know my background is all pharmacy supply chain um I led the pharmacy supply chain for in Mountain healthcare
for about 10 years and then I spent uh several years Consulting uh with different Health Systems around the
country primarily on Pharmacy csc’s and then um and Pharmacy optimizing Pharmacy
procurement and then about five years ago uh myself and a team of Pharmacists uh we teamed up to um really build Trula
um just based on gaps we had seen really as relates to Pharmacy procurement both in analytics and the purchasing space um
and then we joined spend men the tra team joined spendmend about a year ago so um that’s kind of my background let’s
go to Uh Kevin do you want to introduce yourself with Banner help sure do you want me to give kind of the full
description of you know banner and all that stuff yeah that would be great yeah
uh so my name is Kevin roach I uh I’m a senior director of preparation and dispensing for Banner farmacy Services
which is a wholly owned LLC of Banner Health uh Banner Health operates in six
Western States we’re headquartered in Phoenix Arizona uh but we have locations in Colorado Wyoming Nebraska Nevada and
uh California um so in my role I oversee a few areas but you know in the context of
the discussion today um I have uh oversight of pharmaceutical procurement
across our acute care and non-acute Care uh delivery locations um we have uh about 31 uh
acute Hospital pharmacies over 500 uh non-acute clinics and urgent cares and Ambulatory Surgery centers um and you
know our hospitals range from large Urban and academic facilities to small rural critical access uh hospitals um
and we we operate a uh Central Pharmacy Warehouse in the Phoenix area that serves acute nonacute and and Retail to
some extent um but we’ll we’ll talk about uh the csse uh a bit later in the discussion I
think great and thanks Kevin and great to have you on Kevin has um been kind of
really a key at uh for their Central distribution center and a lot of their Pharmacy procurement operations at
Banner and really does an awesome job uh Michelle do you want to go next Michelle with MedStar Health sure good afternoon
everyone um apologize for my voice in advance um I am the manager of our
centralized Pharmacy operations at MedStar Health um we have seven hospitals in Maryland and three
hospitals in the District of Columbia um again I run the um medication Access
Center which is we call medac is our Central Distribution Center um mainly does pixus replenishment for all of our
Hospital sites um we do have a extensive footprint of urgent care and ambulatory
sites as well but haven’t delved out into that space yet um but one of our
um big things is that we are um an eight Hospital dish two um One Soul Community
and two non 340b sites so um part of what we have been trying to
solve and struggle with at um our Central Distribution Center is the
compliant um distribution to our 340b sites and procuring on behalf of them um
I’m also very extensively involved in um primary NDC management standardization
and cost management um initiatives and optimization at MST our
health great thank you Michelle um and for anybody who is on the call that is
either has a CSC or or um is implementing the CSC and you’re considering doing cabinet replenishment
from your csse I recommend talking to Medstar for sure uh because they have that down to a you know it’s a very
efficient process um and I know it’s one of those that every CSC it’s kind of like should we do it is there value
there that MedStar would definitely be one to talk to all right uh Dwayne with
Providence yeah hi my name is Dwayne and I am with Providence St Joseph
Health um I’m the senior manager with our system Pharmacy team um had several
different um initiatives with that team including our procurement automation project which is um tasked with rolling
out inventory systems inventory um optimization software as well as um
standardized procurement software which includes Trula and so we’re in the implementation phase of that um so
hoping to learn a lot on this call as well Providence St Joseph health is um a
um entity that spans about seven different states on the west coast uh so
we’re in Alaska Oregon Washington Montana California Texas and New Mexico
and uh we have about 50 plus um acute care uh facilities as well as an
extensive ambulatory clinics and um uh retail settings so at this moment we’re
uh we’re really focused with this um on our qare sites but just like Michelle said we we haven’t yet delved into the
ambulatory side but are looking for that in the future so great thank you Dwayne and Dwayne has
he’s got one of those very unique uh challenges of some of the mega systems
out there for those that are on the call that would be considered like a Mega System where just spread across so many
many states 50 plus hospitals um so a CSC in in Provident St Joseph’s Health
sense has doesn’t make a ton of sense just because of how spread that spread out they are at least at this point but
um so he’s got kind of the unique challenges of being a mega system which I think we can get into that too because
I think we might have some other Mega systems on the webinar today all right if we go to next
slide so I want to just just we’ll be talking about Trula a little bit on this call um all three um both MedStar banner
and Providence are all Trula customers and so we will be using kind of terms what might be talking about Trula
procurement our tra analytics Trula direct is kind of one our latest product that uh that we’ve launched but I’ll
kind of just to speak to these so just to set the stage of what these products are Trula procurement is really built to
be a single single ordering platform um if you think about how buyers buy today
typically about 90% is going through the wholesaler and about 10% is directs 503
BS um secondaries that kind of thing and if you think about a buyer and how they
buy usually they’re jumping into the wholesaler site to place orders and then they have this long tail of those direct
spends that direct spend that they’re having to call in email faxes are still
going on I still talk to Health Systems where we still have some faxes to manufacturers going on um or you’re
