Pharmacy Technicians and 340B

Speaker 1 (00:05): Welcome to 340B Insight from 340B Health. David Glendinning (00:11): Hello from Washington D.C., and welcome back to 340B Insight, the podcast about the 340B Drug Pricing Program. I'm David Glendinning with 340B Health. Our guest today is Nan Kempadoo, a 340B Internal Auditor for Memorial Healthcare System, based in Hollywood, Florida. Nan is a certified Pharmacy Technician, and we wanted to speak with her about the important roles that pharmacy techs play in the operations and compliance side of the 340B program at health systems and hospitals. Nan recently spoke about this as part of the Pharmacy Tech roundtable at the 340B Coalition Summer Conference, and we caught up with her after that session to learn more. David Glendinning (00:56): Before we go to that interview, let's take a minute to cover some of the latest news about 340B. On August 1st, the pharmaceutical company, Boehringer Ingelheim officially became the seventh drug company to stop offering 340B discounts to hospitals on drugs dispensed at community pharmacies. This development is especially noteworthy because BI is the first company to take this step after the Department of Health and Human Services sent enforcement letters to the first six companies, stating that their actions violated federal law. It is also the first privately held drug company to take this action. HHS has not yet publicly weighed in on this most recent development, but 340B hospitals are calling on the department to initiate enforcement actions against BI. David Glendinning (01:52): Lawmakers on both sides of the political aisle continue to speak out against these drug company refusals to offer 340B discounts. In one of the latest shows of bipartisan support, the U.S. House approved an amendment to a major government spending bill that highlights, "The need to protect the integrity of the 340B program by halting pharmaceutical manufacturer's unlawful actions that have resulted in overcharges to 340B covered entities." Abigail Spanberger, a Democrat from Virginia, and David McKinley, a Republican from West Virginia sponsored that amendment. Please go to the show notes to learn more about this legislative language, and today marks the official start of this year's annual 340B recertification process for hospitals, which will run through September 13th. Did you miss our previous episode on recertification with 340B Health's Steven Miller? David Glendinning (02:51): If so, please be sure to check it out for some helpful advice from Steve on how to navigate this process smoothly. Now, for our feature interview with Nan Kempadoo with Memorial Healthcare System, a six-hospital system serving patients in the South Florida region. In addition to her pharmacy technician certification, Nan has a degree in neuroscience and behavior and more than a decade of retail and inpatient pharmacy experience. Myles Goldman recently sat down with Nan to discuss her insights into how pharmacy techs fit into the 340B world. Here's that conversation. Myles Goldman (03:35): Thank you, David. I'm joined today by Nan Kempadoo. Nan, I had the pleasure of attending the Pharmacy Technician roundtable you presented here at the 340B Coalition Summer Conference. I really appreciated the insights you shared about the importance of pharmacy technicians to the 340B program, and I'm looking forward to continuing that discussion with you here. Welcome to 340B Insight. Nan Kempadoo (03:59): Thank you so much, Myles. I'm really happy to be here. Myles Goldman (04:02): I think it'll be helpful to our listeners to hear about an overview of your career. Why did you become a pharmacy technician? Nan Kempadoo (04:11): Sure. To be quite honest with you, when I started as a tech, I never thought I'd hear somebody ask me for my journey as a technician, so this is great. I did start out as a cashier at Target. During that time, from day one, networking has really helped me. I got to know our pharmacy manager at Target a lot better, and he wanted to bring me back behind the pharmacy and train me on the job to become a technician, and from there, that's where I started my journey as a technician, so from Target pharmacy, I then moved on to a meds-to-bed tech in a hospital, so retail, but in a hospital setting, and then I realized that I really wanted to learn how to become an inpatient technician, and so from there, I transitioned to overnight pharmacy technician in the inpatient setting. Nan Kempadoo (04:59): From there, the next step was to be a buyer, so I joined a different hospital system and I was a buyer there for a while, and then once again, networking brought me to become a 340B auditor because the buyer who I had worked with when I was an overnight tech decided that she wanted me on her team, on her 340B team. Myles Goldman (05:17): Now that you've shared a bit about your career with us, let's take a closer look at your day-to-day with 340B. I know pharmacy techs play a key role in operating compliant, effective 340B programs. Tell me a bit about how pharmacy technicians are well-suited to doing this. Nan Kempadoo (05:35): From my experience, usually the management roles in 340B programs are former buyers, and former buyers are usually technicians, and who better to actually be part of the 340B program management than a former buyer? They're the ones who usually have operational insight on the movement of drugs. They usually know all of the vendors. They're very hands-on with the inventory, so they usually know which drugs do what, which departments they go to, whether it's inpatient or outpatient, how the drugs are used, so buyers who are technicians most of the time, they're really the best people who are suited to manage our 340B programs, in my opinion. Myles Goldman (06:16): What are some of those skills that position buyers to do an effective job managing a 340B program? Nan Kempadoo (06:24): I would say the main thing is just that they do know their inventory and just having that insight into where the drugs come from, about the accounts they're purchasing