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What is the Myers Briggs Type Indicator (MBTI)?

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What is the Myers Briggs Type Indicator (MBTI)?

  • Psychological assessment

  • Developed by Katherine Briggs and Isabel Briggs-Myers

  • Based off of the work by Carl Jung

  • Most widely utilized personality preference in the world

  • Description of personality types based on natural preferences

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What are the benefits of the MBTI?

  • Offers a way to identify strengths and needed areas of development

  • Understand the personality types of others and use them constructively

  • Supports our learning and is holistic – used in personal and professional roles

  • Reflects personality preferences – not likelihood of success or skills

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What are the five core competencies of Emotional Intelligence (EI)?

  1. Self-Awareness

  2. Self-Regulation

  3. Motivation

  4. Empathy

  5. Social Skills

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Energy Source: Extrovert vs. Introvert

  • Extraversion

    • Likes action and variety

    • Outward focus – people and things

    • Speaks to think

    • Discloses freely

    • Multiple relationships

  • Introversion

    • Likes quiet and time to consider things

    • Inward focus – thoughts and ideas

    • Thinks to speak

    • Discloses cautiously

    • Limited relationships

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Perceiving Function: Sensing (S) vs. Intuition (N)

  • Sensing (S)

    • Facts

    • Detailed oriented

    • Literal

    • Present oriented

    • Down to earth

  • Intuition (N)

    • Theory based

    • Abstract

    • Figurative

    • Future oriented

    • Head in the clouds

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Judging Function: Thinking vs. Feeling

  • Thinking

    • Objective

    • Analytical

    • Head

    • Clarity

    • Policy

    • Non-personal

  • Feeling

    • Subjective

    • Experiential

    • Heart

    • Harmony

    • Social values

    • Interpersonal

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Life Style Orientation: Judging vs. Perceiving

  • Judging

    • Decisive

    • Structured

    • Planned

    • Seeks closure

    • Make lists – use them

  • Perceiving

    • Open-minded

    • Flexible

    • Spontaneous

    • Seeks options

    • Make lists – lose them

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Known as: The “Development-of-People” Leaders

Style: People-focused approach, mentors for short/long term goals and vision

Primary goal: Empowering others

Focus on: Encouraging growth

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Known as: The “systems-Analysis” Leaders

Style: Conceptual-focused approach, seeking long-term strategies that can be implemented to maximize production

Primary goal: Mastery

Focus on: Improving systems

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Known as: The “Bottom-Line” Leaders

Style: Task focused approach, dedication to creating and implementing policies and procedures

Goal: Efficiency

Focus on: Doing it right

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Known as: The “In Service-of-People” Leaders

Style: People-focused approach, strive to meet the needs of others

Goal: Helping

Focus on: Offering support

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How can we improve our EI?

  1. Self-Awareness

  2. Self-Regulation

  3. Motivation

  4. Empathy

  5. Social Skills

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  1. Entrepreneur

  2. Intrapreneur

  3. Wantrapreneur

  1. Visionary, takes action

  2. Employee with entrepreneurial approach & passion

  3. Entrepreneurial myth (i have no idea lol)

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Define Entrepreneurship

  1. Text: “the process by which individuals pursue opportunities without regard to resources they currently control”

  2. .End goal = achieve the “vision”

  3. Requires research, passion and perseverance

  4. Involves personal and financial risks

  5. “Identify problems and proactively turn them into opportunities to improve the situation”

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Define Intrepreneur

  • An intrapreneur:  employee who is given the authority and support to create a new product/service/idea/concept/program

  • No concern about resources required

  • No concern about generating revenue

  • AKA “corporate entrepreneurship”

  • Same characteristics as an entrepreneur

  • Less risk and usually less reward

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Why be an Innovator/Entrepreneur?

  • Economic Growth

  • Organizational Survival

  • Competitive Advantage

  • Opportunity for Growth and Development

  • Creativity

  • Improved Performance

  • Accumulation of Wealth

  • Improve the Human Condition

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What are the characteristics of entrepreneurs?

  1. High level of motivation to achieve

  2. Passion

  3. Internal focus on control

  4. Tolerance for the unknown and ambiguity

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What are not characteristics of entrepreneurs?

  • Not high-risk gamblers – They tolerate some risk

  • Not experts in all areas – They “know people”

  • Not quitters – They persevere

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What are the four types of entrepreneurs?