jumping from website to website not super efficient and really we built Trula so that it could be a single
ordering platform if you think on the med surge side you know for most health systems right your med surge team the
right General Supply Chain nonf faracy they’re usually buying through an Erp like PeopleSoft or or um or in for
Lawson you know anything like that and and then they can just Place their posos in there and it routes to the right
supplier I know when I was at Inter Mountain Healthcare we were using poft I remember going hey can we do this could we just do all our for pharmacy ordering
through PeopleSoft and they’re like oh yeah for sure that’s what we built this for and then you know you get into it
and and you know one of the questions that I would have is like well how do you handle 340b and their response well
what’s 340b you know and clearly Pharmacy has some nuances and by the end of kind of you know going through it
they said to me they’re like Curtis there’s just no chance we just can’t support the complexities Pharmacy has
which is why there really hasn’t been a pharmacy platform for it and that’s really what Trula procurement is meant to be all ordering in one platform
whether it goes to the wholesaler to manufacturers or internal to your distribution center and if it is
internal to your own Distribution Center automating those journal entries and enabling 340b compliance for the
distribution to your 340b entities um and so that’s what Trula procurement is again our Utopia is kind of that single
shopping cart um Trula direct is a product we just launched that is really just focused um for clients maybe that
aren’t you know health systems that aren’t ready to roll out you know all their ordering in one platform if it’s
that that 10% of the spend that’s not going through the wholesalers today is how can we make that easier for clients
and so making all of that EDI and electronic and everything like that and then Trula analytics is taking all of
that drug spend and being able to find Opportunities whether it’s cost savings opportunities or um we have some new
tools related to margin optimization with biosimilars we looking at Price variances where contracts may not be
loaded correctly those types of things so that’s those are the three products that we might be you we you’ll hear
throughout the webinar today all right go next
slide so you got to be introduced to the three Health Systems a little bit so between Banner MedStar and then
Providence St Joseph Health um so you can see who has csc’s you know banner and metstar so we’ll be talking about
those um and then all all three clients have both truly analytics and Trula procurement so we’ll kind of dive into
some pieces of how they use that software how you know you know how it can help solve some challenges and and
accomplish some of their goals but again primarily what we want the webinar to be about is you know what are some of the
things that they’ve been focused on and and challenges that they’ve been tackling and then what are they focused on for the future so we’ll um now go
really to the panel discussion um and so we can really what
I want to talk about is just current state of Pharmacy procurement at each Health System what are some of the obje
as they’ve been trying to accomplish and so on and I’m going to start with Michelle um at MedStar I think you know
you guys when I met you know started working with you guys it was I don’t know probably four years ago almost five
years ago actually five getting there and um and and medak is doing cabinet
replenishment again a very again for anybody on the call Super efficient cabinet replenishment from a CSC um and
uh and that’s when we start working work together but do you want to kind of talk about your guys’ journey at at medac and
you know what some of your objectives were and and kind of go from there sure
so um medak was born in 2014 um and it really came about because
of our um transition from wholesalers um we lost the ability um of cardinal
assist um we went to messen and so we needed something to replace um that
process for our our sites um so that’s kind of the impetus for medac to um be
born um and as we um evolved with the
csse um we realized that we were very limited in our procurement and um
ability to dispense to our 10 sites um because of our 340b constraints and
compliance um the CSC as it was in 2014 could only
purchase at GPO cost but we were dispensing to again seven dish hospitals
One Soul Community and two non 340b um so we were really it was tying our hands
as to how many medications we could dispense to the hospitals um and kind of
how much they wanted to utilize the central distribution center for their services um so we needed a solution um
kind of put in place to help us solve the issue of the 340b compliance um to
help us grow um within the CSC and provide um Optimal Care to all of our
patients at our 10 hospitals um so that’s where we started um the discussion with Trula um and we really
partnered in um this development of the product of um the solution that now
exists today we have been live with the 340b solution um the 340b engine within
truus um since um the fall of 2019 um and so that has immensely helped
us to grow our formulary at the um Central Distribution Center um as well
as offer offer different Services um that are now available to our sites so
again we primarily our primary function at the CSC is um daily pixus
replenishment for our 10 sites but we also do um Central RFID tagging um for
all of our um o medications for blue site use um as well as um on the other
side of our our business we do all of the flu vaccine and coid vaccine um
dispensing to all of our clinics and urgent cares and
uh Michelle for um you know since you guys have gone live and you’re Distributing the 340b sites from your
csse have have any of your sites gone through a HSA audit and if if so any any issues related that with your central
distribution model yeah um so there definitely have been hersa audits have
um has the term Central Distribution Center come up in those audits um no so
therefore um we’ve kind of steered clear of any issues or any kind of inquiries
