Niche pharmacies
Local facilities join growing trend for nursing-home residents
are gaining traction in the marketplace as nursing homes and skilled nursing facilities turn to them for special delivery of their medications.
The average nursing-home resident has many as a dozen prescription medications. To dispense the pills from regular pill bottles can be time-consuming for nurses and increase the risk of mistakes, diversion and drug interactions.
That’s where niche pharmacies such as Guardian Pharmacy Services, which recently opened a new facility in Orlando — its seventh location in Florida — come in.
“We don’t have specialized packaging and consultants in average retail stores, so these pharmacies evolved,” said Dana Saffel, president and CEO of Pharmacare Strategies, a consulting firm in Florida.
The pharmacies mainly contract with long-term care facilities such as nursing homes to fill residents’ prescriptions.
“There are no on-site pharmacies in nursing homes, and that’s where we come in,” said Alan Obringer, president of Guardian Pharmacy of Orlando and an industry veteran.
Long-term care pharmacies came about in the 1980s, when
“We answer the phone. We try to text everybody, like it’s our own grandmother. And we customize our services.” Alan Obringer, president of Guardian Pharmacy of Orlando
There’s already been an increase in the number of pharmacy-school graduates who choose to specialize in geriatric pharmacy.
federal provisions began to require nursing homes to have special packaging for medications and regularly bring in consultant pharmacists to review residents’ medication.
Today, the leading long-term care pharmacy service provider in the U.S. is Omnicare, which was purchased by CVS Health Corporation for nearly $13 billion in 2015. Behind it is PharMerica, which was acquired by private equity firm KKR last week in a $1.4 billion deal that includes Walgreens as a minority investor.
Behind them are companies like Guardian, and there could be more of them in the near future because of the demands of the aging population, particularly in states like Florida.
There’s already a spike in the number of pharmacy-school graduates who choose to specialize in geriatric pharmacy.
“The geriatric specialty has been growing very rapidly, and I expect it to continue to grow rapidly,” said Thomas Clark, senior director of geriatric pharmacy certification at Board of Pharmacy Specialties, an autonomous division of the American Pharmacists Association. “In the first half of this year we doubled the number of applicants for the specialty to 700.”
Running a long-term pharmacy is not easy business. Profit margins are slim and competition is stiff, particularly for smaller groups.
“Our biggest challenge is competing with large chains to get the business [of long-term care facilities] in the community,” said Bri Morris, who manages longterm care services for National Community Pharmacists Association.
But recent changes in federal guidelines, which reward providers for quality and patient satisfaction, are giving smaller companies new opportunities.
“The number of nursing-home beds has been declining,” said Clark. “That’s in part because assisted living is growing and taking on less acute patients.”
Also, the rapidly growing aging population is more likely to “age in place” instead of moving into a nursing home. They also want more personalized care.
“The most common issue for long-term care facilities is non-personal care,” said Obringer of Guardian. “We answer the phone. We try to text everybody, like it’s our own grandmother. And we customize our services.”
Founded in 2004, Guardian currently has 29 locations in 20 states, serving nearly 90,000 residents.
Guardian’s corporate team handles the business operations, including payroll, HR and IT, and each location handles the pharmacy side of the operation.
The company’s Orlando location set up shop in March after purchasing Central Care Pharmacy, which was owned by Sridhar Nadimpalli.
Nadimpalli has stayed with the new company as the director of operations and on a recent afternoon was busy managing prescriptions in the pharmacy stockroom, along with his employees who also joined the Guardian team.
The pharmacy currently has 15 employees and is planning to hire additional staff before the end of this year.
Its roster of 200 residents is expected to grow to nearly 2,000 by the beginning of September, said Obringer, during a tour of his facility. And to do that, he is looking beyond the traditional contract with a long-term care facility.
He’s expanding his offerings by building a sterile preparation area for compounded medications. And he’s planning to start a mail-order service.
To consultants like Saffel, that’s the right thing to do.
“The forward-thinking businessminded long-term care pharmacies would turn their attention to community services,” she said.