  1. Personal Achievers

  2. Super Sales People

  3. Expert Idea Generators

  4. Real Managers

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Describe Personal Achievers

  • Need for feedback

  • Need for accomplishment

  • Strong commitment

  • Internal locus of control

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Describe Super Sales People

  • Capacity to understand others, empathize

  • Belief that social processes are important

  • Good at building external relationships

  • Belief in sales force

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Describe Expert Idea Generators

  • Build venture around new products

  • Involved in high-tech companies

  • Desire to innovate

  • Intelligence & creativity provides a competitive advantage

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Describe Real Managers

  • Desire to take charge, compete, be decisive, stand out

  • Desire to be corporate leader, desire for power

  • Positive attitude toward authority

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  • Level of Difficulty to Obtain:

    • easy

  • Cost:

    • least costly ($35 - $85)

  • Level of Protection:

    • Least protection (only protects the form, or original work which is the end result of the idea/concept)

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  • Level of Difficulty to Obtain:

    • moderate

  • Cost:

    • moderate cost ($750+)

  • Level of Protection:

    • More Protection (of names, brands, logos and other distinctive marketing devices)

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  • Level of Difficulty to Obtain:

    • high

  • Cost:

    • high (takes at least 2 years and many thousands to file + legal fees for IP lawyers)

  • Level of Protection:

    • Highest (protects the idea, process, method and design of products and businesses)

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What is the Return on Investment equation?

ROI = __Net Return on Investment__​ × 100%

Cost of Investment

  • ROI is typically expressed as a percentage

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What are Incubators?

  • Entity with expertise to help get a new businesses started

  • Usually for an equity stake – piece of the action

  • Often connected  to academic institutions

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Definition of a Pharmapreneur

  • IDs, creates & pursues new opportunities

  • Successfully implements new ideas into practice

  • Willing to take risks

  • Fills unmet or unrecognized needs

  • Creates value through innovation

  • Improves patient care

  • Responsive to changes in healthcare  or markets

  • Willing to make sacrifices

  • Includes social entrepreneurship & intrapreneurship

  • Leverages knowledge, skills & resources

  • Goes beyond traditional roles in pharmacy

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What is Disruptive Innovation?

  • Simple but innovative products or services that displace established competitors

  • Ex: Smaller company with fewer resources that challenge and disrupt established businesses

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People don’t buy products or services…


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How to build wealth…

  • Innovation of new ideas

  • Leverage

  • Acquisition & finance

  • Create value for many people

  • Challenge the status quo

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The #1 reason for unethical behavior is?


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5 Core Business Principles

  1. People don’t care how much you know, until they know how much you care.

  2. The more you help others, the greater your own success will be.

  3. It’s all the LITTLE things done exactly right that separates the ordinary stores from the extraordinary ones.

  4. Consistent execution is a competitive advantage.

  5. If you can measure it, you can manage it. If you can manage it, you can improve it.

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The myth about price…

Price = Value


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What are the four primary functions of leaders?

  1. Planning = dedicated efforts to ensure sustainability & optimize future success

  2. Organizing

  3. Controlling

  4. What’s missing? → Personal Mission/Vision Statement

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What are the typical barriers to all types of planning?

  • Failure to implement or execute (most common)

  • Lack of upper-level support

  • Poor planning skills and capabilities

  • Failure to monitor and revise when needed

  • Failure to commit sufficient time & resources

  • Failure to monitor progress

  • Conflicting demands such as crisis issues

  • Interpersonal issues (power, politics, resistance to change)

  • Very rapidly changing environment


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What is the purpose of business planning?

  1. “What if” feasibility scenario (–“Should we invest in this initiative?”)

  2. Provides needed info & lists necessary actions

  3. Projects future risks and benefits ($)

  4. Evaluate vs. other possible projects

  5. Increases the likelihood of reaching goals

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What is Competitor Analysis?

  • Identify and gauge competitors

  • Understand the competition

  • Review & compare their strengths & weaknesses

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Define Processes and Operations

  • People

    • Organizational structure – reporting relationships

    • Staffing levels

    • Personnel requirements

  • Place

    • Physical facilities

    • Equipment

    • Resources

  • Process

    • Day-to-day work activities

    • Policies and procedures

    • Marketing/advertising

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Assess Strengths, Weaknesses, Critical Risks and Opportunities

  • Internal Characteristics:

    • __S__trengths

    • __W__eaknesses

  • External Characteristics":

    • __O__pportunities

    • __T__hreats

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What are the reasons business plan proposals fail?