to be honest um it’s more just related to the within the hospital wall
spent and um from a from your guys’s perspective like you mentioned your
ability like you’ve been able to expand the number of of medications that you’re you know being able to supply for your
sites um from a from a value standpoint for the site so any kind of um just
general numbers or anything that that you’d be able to share so we have um at this point 750 items on
our medac formulary and continuing to grow um our sites are in the 90%
compliance rate with those 750 items um
which is about 80% of what’s in pixus um across the
system I think yep yeah that’s awesome and then maybe
one more question I know a big Focus that you’ve kind of as you guys got your 340b model up and going and start
Distributing to the 340b site so is really trying to drive NDC standardization across the system that’s
been a big focus of yours um you know can you talk about that work that you’ve
done um and and then what your results have been so far with that because that
obviously was a big one that a lot of people on the call selected as something that they’re driving towards yeah
absolutely so um I live in the primary NDC space I
coordinate the for the health system so it’s my day in and day out work um and so really understanding our
opportunities as a system to standardize um as well as um we undertook this
effort in March of 2022 um we really needed a way that we
could um number one identify um primary NDC opportunities as
well as track realize savings for once we do make those changes so many um
avenues that we’ve had in the past give us projected savings but that only means
so much um you the the boots on the ground have to be doing the the the work
and the changes to actually realize the savings um ahead um so we did start
working with TR analytics in March of 2022 um and have really delved into the
primary NDC standardization space um as you can imagine it was very um out of
line um across the system um and really bringing uh all 10 sites together um
so uh within the tool it does stratify those that have the most savings
opportunity um so tackling those first so since March of
22 um we have saved a realized savings
um across the system of $ 7.17 five million um that’s excluding biosimilars
if we were to include biosimilars we’re more in the $1 million um savings range
so it’s really nice to see the efforts of your work too um is that as you see
the buyers transitioning and standardizing to that NDC you can see
the daily savings going up and it only makes you want to save more yeah well and I think one thing that I think
you’ve done a really good job of just is is being able to be efficient with that decision- making I think sometimes it’s
it’s easy for Health Systems to kind of you know say get a lot of input and sometimes it’s just like Decisions by
committee tend to slow things down quite a bit and you guys have been really really efficient with your decision- making which has helped you not leave
kind of leave money on the table so you know great great job on your guys’ end for
sure thanks all right let’s um let’s transition to Banner I know Kevin you
guys have obviously you’ve done a lot as well in the NDC standardization space but do you want to kind of describe your
guys’ operations with asrx this you know you kind of mentioned the services that you provide to your sites and and um how
does Trula fit in in there as as far as your CSC goes yeah sure so you know I’ve
been with uh bner Pharmacy services for about eight years um my background is in industrial engineering um so coming into
um you know the pharmacy space I didn’t have you know a deep understanding of uh
pharmaceutical procurement i’ never never you know been in the the seat of a buyer um you know and as I got into uh
my role uh I think it was uh surprising to me to understand the complexity of
the decisions that are made on a daily basis uh at the at our uh facilities uh
when it comes to procurement and um you know the the potential for non-standard uh processes and non-standard outcomes
in terms of uh you know what we’re buying and uh where we buy it from um
you know one of the things that you know I I noticed very quickly was that we have a uh Central Distribution Center
acrx uh as we call it um where we we stock medication and um you know the
I’ll talk about the strategy of you know what we stock or what we don’t stock but um you know we were always playing uh
kind of you know I’ll call it Monday Morning Quarterback on um hey you bought this from from here and you know we have
it here or you know hey don’t buy it from from from us yet because we we need
to hold on to that stock um so it was really you know trying to retrospectively fix changes and that’s
not only with you know the uh Central distribution center but it was also you know as Michelle talked about the NDC
standardization you know we we make a system conversion on a you know a medication of you know we’re we’re going
to this manufacturer um and then it’s it’s trying to chase down people and saying
hey have you adjusted your uh your automation you know this is the preferred NDC this is the preferred
Source um so I think you know when when we started talking Curtis and and again
you know this was uh developmental days um you know back uh uh pre-co times um
it was it was uh you know working to address those those uh challenges and you know as we’ve implemented uh Trula
um it’s we had a a platform for ordering from our csse uh previously it was not a
great platform and uh really didn’t meet the needs of you know our health system
um uh trula’s been been able to not only provide a platform for ordering but uh
the the platform for daily operations within our csse so Inventory management
uh you know par levels um any messaging towards the the buyer team that needs to be out there um but you know so we we I
think started out with a platform for all of our hospitals all of our clinics to uh order from our CSC uh and have
evolved that into um connectivity with uh the various systems our buyers use um
so we can get you know our buyers using you know Pharmacy automation to generate orders or replenishments um you know for