on. Particularly, if they're a buyer at a 340B organization already, they do already have background on 340B. Maybe not as in-depth as if they were actually within a 340B department or managing the program, but they already have the basic knowledge that they need, and really, we rely on them for compliance, how they purchase does matter, how they purchase does affect our compliance at the end of the day. Myles Goldman (06:59): What are the different types of 340B roles pharmacy technicians have in hospitals? Nan Kempadoo (07:06): We have our 340B team, and just within our 340B team, we have our program coordinator, we have our senior auditors, and then we have our entry-level auditors, and all of our [star 00:07:19] technicians, so those are the roles that are within the 340B team department, but then, outside of the 340B team, we also have a lot of various roles that technicians play that impact our program, so we have Pyxis administrators. They really help us know the drug movement throughout the hospital. They usually know where the Pyxis machines are within the hospital, what drugs are in them. They help us reduce waste on specific medications, and that's how they can help us impact our program. We have our reimbursement specialists, who are also technicians. Nan Kempadoo (07:50): They manage our free drug programs. Usually, they can give us a lot of insight on those programs, and once again, help us impact the 340B program. We also have our systems analyst. One of our analysts, he works with our pharmacy software on the contract pharmacy side, so when it comes to needing modifiers for claims and things like that, he's our go-to person. Then, of course, the buyers and our inventory specialists. Nan Kempadoo (08:16): They're the ones that are most hands-on with the drugs, and they usually have a really good knowledge of the program as well. Also, our 340B program coordinator, she also does a lot of advocacy. She is part of FSHP, which is a branch of ASHP. She's very active, so she advocates for 340B during their annual conferences at FSHP. Myles Goldman (08:40): How have you seen the role of pharmacy technicians evolve over the past decade in 340B, in hospitals? Nan Kempadoo (08:48): There's definitely an increase in more advanced roles for technicians, not just in quantity, but different types of roles as well. Well, just starting with the 340B program, we have auditors, senior auditors, program coordinators, program managers, even program directors. All of these fields can be filled by pharmacy technicians. In the space of 340B, we kind of went from just being auditors to being all of these managerial roles as well, and not only that, we can also be 340B consultants. I have seen pharmacy technicians in Apexus, so there's been just a lot more advanced roles that technicians can fulfill. Myles Goldman (09:30): When you first started working in 340B, were there any resources you used to help you understand the program and build your skill set? Nan Kempadoo (09:39): Absolutely. My first resource was my co-workers, because I needed to know where to look for the additional resources, and they were able to point me in the right direction. The first place they pointed me to was 340B University OnDemand. Doing the OnDemand University, that really helped me get the basic knowledge that I needed, and in fact, I actually plan on redoing that just so I can go back and hone in on those little details that I missed on my first round, so that was a big help. Also, 340B Health, our organization, they have signed our entire department up for 340B Health, so we get the articles, the webinars. Nan Kempadoo (10:19): I love the webinars because there's always enough entry-level dialogues, so to speak. For people who are just starting out in 340B, there's a lot of webinars that I can actually follow as a newcomer, and then there's also more advanced webinars for people who have been in the 340B worlds for a while, so that was a great resource. Also, hrsa.gov. Whenever I have questions, that's usually the place that I start, if I need to know something specific about 340B. Then, last but not least, 340B Insight. Nan Kempadoo (10:50): That really gives me some insight. You guys really do what's in your name. Listening to stories of different organizations and different people within the 340B community, that's also awesome. Myles Goldman (11:00): Well, we certainly appreciate you listening into us. Was there any training programs at your health system to help you as well? Nan Kempadoo (11:08): Absolutely. Our team is really big on training. All of our pharmacies have either a binder or a folder that has all of our policies and procedures. We also have presentations that our teams have created that kind of outline how our specific organizations, 340B program runs. They always have those resources on hand. Nan Kempadoo (11:31): We also do one-on-one walkthroughs with anyone who is going to be purchasing with our team, so if we have a new buyer, what they would do is they have a day of training with us, where we would walk them through all the specifics on our 340B program, and then how to use our TPA, how to use our vendors, our wholesaler vendors, website, and then not only that, we also have monthly operational calls for both our mixed use space and our contract pharmacy space, where we discuss anything in the 340B program, any changes that may impact us operationally and vice versa, maybe any operational changes within each pharmacy that could impact our program. We also have site visits. We go out to each individual pharmacy every month just to touch base. Sometimes you get a lot more information when you're in-person and doing one-on-one meetings. You can get more dialogue or more information that way, meeting in-person versus just remotely or on a call. Myles Goldman (12:33): During your conference presentation, you discussed how the training process includes making sure everyone on the 340B team understands the program's impact. Can you explain why this is important? Nan Kempadoo (12:46): I love this question because I always