  1. Vague or too loosely defined

  2. Not enough time dedicated to planning process

  3. .Many regulatory or environmental issues

  4. Interpersonal or power/political/culture issues

  5. Lacking in planning skills

  6. Too costly, too risky, too complex, too little ROI

  7. Mismatched to company mission/vision

  8. Too few top decision maker endorsements

  9. Too little communication about the plan

  10. Failure to implement or execute

  11. Failure to monitor progress and make needed changes

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Pharmacy Administration Structure includes…

  • Operations

  • Compliance/Regulatory Affairs

  • Managed Care

  • Services or Programs

  • Clinical Programs

  • Procurement

  • Business Intelligence

  • Centralized Services

  • Information Systems

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Pharmacy Operations

  • Oversight of the daily business activities to ensure safe and efficient delivery of pharmaceutical services directly to the patient

  • Execution of daily activities should align with the vision, mission, and goals of the organization

  • Pharmacy Operations is responsible for oversight, communication, and execution of

    • Standard Operating Procedures

    • Pharmacy Process Workflow

    • Quality Related Process Management

    • Pharmacy Services and Programs

    • Financial Performance

    • Inventory Management

    • Pharmacist Staffing

    • Customer Service Delivery

    • Human Resource Performance Management

    • Operational Succession Planning

    • Professional Development

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Pharmacy Operations- Executive Management

  • Coordinating strategic vision and planning

  • Oversight for all functional areas of business

  • Ensure alignment across various functional areas

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What is Command Intent?

  • Gives a description of the desired outcome in relation to a current objective or mission

  • Focus on the endpoint and not how to achieve that endpoint

  • Coordinate a team to focus on what needs to get done in the moment, even when monumental change is encountered and original plans can no longer be applied

  • Managers must develop plans and communicate plans effectively

  • Empowers initiative, improvisation, and adaptation by providing guidance of what a successful outcome looks like

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Roles and Responsibilities- Director/Manager of Pharmacy Operations

  • “Upper Management” with responsibility to oversee entirety of Pharmacy Operations

  • Work closely with executive management on development of long-term operational strategies and/or goals to meet the company vision and objectives

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Roles and Responsibilities- Regional Operations Manager/District Operations Manager

  • ”Middle Management” with responsibility to oversee Pharmacy Operations in a defined geography or territory

  • Executing organizational operations plans

  • Inspiring and providing guidance to “front-line” managers to assist with performance improvement and accomplishment of business objectives

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Roles and Responsibilities- Pharmacy Manager/Pharmacist-In-Charge

  • Oversee daily business operations of a specific pharmacy location in accordance with defined regulations and Standard Operating Procedures

  • Responsible for pharmacy practice to include:

    • Monitoring/Evaluating/Dispensing Prescription Drug Orders

    • Counseling patients on proper drug use

    • Administration of ancillary clinical services

  • Accountable for pharmacy operation to include

    • Supervision of pharmacy staff and execution of pharmacy workflow

    • Performance management and improvement of staff

    • Safe medication storage, diversion control, and pharmacy inventory

    • Appropriate delivery of day-to-day customer

    • Appropriate scheduling of pharmacy staff to meet business needs

  • Analyze pharmacy performance data and addressing opportunities for growth and improved performance

  • Leverage “middle management” to be mentor or coach for professional development

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What is Project Management?

  • The application of processes, methods, knowledge to achieve a specifically agreed objective.

  • A discipline designed to deliver projects on time and on budget.

  • Have a start and finish.

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What is Change Management?

  • The application of a structured process and tools for leading the people side of change to achieve a desired outcome.

  • All meaningful projects involve change management.

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What is Transformational Change?

  • Transformation isn’t about doing it better. It’s about redefining how something is fundamentally done.

  • Business transformations are occurring at an ever- increasing rate and the results aren’t great.

  • Continuous over years.

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Examples of Project Management

  • Plan a party

  • Build a home

  • Develop a drug

  • Implement EMR

  • Launch a new website

  • Process redesign

  • Implement new federal regulations

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Examples of Change Management

  • A reorganization

  • New boss

  • Add Pharmacy Techs / Robots

  • Expanded scope of practice

  • Mergers & Acquisitions

  • Launch a new department

  • Almost any project

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Examples of Transformational Change

  • iPhone, Uber, Amazon

  • Solar energy

  • In-person to digital sales

  • Pharmacist prescribing authority

  • Small molecules to biologics

  • Personalized Medicine (e.g., Herceptin)

  • CAR-T Therapies

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Why do most change efforts fail?