their their carousels in the pharmacy um we can uh kind of grab those uh those
exported uh orders and uh send it into uh Trula as the source and utilize the
logic within the uh system there to split out um you know what do we want to have go to our csse what do we want to
have go to our wholesaler um you know Curtis as you described the wholesaler gets the the uh you know vast majority
of our business um you know we utilize our uh csse for you know kind of a niche
uh purpose when it comes to procurement um you know cost savings uh shortage
management um key strategic agents um you know that we’ll focus on um but you
know when we we want to be able to control that ability not only to direct
um you know where are our orders going um but also uh you know what NDC are we
prioritizing if we’re going towards the the CSC um you know we I don’t have to
play the the Monday Morning Quarterback on those orders it it’s it’s more uh just putting an NC in the top spot and
uh you know uh driving purchasing towards that NDC so uh you know I think
it’s it’s been good partnership with um the various uh sides of the ordering
from Pharmacy automation to our wholesaler uh to to Trula uh you know to bring all those pieces together and uh
you know kind of uh automate some of the the the previous uh you know I’d say decision-making that that resulted in uh
non-standard outcomes um so yeah hopefully that provides a good kind of
overview of it yeah for sure and Kevin you guys you have a massive Clinic
distribution operation from your CSC can you just speak about that like I think it feels a little daunting sometimes for
heis like oh I don’t know if I even want to try and get my arms around that because it could be so large do you want
to just speak to how you guys did it and how it’s going with with your clinics yeah you know and and the clinic space
is is very different just because we have so many of them and you know the clinics don’t have a pharmacy buyer um
so it could be a number of folks that are inputting orders for for that clinic um and again you know the vast majority
of what they use at the clinic uh would come from our our wholesaler um you know they the wholesaler has a uh system
that’s you know more tailored to non AQ procurement uh that that’s used by by our clinics um you know but we’re able
to establish formularies within the wholesaler and also within Trula um you know where we’ve seen success on on you
know with with the clinics um I I’ll say is targeting classes of of medications
uh things where we would have um savings and uh you know the ability to
centralize and redistribute um you know it like we’ve gotten feedback about you
know um we we do a lot of vaccines uh from from our CSE uh but like flu
vaccine for example um you know the the clinics really uh struggle with um
receipt of flu vaccines um you know where they would get that first push
from the manufacturer um you know we we had the manufacturers generally sending a third a third and a third uh you know
depending on the timing um and so they get that first push uh from the manufacturer of flu vaccine in in late
August uh fill up their fridges with with their doses for the season uh for the first third of the season and then
you know if it was a slow uptake on vaccine uh you know oftentimes those clinics would get another order pushed
to them and it would overload their fridges um so we we changed that distribution to have you know that first
order go to the clinics and then subsequent orders go into our Central distribution center for ordering from
the clinics so that one wasn’t necessarily a big costs saver but it was it was a service to those clinics to
help avoid you know Refrigeration overload or or you know failures in that space um but we found success I guess
going back to the question you you know when we focused on classes uh of of uh
meds or or you know vaccines for example so you know no matter who’s doing the procurement at an individual Clinic they
know okay you know for for these common meds you know that’s going to the wholesaler oh if I need to order
anything of you know a given targeted class uh that we’ve uh reinforced um
that would go into the the tress space um I think there’s uh further abilities you know down the road to connect uh you
know similar to how we’ve done on the acute side with the wholesaler um but you know I think they’re they’re not there uh right now on on the wholesaler
side yeah oh great thanks Kevin uh Dwayne let’s let’s go on to you guys at
Providence um you’re obviously different situation where you don’t have a CSC and
and but you guys have some major initiatives that you’ve been doing systemwide that are that are just
they’re big that you guys have been rolling out can you kind of speak about what you’ve been focused on over the
last you know year and a half and and how what’s going so far and and any of
your guys’ results sure yeah and and um a little bit different than um Michelle and Kevin
we actually started looking at this um all kind of during coid post Co so we’re
um maybe as far as Trula is concerned a little bit behind the the two of them but they’ve been great in providing
insight as well as you have but um yeah we we really took this on um you know we
historically have always had an NDC substitution or standardization process across Providence um it it seems very
daunting in that we have it across seven states it’s a large system and there’s a lot of variance right now with the way
things are being purchased as well as our contracts so um so a lot of that
standardization work um Trula is really assisted with um but really the the reason we um even went to Trula um
really stems off coid and our inventory systems we we really took on this initiative based on our automation being
able to roll out an inventory system um to all of our acute care sites so that
we could have oversight into our inventory um specifically around those essential medications we needed during
coid so I have to say Co had some positive outcomes in this regard and that we did not have that established
across our system prior to it um so with that we um we we have that initiative
