The only time you'll see PharMerica's products is when a nurse hands you a pill in a paper cup. As the country's second-largest institutional pharmacy operator (behind Omnicare), the company provides purchasing, packaging, and dispensing of drugs to hospitals, nursing homes, assisted living facilities, and other long term care settings with approximately 320,000 beds. PharMerica operates about 100 institutional pharmacies, including 15 focused on infusion therapies and five for oncology medications, from which it packages and delivers medications in unit doses (rather than in bulk) to its customers in 45 states. It also provides consulting and monitoring services of drug usage to help care facilities comply with government regulations.
PharMerica's institutional pharmacy segment accounts for a majority of sales. Other revenue comes from the hospital pharmacy management division, which provides onsite management of pharmacies at more than 80 US hospitals in about 20 states, and its infusion business, which operates more than a dozen infusion pharmacies that ship products to homebound patients. Pharmacy management services include patient safety and regulatory compliance, work force optimization, and drug utilization management. The company also provides consultant pharmacist services to some two-thirds of its patients served.
PharMerica offers a number of services through online portals including help with medication management (ordering, refills, discontinues, returns), regulatory updates, formulary guides, billing, reporting, and management and utilization reports. It also offers patient medical record management services.
PharMerica operates facilities in more than 40 states and serves customers in 45 states. Its largest operating markets include Arizona, Texas, California, Florida, Pennsylvania, Tennessee, and Hawaii.
Sales and Marketing
PharMerica receives nearly half of its annual pharmacy services revenue from commercial Medicare Part D Plans. The government reimbursement programs Medicare and Medicaid combined account for about 10%. Other payers include institutional health care providers (25%), commercial insurance companies, private payers, and contracted providers. PharMerica keeps a close eye on changes to federal health care laws and insurance reimbursement policies which have the potential to affect its bottom line.
The company's products and services are promoted through a national direct sales force. Its customers are institutional health care providers including skilled nursing facilities, nursing centers, assisted-living facilities, hospitals, homebound patients, and other long-term care alternative care providers.
After a 12% dip in 2012, revenue dropped another 4% in 2013 to $1.8 billion due to lower contracted customer accounts in the institutional pharmacy segment. However, revenue recovered by 8% to $1.9 billion in 2014 thanks to the 2013 acquisitions of five long-term care businesses and the acquisition of specialty pharmacy OncoMed. Another four long-term care businesses acquired in 2014, as well as addition of an infusion business, also contributed to the rise in revenues.
After seeing net income rise, PharMerica has seen profits fall for three years. Net income dropped 64% in 2014 as expenses related to litigation, settlement, selling operations, and general purposes climbed. The acquisition of OncoMed Specialty also cut into the bottom line.
Cash flow from operations fell 68% in 2014 to $48.4 million due to an increase in inventory purchasing and an increase in accumulated rebates receivable.
By consolidating in what has historically been a highly fragmented market, PharMerica has secured its position as one of the largest institutional pharmacy providers in the country. It has grown geographically by acquiring smaller, regional competitors that operate in markets the company wishes to enter. It also targets new sales and retention of existing clients. To that end, the company is looking to broaden its product and service offerings into new areas. PharMerica continues to expand its digital offerings to keep up with growing demand from customers for such services.
Organic growth is being fueled by a strong pipeline of new drugs, increased patient utilization, and a favorable pricing environment. Over the past few years the company has been beefing up the amount of generic drugs it dispenses as a way to reduce costs and capture more customers. More than 80% of the prescription drugs PharMerica dispensed in 2013 were generic (compared to roughly 70% in 2008). This number is likely to increase as more pharmaceutical companies lose exclusivity patents and additional generics are introduced to the market. However, selling generics is a double-edged sword since a shift from brand to generic decreases PharMerica's revenue, but at the same time improves gross margins.
In 2015, PharMerica entered into a drug sourcing and distribution partnership with Cardinal Health that will extend through mid-2018.
Mergers and Acquisitions
In 2014 PharMerica purchased BGS Pharmacy Partners (serving long-term care facilities in Utah and Nevada), Altius (home infusion services), RxAdvantage (serving long-term care facilities in Alabama and Florida), and Millennium Pharmacy Systems (serving long-term care facilities primarily in the mid-Atlantic).
The following year the company added to subsidiary Amerita's specialty home infusion operations with the acquisition of Coastal Pharmaceutical Services (dba InfusionRx) for an undisclosed amount. That deal broadened Amerita's market presence, particularly in Southern California.