  • Insufficient aspirations

  • Failure to understand stakeholders needs

  • Lack of organizational engagement

  • Lack of planning

  • Insufficient investment in skill and capability development

  • Inadequate leadership support and modeling

  • Insufficient time and resources

  • Focus on systems over people

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Tools and resources to manage projects

  • Project Charter

  • SMART goals

  • Work Breakdown Structure (WBS)

  • Gantt Charts

  • Project Evaluation and Closeout

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Elements of a Project Charter

  • Mission

  • List of key stakeholders

  • Definition of project scope

  • Team members / Roles / Responsibilities

  • Project schedule

  • An estimated budget

  • List of anticipated risks and management plan

  • Change control process

  • Success Measures

  • Signature page

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What are the factors of SMART goals?

S- specific

M- measurable

A- attainable

R- relevant

T- timely

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What is a Gantt Chart?

  • Tool to manage schedule and resources

  • Reports project progress

  • Visual display of the project schedule

  • List of key tasks, due dates and milestones

  • Provides estimate of time to complete

  • Outlines task dependencies to coordinate planning across the team and stakeholders

  • Assigns ownership of tasks

  • Can assign budget and resources to tasks

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Project Closeout Steps

  1. Debrief the team and stakeholders

  2. Evaluate project performance

  3. Lessons learned

  4. Celebrate

  5. Close the project

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Successful project managers have the following skills and capabilities…

  • Communication

  • Scheduling

  • Negotiation

  • Leadership

  • Planning

  • Team management

  • Risk management

  • Critical thinking

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Kotter’s 8 Steps of Change

  1. Create urgency

  2. Put a team together

  3. Develop vision and strategies

  4. Communicate the change vision

  5. Remove obstacles

  6. Set short term goals

  7. Keep the momentum

  8. Make the change stick

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What are the factors driving drug spending?

  • Impact of manufacturer price increases drugs

  • Higher utilization of certain available drugs

  • Impact of drug shortages driving up costs

  • New drugs approved by the FDA

  • Drugs going off patent and resulting lower cost generics

  • New high-cost specialty drugs have added billions to annual drug spend

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What are the factors influencing buying?

  • Pharmacy mission or specialization

  • Patient population demographics

  • Sales history

  • Drug formularies

  • Industry and drug research data

  • New product launches and pharma sales data

  • Patent expirations

  • Drug shortages requiring substitutions

  • Health plan/PBM utilization management

  • Consumer demand

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What are the Five Rights of Procurement Purchasing?

  1. Right products

  2. Right quantity

  3. Right time

  4. Right price

  5. Right vendor – aka right sourcing

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Right Product

  1. Past and current usage

  2. Target market

  3. Pharmacy goals/image/niche

  4. Formulary

  5. Pharma research data

  6. Industry promotion

  7. Consumer information

  8. Reliable sources of supply

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Right quantity

  • Have just enough product on hand to cover consumer demand at any given time

  • Too much inventory ties up $ cash

  • Too little inventory may result in current and future lost sales and unhappy customers

  • Track demand and monitor usage trends

  • Anticipate fluctuations in demand - seasonal

  • Monitor drug shortage situations

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Right time/POS

  • JUST-IN-TIME (JIT) = replacement stock received within a very short period of time after sales have depleted almost all stock on hand

    • Minimize inventory and related carrying costs

    • Supply Chain problems & drug shortages are a threat

    • Day you don’t get a product could be the day you are out of stock

  • POINT OF SALE (POS) TECHNOLOGY = allows for maintaining a perpetual inventory

    • Integrates purchases with sales from POS system

    • Stock-on hand and automated reorder points

    • Received stock uploaded to the perpetual inventory by EDI

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Right price

  • TERMS OF SALE – pertain to discounts & dating

  • Discounts = reduction in price

  • Dating = period of time allowed for taking discounts and the date when the invoice becomes due/payable

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Right vendor

Criteria for Vendor Selection:

  1. Product availability – full range of products

  2. COMPETITIVE PRICING, discounts, financing & credit options

  3. ACCURACY of filling orders

  4. FILL RATE – frequency of out-of-stock situations

  5. DELIVERY schedule – same or next day, 5+ days/wk.

  6. Consistent, on-time delivery

  7. Returned goods policies

  8. Product placement and merchandising advice

  9. Value-added services – backorders, drop ships, bar-coded shelf labels

  10. Track and trace capability

  11. Technology – order entry devices and software

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What are the 3 Types of Stock?