right now we’re we’re probably about a year into about a three-year phase of rolling that out to our cute care sites
so it’s it’s definitely at the beginning phase um rolling it out in waves um but
with that implementation of inventory systems as well as inventory optimization software with those systems
uh we really wanted to look at a holistic approach for our buyers and for purchasing and our standardization
process and so Trula really helped fill that Gap um as Kevin mentioned the
inventory software um produces the orders that the buyers are placing on a more automated basis based on inventory
levels and by allowing the integration of Trula with those inventory systems
has really helped Aid the process for our buyers and that um it helps drive to
those standardized ndcs at the time of purchasing which is the ultimate goal we want to take that guesswork out of the
buyers’s hands um allow them to really focus on their day-to-day act activities
and not have to really look at contracts pricing and all of those decision
makings of course they’re needed in other regards to really say what is most
appropriate what are the our inventory levels that are most appropriate making sure they get their back orders in but
Trula is assisting with uh you know that work of which medications can we
substitute for on a generic basis basis um you know at the time of purchasing um a lot of times um our buyers are really
um thinking this as an extra step I will say that um so the training involved
with this piece has has been um some of our learning phase um as we aren’t fully
standardized at this point um but when you look at as Michelle and Kevin said at the savings involved that you see by
um going with with a system like Trula um we’ve seen um savings far exceeding
what we originally projected uh so we can take that information back to the buyers and see show them the benefits of
these systems um but as well you mentioned the other um initiatives that we have and we’ve always had we’ve
always had a NDC standardization process across our system um prior to Trula um
but as Michelle was how said how how do you actually um Define the actual
savings the realized savings that you’re seeing and Trula provides that Insight um we we did um calculate that on our
own in the background not myself but um having a manual process to do that which
was very time intensive and by working with Curtis and and the Trula team um
we’ve been able to uh agree on a methodology that really tracks the the
realized savings that we’re seeing that we can really trust those are true savings that we’re um achieving from
this process so yeah you guys you guys have piled on a lot of savings pretty
quickly uh Dwayne even you know as you’ve rolled out to maybe a about a quarter of the site so far um it has
been it’s really fun to watch I mean I think it’s it’s impressive I would you say one of the biggest challenges you
face is just kind of change management with as far as how the buyers for the how you know the buyers you know this
how they’ve been doing things for a long time and to kind of change how they’re they’re buying um yes I I think um the way that
we’re rolling this out uh Trula is just one part of our roll out so the inventory software to those sites along
with truler are all being rolled out to the sites at the same time so yes I think the the change management process
um just the unknown the site variance um between all of our sites the contract
variances that we’re seeing have uh have really produced some of those challenges
but I think when we drive back to the the main point behind this they really understanding the benefit of it um Trula
is not our biggest uh challenge with these roll outs um in fact uh for a lot
of our sites they really see the benefit and they’re they’re seeing positives um
in other regards as far as what medications they’re having to unit dose you know a lot of the things that we can
set up in tra to make their lives easier after the purchasing there’s a lot of operational aspects that we can um Aid
with with the software as well one one other thing though I I
don’t think I actually think everybody’s seen it as a benefit as far as the analytics and the NDC standardization
process and that it’s presenting the opportunities we’ve always seen But in a very um very well structured format that
we’re able to pull that information out and act on it quickly um we do have a
probably a little more um hurdles to go through after we identify those to get
them implemented but um it is still a streamlined process compared to what we were used
to yeah you um you kind of mentioned using the analytics uh for NDC standardization which I tends to be like
all of our clients that’s a that’s a big piece obviously it’s a big chunk of money that to go after how are there
other ways how else do you utilize the analytics kind of in your daily work yeah for the most part um my my
biggest focus on that and I had that team is the NDC standardization process but I also use it to uh drive that
contract variance review that we’re seeing um what it’s called in the in the
system is catalog variances and so I’ve looked through all the reports within Trula and piecing them together it’s
easy to to bounce from one to the other and actually present this data to the
teams that are also looking at this I’m not the head for contract um review or
Contracting in general but I can present this information we meet on a a weekly basis as well as with our Whaler and
with our G uh to help identify and work on these opportunities so Trula really
provides a format um that we can use to um have these meetings and actually use
it as our main discussion point when we’re looking at that we’ve we’ve actually met with our wholesaler and we
just pull up drula and we go through it and um it’s the easiest way to identify y it easy easiest way to give the
information they need if it’s something they can act on on their end as well so um I think those are probably the two
main um main objectives although recently um we have start began we’re
very very in the very early phases of it of looking at the biosimilar reports um
and then I really want to tackle next The Wack review as well um trying to