love explaining the why behind what we do what we do. I think really, for anything, you should know the why behind any procedure. For us, it is very important for our organization, everybody in it to understand how the savings that we get from the program is reinvested into our community. One aspect of our program that I'm very proud of is our primary care centers, for example. Our primary care centers, they usually service our low-income and indigent population. Nan Kempadoo (13:18): To me, this is like the essence of what we strive for with 340B, giving back to the underserved. Our primary care centers, they usually consist of case managers, social workers. Some of the primary care centers actually have onsite pharmacies, so what better way to serve our patient population than to have everything so accessible in one area. It's not a revenue-generating area. That's not its goal. Its primary goal is to service our community, so I think that's a beautiful thing, and it's really the essence of the 340B program. Myles Goldman (13:51): You've referenced your team a lot, which is great. How do pharmacy technicians work with their pharmacist colleagues to operate a good 340B program? Nan Kempadoo (14:00): Really, I feel like the pharmacy technicians are the foundation, our buyers, our purchasing technicians, the way they're so hands-on and they handle and understand their inventory on such a detailed level, and then our pharmacists, they help us manage on a more operational level. Our buyers and our purchasing techs, they know the drugs. They just know it just from seeing it day in, day out. Our buyers, they know our vendors, they know the flow of the drugs through the organizations, and working together, the pharmacists on the operational, and then our technicians on the detailed end of things combined, they make a well-oiled machine. Myles Goldman (14:40): Are there meetings between pharmacists and pharmacy techs about the program or any like working groups or anything like that? Nan Kempadoo (14:46): Yeah, those operational calls I spoke about earlier, it's actually everybody. We have one monthly operational call for the mixed use end, where all of the pharmacists and all of the technicians from the organization are invited, and then on the contract pharmacy end, the same thing. We have our pharmacy directors on there, operation managers, we have our individual pharmacy managers in the call. Our buyers are on the call, and then our 340B team. We even have supply chain on those calls. Whoever is touching the program in any way, we want them on those calls. Myles Goldman (15:22): What is the greatest challenge you would say you faced in your career and how have you overcome it? Nan Kempadoo (15:30): For me particularly, it was just refining my soft skills. A lot of times, we don't understand how important that is, and really, throughout my pharmacy technician career, for the most of it, I didn't really have to use a whole lot of soft skills, but then, when I advanced and now I found myself in this 340B role, I really had to use those, they became very important, so things such as public speaking, not just in big presentation, but little things like meetings, you have to present yourself in a certain way. You have to present yourself professionally. I would get so nervous, so I had to work on that. Some things that seem small, but they're very important, like digital literacy and written communication, just how to word an email, how to send an email and communicate effectively through that email. Nan Kempadoo (16:17): Time management, I think that's part of soft skills, and I think a big one for us in the 340B world is improvisation. We come across so many different challenges, and we have to adapt. We have to figure out a solution to this new, I wouldn't say problem, but to this new challenge. Those are some things that I feel like I really had to refine in my career. Myles Goldman (16:41): I think people can certainly relate to a lot of those, and this may be a good segue, what advice would you have for a pharmacy technician just starting out their career in 340B? Nan Kempadoo (16:54): For a new pharmacy technician, starting out their career in 340B, I would say that there's always something new to learn, and it doesn't even matter at what stage of your career you're at in 340B. There's always something new you can learn, and because of that, I would say always push the boundaries of your comfort zone because that is the best way to grow. If you're not uncomfortable, you're not growing, so always try to push those boundaries. I would maybe like Google a list of soft skills and maybe divide that up. What are you strong in and what are you weak in? Nan Kempadoo (17:25): Wherever you have those weaknesses, I would try to practice or refine that a little bit more. That would have helped me. Myles Goldman (17:32): Man, I've enjoyed hearing about your career experience and all the great opportunities available to pharmacy technicians in the 340B program. Thank you again for taking time out of your busy conference schedule to join us. Nan Kempadoo (17:47): Thank you so much for this opportunity, Myles. David Glendinning (17:50): Our thanks again to Nan Kempadoo for giving us her pharmacy technician perspective on 340B operations. We appreciate Nan and all the pharmacy techs who help hospitals and health systems run effective, efficient and compliant programs, and we are thrilled to hear that she's a regular listener and a fan of our podcast. Do you have colleagues whom you think would be fans of the content we cover on 340B Insight? Please let them know. They can find us by going to 340bpodcast.org, and if you have any questions, episode ideas, or feedback for us, you can email us at podcast@340bhealth.org. David Glendinning (18:30): We'll be back in a few weeks. As always, thanks for listening, and be well. Speaker 1 (18:40): Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340bpodcast.org. You can also follow us on Twitter @340BHealth, and submit a question or idea to the show by emailing us at podcast@340bhealth.org.