traits of innovation and a few other material

• what's new?

  • zepbound -- lilly weight loss drug now available for direct pt shipment via amazon
  • lilly direct connects pts w/ telehealth services that can prescribe, process and mail to pts
  • they'd offer this via TruePill
  • now, both TruePill and amazon
  • lilly direct has link to FormHealth or a local doctor, for either telehealth or local doc visit
  • either are "obligated" to prescribe
• who is shigeichi negishi?

  • won national calligraphy contest
  • in japanese army in WW2
  • sold olympus cameras
  • sparko box -- basically invented karaoke
• sparko box

  • almost all new inventions are actually a new assemblage or application or use of something that already exists
  • very rarely is an innovation completely BRAND NEW
  • sparko box -- 1967 when he was 45 yrs old
• to thine own self be true

  • what is a dry promotion?
  • congratulations! you've got a big new title!
  • bigger responsibility, more work, more stress
  • but NO more money
• but, maybe say "yes" if...

  • the promotion lets you get involved in expanded training
  • the new title adds to your resume
  • attend meetings, events, that you wouldn't otherwise
  • opportunity to grow professionally
• and finally...

  • no money?
  • how about more flexible schedule? more time off? benefits related item stock options?
• compounding

  • beyond use dating
  • expiry dating
  • proper labeling use
• does owning independent pharmacy or innovator pharmacy pay off?

  • usually, yes
  • about 22000 - 23000 independently owned pharmacies in the USA
• grow profit % at innovator pharmacy level

  • over the last 10 yrs, an average of 22% to 23%
  • gross profit % somewhat declining especially in CA
  • but still strong!
  • what does that mean in $'s?
  • the average pharmacy had expenses of 18% to 21%
  • leaving a net operating profit % of 3
  • some years it's 2.7 or 2.9 or 2.5
  • but a rough average over the last 15 - 20 yrs is about 3%
• DIR [department of industrial relations]

  • PBM clawback [recovery of money already disbursed] of money reimbursed to pharmacies where the PBM can "prove" that the amount reimbursed was "too much"
  • based usually on some "proof" of a lower drug acquisition cost or rebate being available
  • and yes, DIR is legal
• entrepreneurial spirit

  • it can be about jumping through a profit window that is open for a short time
  • like the compounded drug shortage ever-changing new rules
  • why?
  • because the idea of a "sustainable advantage"
  • important to know: there is NO such thing as a sustainable advantage
  • most entrepreneurs experience failure of one sort or another
• innovation: inherited trait? or a developed skill?

  • what is associational thinking?
  • a cognitive skill:
  • it can be learned and it can be taught
  • connecting wildly different ideas
  • combining disparate objectives
  • blending existing services and technologies in a new or different way
  • "creativity is connecting things" -- steve jobs
• combinational play

  • einstein called creative thinking "combinatorial play"
• is innovation magic?

  • innovators and entrepreneurs rarely create something completely new
  • they most often combine ideas collected in new ways
• the core skills for developing an entrepreneurial or innovative management idea

  • questioning
  • observing
  • networking
  • experimenting
• what banks finance pharmacies

  • low default rate
• measuring innovation's success

  • personal satisfaction
  • longevity
  • pride of ownership
  • material measures
• what's revenue?

  • for a company, this is the total amount of money received by the company for goods sold or services provided during a certain time period
  • net income = revenue - expenses
• profit

  • conversely, is the infamous bottom line
  • this is usually called net profit
  • because it is the amount of income that remains after accounting for all expenses, debts, additional income streams and operating costs
• net income

  • net operating income - the income or cash flows that are left over after all of the operating expenses have been paid
  • net operating income is usually stated separately on the income statement
• DSC

  • total debt service refers to all costs related to servicing a company's debt
  • this often includes interest payments, principle payments, and other obligations
  • the debt service amounts is rarely given in a set of financial statements
• DSC? what's that?

  • a DSCR greater than 1 means the entity - whether a person, company or government - has sufficient income to pay its current debt obligations
  • a DSCR less than 1 means it does NOT
  • DSCR = net operating income / total debt service
• healthcare spending

  • NHE grew 4.1% to $4.5 trillion in 2022, or $13,493 per person, and accounted for 17.3% of gross domestic product (GDP)
  • medicare spending grew 5.9% to $944.3 billion in 2022, or 21% of total NHE
  • medicaid spending grew 9.6% to $805.7 billion in 2022, or 18% of total NHE (Dec. 13, 2023)
• 340B, HRSA and DHHS and drug discounts

  • 340B -- legislation that set deep discounts for drug manufacturers to sell products to non profit hospitals and clinics
  • the hospitals and clinics were free to sell at a higher price
  • HRSA and DHHS allowed "discounts" to spread to other buyers
• 340B

  • federal court have ruled that HRSA and DHHS "over reached" and their "effort is unlawful"
  • "the relevant law says nothing about such duties"
  • what does this mean for the world of pharmacy?
  • certain drugs (especially from astra-zeneca, sanofi and novo-nordisk) may NOT be eligible for deep 340B discounts to the extent they were
• inflation reduction act

  • impact on Medicare
  • nation's largest buyer on pharmaceuticals
  • act gives Medicare authority to negotiate pricing (certain high priced therapies)
  • federal government has release list of first 10 drugs whose newly negotiated price takes effect in 2026
  • drug makers must also pay rebates to feds for price increases higher than rate of inflation
• the future? new therapies a "one and done" miracle?

  • since last year, 4 new drugs that are a "1 time gene treatment"
  • all cost at least $2 million per patient
  • hemiginix $3.5 million treats hemophilia B (one time treatment)
  • about 30 new gene therapies are coming by 2024, 2025, 2026
  • who's gonna pay for this?
  • insurers are use to chornic, over time therapies and payment
  • being studied now, without knowing for sure the longevity/outcome/results
  • such as cigna testing a per member, per month fee paid by employers for "future needs" of employees
  • use of gene therapy
• an example

  • carac or fluourouracil
  • kaiser cannot get it
  • no estimation of when