help limit The Wack spin that we have our um at our facilities that that’s a that’s a concern so thanks for sharing
and and when Dwayne’s talking about the wax pens so there’s there’s tools in the analytics that identify kind of a high
amount of bad whack so trying to identify is the accumulate like we not accumulating correctly on an NDC or
something why do we have so much whack when whack is more expensive than 340b in GPO so um I know for interested time
I’m just going to for Michelle and Kevin and I’m going to open it up to both you whoever wants to start but for those
that do have csc’s um you know there’s a lot of there’s a lot of services you
could provide at a CSC whether it’s you know uh pre packaging of medications
whether it’s low unit measure distribution whether it’s cabinet replenishment like Michelle you’re doing at metstar um or even sterile
compounding non-sterile compounding liquid unitos packaging like there’s just so many things that you can do and
I know both of you kind of have you know both your health systems have different things that you’re doing can you just
talk about you know the do you guys are you evaluating
other services all the time or what’s your kind of what’s your stance on that is it something that you’re looking to
expand or you’re kind of like you know what we’ve got what we do here and and this is the you know for our health
system this is what makes sense for us can do you w to both of you kind of want to speak to that for a
minute sure Michelle do you want to go first or you want me to you can go
first okay um so you know collocated in this same building as our uh CSC we also
have a uh Central uh like home delivery Specialty Pharmacy on the retail side um
you know that’s a that’s a separate operation and I’m you know I won’t get too far into that but you know it’s something to consider when you when you
think about you know the location for Central Services uh or Central Pharmacy
um you know within the same area of our csse we do have uh sterile compounding
facility uh we do all patient specific uh compounding so tpn that sort of stuff on a daily basis
um you know the the unit dosing and you know broader uh Central uh sterile
compounding would be something I’d be interested in in uh going down that path but um you know I think regul from a
regulatory standpoint um you know the FDA has has definitely uh doesn’t want
uh you know large scale scale uh sterile compounding going on um you it’s also been the interpretation of our state
board that uh you know even repackaging uh is not something that they uh you know want to be uh want done in this
sort of an operation they they look for a manufacturer’s license and in that setting um so you know our CSC uh is
really I’d say focused on a few things um you know it’s spot buys ad hoc uh
opportunities with manufacturers um you know uh I think Dwayne talked a bit about you know the
the medications that are crucial uh to the health system or or you know the you know we’ve worked a lot with our
clinical team uh you know you reference coid you know uh targeting if things go
sideways you know what are the most important medications that we need to have our hands on and and developing
Contracting strategies and sourcing strategies around those uh meds um you know that’s been a real good benefit for
our system and helped us avoid a lot of national shortage uh issues um you know
we hold a wholesale license at our CSC which uh you know allows for some creative uh direct Contracting with
manufacturers um you know sometimes there there’s pricing that they don’t want uh kind of exposed uh on a larger
scale so uh they’re willing to to do that uh directly um but you know one of
the things that um you know hits with our CSC and also with the NDC uh
standardization side is you know if we have like a Market Basket contract with a manufacturer where we have you know
certain thresholds that we have to achieve um you know when we’re getting towards the end of that you know our
csse could be you know the ability to to say okay we need to have x1,000 more uh
before this this contract ends let’s bring it into the CSC and then we can redistribute out from there um you know
so that’s that’s an option um but you know when when we talked about uh NDC standardization what what Dwayne was
talking about earlier it jogged my my thoughts on uh you know this topic of
you know there’s often times where our buyers are trying to do the right thing and buy the cheapest uh you know
medication that’s available from the wholesaler you know however we might have a contract that has a backend
rebate or you know some sort of Market Basket uh approach that we don’t want them buying the cheapest we want them
buying you know the the one that’s going to provide the best overall cost and and that’s not you know always visible in
the wholesale system you know and and you can’t fault a buyer for trying to buy the cheapest um but you know
sometimes that’s just not what we we want but you know being able to set those NDC preferences uh you know
through the NDC optimization and you know preference setting in Trula is it’s it’s an approach we’ve taken but um I
wanted to hit that while we’re talking about kind of the CSC function and Market Basket contracts those sorts of
things yeah for sure uh how about you Michelle yeah Kevin you’re absolutely right on on that um it may not be face
up that it will end up being the cheapest or the most Ben beneficial for the system but driving that compliance
to that specific NDC that gets to that end goal I totally agree with you there
um for our CS so um we kind of have a three-part Central Distribution Center
um and because we’re a little bit more unique um in that we’re more um
centralized in a um footprint of our hospitals so we can have those daily couriers that are running our pixus
replenishment to our sites um we are centrally located between um within
Maryland and DC so we have that ability to have that those access points via Courier um so we have a specialty
pharmacy here as well um that was instituted in 2020 um we have as well um
an I um compounding section of our um CSC that compounds tpn for our hospitals as