  1. Cycle Stock – regular inventory needed to fulfill orders

  2. Safety or Buffer Stock - additional inventory needed due for:

    • Current demand fluctuations - ↑# Rx for a certain drug

    • Current supply fluctuations – drug shortage

  3. Speculative/Anticipatory Stock – additional inventory for:

    • expected future demand, or upcoming price increase or anticipated drug shortage

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Inventory Ordering Method

  • Scan Inventory

  • Establish Minimum Par Level (set quantity to have in stock)

  • Determine Order Quantity

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What are the different methods of Scanning Inventory?

  • Visual method:  ID low inventory daily – want book

  • Periodic method:  inspection at regular intervals

  • Perpetual method: electronically measure inventory in real time

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How do you Determine Order Quantity?

Determine Order Quantity = how much to order – typically quantity needed to get to par level

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What is a Quantity Discount?

  • Financial incentive for purchasing large quantities

  • Either on a single order (noncumulative) or over a set time period (cumulative)

  • Discount may be in free goods (e.g. buy 10 get 1 free), rather than a price discount

  • Advantages = ↓AAC (actual acquisition cost)

  • Disadvantages = ↑ inventory, ↑ carrying costs and risk of unsellable merchandise

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What is a Cash Discount?

  • Small discounts offered for prompt payment

  • 2/10 EOM, net 30 = 2% discount if paid within 10 days of the end of the month, otherwise the net or full amount is due in 30 days

  • Advantages = significant discount - 2/10 can = 36% in annual savings – without having to purchase excess inventory

  • Disadvantages = implications on your cash flow – set up a line of credit

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What is a Serial Discount?

  • Both quantity and cash discounts

  • Order of application of multiple discounts does not matter

  • Example:

–List price = $100

–10% Quantity Discount - $100 x 0.1 = $10

–$100 - $ 10 = $90

–2% Cash Discount - $90 x 0.02 = $1.80

–$90 - $1.80 = $88.20 final cost (11.8% total discount)

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What is the meaning of the following acronyms:


  • EOM = end of month

  • AOG = arrival of goods

  • ROG = receipt of goods

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What are the 3 types of Invoice Dating?

  • Dating = time a specified discount may be taken and the time when payment becomes due:

  • Three types:

  1. Prepayment – estimated payment made before initial ordering and delivery based on 3 mos avg

  2. Collect on Delivery (COD) –payment is due at time of delivery – not seen too much

  3. Delayed or Future – payment is due sometime in the future – if no dating, due 10 days from EOM

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Types of Pharmaceutical Suppliers

  1. Manufacturer – direct buying

  2. Primary Wholesale Distributor  – indirect buying

  3. Secondary Wholesaler - backup

  4. Outsourcing Compounding Pharmacy

  5. “Gray Market” – good or bad?

  6. Specialty Distributor – high $ drugs

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What are Group Purchasing Organizations (GPOs)?

  1. National & regional buying groups

  2. Use pooled buying power

  3. Utilize a competitive bidding process

  4. GPO’s negotiate directly with manufacturers based on combined volume

  5. Also bid out prime vendor wholesaler awards

  6. Charge a monthly or annual fee to members

  7. GPO’s can also get rebates from manufacturers.

  8. GPOs have driven prices so low mfg. have stopped making some products

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Drug Quality and Security Act (DQSA)

  • Title I Compounding Quality Act – 503A and 503B":

    • 503A Traditional Compounder (Rx)

    • 503B Outsourcing Facility (no Rx)- Voluntary Registration

  • Title II Drug Supply Chain and Security Act (DSCSA):

  1. Tract and trace drugs

  2. Find and remove dangerous drugs

  3. Electronic system to monitor drug supply – “cradle to grave”

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What is the Purpose of DSCSA?