well as a lot of our oral medications that are you know so that the sites don’t have to
be doing that on um site really when we were looking at what services are
um best lend themselves to a central distribution model is you know what is
what can be done once and not duplicated 10 times with staff with Resources with
extra stock sitting on your shelf um kind of like what um your inventory turns are going to be better your weight
is going to decrease or be nil um from a central distribution um portion um so
that’s where we brought in the RFID tagging it’s a huge um resource um time
suck so um by doing that centrally you can kind of really churn them out and
get them to your sites um but with Pixis replenishment that has been our our our
big win um from the medac perspective um as for growth opportunities um
potentially looking into the repackaging space but again as Kevin said that you know
regulation um sometimes ties your hands um for that um because right now we do Outsource our repackaging by insourcing
it could significantly um increase our savings across the system as well as turnaround
time um as well the other thing is when we started this um Central Distribution
Center we didn’t realize um I guess how much utility it would have um
over the nine years that we’ve been open um so our footprint physical footprint
of our space is very small for the amount of drug that comes in and out of
here every day um so that’s right now our physical limitation um for growth is
we literally need temperature control warehouse space to keep the drugs um to store them and in order to grow um so
just waiting on Capital funding for that but um definitely a lot of growth space um again with the uh ambulatory clinics
as well there like um we just recently um went through a a barcode um Med
Administration rooll out with all of our ambulatory clinics and one of we found one of our limitations from um some of
our wholesalers is they just don’t have unit dose um oral medications um in a
unit dose bar coded fashion either you know two tablets come in a package or something like that so having the
ability to Source them from our Central Distribution Center will help um you know increase that safety component as
well for them yeah awesome um we’re gonna we’re
with 10 minutes remaining I want to open it up for a Q&A so if you do have questions you can put them in the chat
and then um Aiden or for my team or myself will be able to see those as if
so so if you have questions let me know as as we’re going I think one of the things that um maybe just to ask Dwayne
if you while we’re kind of waiting for a question to come and do you want to just speak about where you you know where’s your focus over the next obviously
finishing out your your roll out across all your sites with your inventory system and trua and everything else but
what’s kind of the the big kind of where you want to see things of the next couple years for you
guys yeah I think um I think we’re still not quite to the the CFC type um stage
yet but um what we’ve what we’re really looking for is how we can use not only
the analytics with Trula but also um the purchasing on more of our ambulatory
side so I think that’s the the next um main focus for us um and and I may be
involved with that but as You’ mentioned um it is another about two years um for
this initial roll out so that will be in tandem to this so that’s where our
primary focus is and how can we drive standardization across all those clinics how can we review our price variances
and our um NDC standardization opportunities for more of our ambulatory side so that’s that’s our primary focus
I think going forward the other thing I would add is um one of the struggles that we’ve
encountered at least um there’s it’s all good to set a primary NDC but as we all
know that primary NDC could very well be on shortage majority of the year um so
it’s very important to be able to set like a secondary tertiary NDC and we’re all moving the same as a system to say
if primary is out by secondary secondary is out by tertiary um so that it’s not a
free-for-all when the primary is out um that there’s a a standardized way to
move from one to the other because yeah again it’s all good to have your primary NDC but it could be a free-for-all once
that’s on shortage it’s like okay what what’s what’s next yeah I think having that sword in
place is huge um and having it just kind of Auto go down the list of what your preferences are so you can still
maintain that and that kind of goes to one of the questions popped up is can can we expand more on NDC standardization like what is it I think
it’s actually a really good question because um you could talk about you could talk about NDC
standardization across a health system that has many sites you go okay for a given medication let’s say this strength
and size of a medication there can be you know 15 different ndc’s and generally the goal is you you want your
health system to kind of drive together to the same NDC it increases your negotiation leverage with manufacturers
your ability to maximize cost savings um and you know if if you have a manufacturer saying Hey I want you to
buy my NDC my drun and they give you some contract but then you don’t have an ability to drive that compliance you
know you’re kind of losing money leaving money on the table and then the manufacturers aren’t so willing to give you a great deal the next time either
and so if you can drive that standard but I will say where things get a little
complex in Pharmacy and it was talked about earlier is when you when you look at an NDC we’re looking at a lot of
times if you’re most health systems have 340b covered entities you’re looking not just at one price right you’re looking
at your 340b price what’s my go price what’s my whack price what’s my mix of 340b GPO and whack and how and to
determine what is the optimal NDC to drive to this could even apply to just a
a single entity Health Hospital right if you’re if you’re a 340b covered entity a
buyer trying to determine what is that optimal NDC to buy can be super challenging to do manually and most
hospitals are buying over 3,000 different medications every year and for them to try and figure out you know and
they’re dealing with over 15,000 price changes on the ndcs they buy every year so to constantly be able to determine
what’s that optimal NDC can be challenging and so that’s where tool like really you know why we built a tool
like trua to say hey help me identify like what is that optimal one to drive to and then can I drive it as a system
now we do know that there are situations where sometimes you can’t and and Kevin
and Dwayne have both really pushed me on this so you guys are you guys are the big ones on this but sometimes you you
really can’t drive as a system always right sometimes you have a dish hospital
and they’re getting some different pricing that the non- dish hospitals are getting and those types of things so that’s where you know even in Trula side
our software like a big focus of ours is to how do we make that even smarter so looking at different covered entity
types and have different Logic for different different you know situations of different locations so it’s a big
focus of ours right now it’s a good question um with just a couple minutes
left I think just as far as you know we have you know a lot of different health systems on the call some that have csc’s
some that don’t some that are just really saying hey you know I’m just trying to figure out what can I do to
drive more value in pharmacy purchasing for my health system I’m just going to we’ll kind of Rapid Fire between the
three of you I’ll start with Michelle I mean any recommendations you would have
for anybody on the call whether it is you know related to a csse or pharmacy
purchasing can you state the question one more time sorry yeah yeah yeah no worries really just for anybody on the
call like do any recommendations you would have to say hey like this has been
kind of like our number one thing like if you’re going to either go after a CSC or you’re trying to optimize pharmacy
purchasing I recommend you do this um so I would just stress the
importance of an um a good analytics program because it’s really it allows
you to use your time wisely so tackling
the um the items that have the most potential first and not having to dig
toine those I think is key um and have having something at your fingertips
that’s actionable and that’s trackable um so I would say that that’s my my big
win um is that I feel like our our health system has really um benefited um
not only from a cost savings but a workflow perspective from having like upfront analytics um that are actionable
that’s awesome I always you guys know this my Mantra is you can’t optimize what you can’t see and Pharmacy is so
big there’s so much data and how do we like Stitch it together in a way that just makes it a lot easier to digest and
like you said Michelle be able to focus on the big stuff first how about you yeah then you feel like you’re getting
somewhere yeah yeah Michelle stole my answer so
uh and say um you know as so I said earlier I’m an engineer by background
not not a pharmacist or pharmacy technician having those Partnerships between your procurement and contract
ing side your operations side and your clinical side and and just the the ability to make decisions in that space
is is huge um you know there are times where we’ll bring something into the csse and the price will erode and you
know there might be a better uh option out there and so you know facilities or leaders at facilities will push back and
say no you know we we can get a better deal you know through through the wholesaler you know we’re done uh buying
this and it’s like we have to have that alignment to say no this is this is a decision we’ve made as a system and we
have to you know be accountable to that decision and and um you know we’ve already made the purchase so we’re we’re
going to go in this direction and have that partnership and accountability uh across the system and uh you know if if
the prices eroded and we need to you know go back and change strategies that’s fine but we need to do that as a
system great and and how about you Dwayne yeah I think I Echo um what both
Kevin and Michelle said um the analytics software is key um and the nice thing about having a
really good analytic software such as Trula is that um you don’t only have the actionable items but it’s integrated
fully with all of the spin data from the wholesalers and manufacturers that you have integrated into it and so you’re
able to pull up the information that you need to take action on that right away you don’t have to go to multiple systems
I think that streamline efficient efficient process is what we’ve really
gained from this and being able to review it and re-review it as Kevin mentioned sometimes those pricing um
situations the road you need the ability to see that all of a sudden you’re actually spending more than you were
before or there’s additional savings that you could go after and re-review those opportunities and um and that’s
nice to see in a presentable format so yeah definitely well thank you guys I we’re
at time and I I just I want to thank the three of you for jumping on I know you guys are all super busy and for you to
jump on and join me in this discussion means a ton to me um I love working with all of you and we have some amazing
Trula clients and and um other health systems that we’re talking to and it’s so fun to just kind of learn from
everybody so I hope uh I know this was helpful for me it’s always fun to listen to you guys and then hopefully it was
helpful for everyone on the call um again thank you so much Kevin Dwayne Michelle for your time um for those that
attended really appreciate you joining if you have any questions feel free to reach out to us um this webinar will be
it’ll be kind of sent out as a recording to so for for anybody that registered you guys can have access to it um but
again thank you and and uh it’s fun it’s fun to see where Pharmacy procurement is going and transforming and and we’re
seeing we’re seeing changes and I think um good Partnerships with between vendors and Health Systems is is key to
making it happen so um again thanks everybody and hope everyone has a great rest your day and and thanks for
attending the webinar thank
you