  • Purpose: Improve detection and removal of potentially dangerous products from the drug supply chain

  • Also enhance the FDA’s ability to help protect from drug contamination and counterfeiting

  • 2023 Goal:  electronic, interoperable track and trace system

  • Imported drugs and APIs – greatest risk

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Consumer Reports “Drug Store” Ratings

  • Top Customer Complaint = ”Out of Stock”

    • 32% of surveyed said their pharmacy was out of stock of the med they needed at least once in the past year

    • Customer satisfaction takes a hit

    • Loss of customers results in a financial hit

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What are the Costs Associated with Inventory?

  1. Acquisition – cost of product

  2. Procurement – costs associated with purchase of product

  3. Carrying – cost related to storing product

  4. Stock out/Shortage – costs associated with not having product when needed

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Inventory Management Summary

  1. Goals:

–Minimize procurement and carrying costs

–Balance supply and demand

  1. Advantages of good Inventory Management:

–Keep expenses down

–Improves cash flow

–Improves customer service

  1. Disadvantages of poor Inventory Management:

–Shortages/stock outs = customer complaints

–Increased operating costs - higher cost emergency orders

–Loss of interest on $ if invested elsewhere

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Effective Inventory Management Advantages

  1. ↓ operating expenses

  2. ↓ COGS (cost of goods sold)

  3. ↑ gross margin – (Rev – just COGS) – in retail  ~22%

  4. ↑ net profit (Rev – all Exp.) – in retail ~ 3%

  5. Every $ in inventory savings increases gross margin and net profit

  6. Spending less on inventory improves cash flow

  7. Drugs in stock to meet customer needs = good customer service

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Formulas to Know !!

  • Cost of Goods Sold (COGS) = beginning inventory + purchases for the period – ending inventory

  • Average Inventory = (beginning inventory + ending inventory) ÷ 2

  • Days on Hand (DOH) = 365/Turn over (TO)

  • ITOR or TO = COGS ÷ Average Inventory

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Number of __D__ays of Inventory __o__n __H__and

  • Days on Hand (DOH) = 365/Turn over (TO)

  • Lower days on hand would represents more effective inventory management, with all else being equal

  • Remember Leap Years (like 2020) = 366 days

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Advantages of a High ITOR (Inventory Turnover Rate)

  • Reducing investment in inventory frees up $

  • Increases return on investment

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Disadvantages of Too High an ITOR

  • Possible out of stock situations and angry customers

  • Excessive staff time spent on inventory management

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Disadvantages of Too Low an ITOR

  • Excess unsold inventory sitting on the shelves

  • Out of Date/Expired products

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Factors to Consider in Good Inventory Management

  1. Selection of generic products

  2. .Reduction of inventory size

  3. Returned goods policies – use reverse distributors/returns processors

  4. Management of unclaimed Rx -  1 in 8 or 12%

  5. Monitoring shrinkage (shoplifting, #1 = employee theft, wastage, lost products)

  6. Use of formularies and therapeutic interchange

  7. Other factors – IV to po conversions, consignment products (e.g. high cost Factor VII)

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When is Physical Inventory done?

  1. At least annually at end of fiscal or calendar year

  2. At start or end of business day

  3. Define what to count?

    –Count it if it hasn’t been charged to a patient (or their insurance) or costed out to a patient care area

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What are some other inventory issues?

  • Shrinkage = lost, stolen, misplaced, wasted merchandise

    • internal theft (prime issue with controlled substances)

    • external theft

  • Organized theft

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Ways To Fight High Drug Costs

  1. Use of generic drugs

  2. Find evidence-based alternatives

  3. Reduce waste of drugs

    1. Dose rounding

    2. Draw up multiple syringes out of one vial

  4. ID drug shortages quickly

  5. Purchase higher use drugs before known price hikes

  6. Educate about high $ drugs & shortages

  7. Become a 340-B Pharmacy

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Special Medications

  • High cost (> $670/month)

  • Treat rare or orphan disease state

  • Difficult to administer

  • Require special handling

  • Require frequent, ongoing clinical assessment

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Top 10 drugs by expenditure

  • Adalimumab

  • Apixaban

  • Dulaglutide

  • Semaglutide

  • Ustekinumab

  • Insulin Glargine

  • Pembrolizumab

  • Bictegravir/emtricitabine/ tenofovir/alafenamide

  • Etanercept

  • Empagliflozin

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Why are specialty medications so costly?

  • Aging population

  • Complexity of development and production

  • Targeted population shifting

  • High launch prices

  • Price escalation after market entry

  • Complex, uncoordinated insurance payments

  • Legal considerations

  • Provider incentives

  • Shifts in practice site of service

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