The only time you'll see PharMerica's products is when a nurse hands you a pill in a paper cup. It is 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 more than 330,000 beds. PharMerica operates more than 90 institutional pharmacies, from which it packages and delivers medications in unit doses (rather than in bulk) to its customers in 44 states. It also provides consulting and monitoring services of drug usage to help care facilities comply with government regulations.
PharMerica also manages onsite pharmacies at more than 90 US hospitals. Pharmacy management services include patient safety and regulatory compliance, work force optimization, and drug utilization management. It offers most, if not all, of those services online through its eService Center, a customer web portal that provides clients with a wide range of tools including help with medication management (ordering, refills, discontinues, returns), regulatory updates, formulary guides, billing, reporting, and management and utilization reports.
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 less than 11%. Other payers include institutional health care providers (30%), commercial insurance companies, 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.
By consolidating in what has historically been a highly fragmented market, has PharMerica 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. The company is also looking to broaden its product and service offerings into new areas. In addition, PharMerica introduced the majority of its online services in 2010 to keep up with growing demand from customers for such services and to stay in line with the growing digitization of the US health care system.
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 78% of the prescription drugs PharMerica dispensed in 2011 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 sort of a double-edged sword since a shift from brand-to-generic decreases PharMerica's revenue, but at the same improves gross margins.
To get the best deals on certain branded drugs, in 2011 the company increased its inventory spending. While this shrank its cash flow, it helped to improve its gross margins.
Mergers and Acquisitions
Recent acquisitions of small institutional pharmacies included the 2010 purchases of Integrity Pharmacy Services, (Florida, Massachusetts, and Pennsylvania); Lone Star Pharmacy, (Texas); and the bankrupt Chem Rx, (New Jersey and New York). Early in 2011 PharMerica entered South Carolina by purchasing Ark Pharmacy.
In additioin, in 2012 the company expanded its operations into a new business area through the acquisition of Amerita, a provider of specialty home infusion services in Colorado, Tenessee, Texas, Oklahoma, and Utah.
PharMerica was formed through the 2007 spinoff and merger of Kindred Pharmacy Services (from Kindred Healthcare) and PharMerica Long-term Care (from AmerisourceBergen). PharMerica Long-term Care contributed about 80 regional pharmacies while the smaller Kindred Pharmacy Services added another 46 pharmacies. As part of the arrangement, Kindred Healthcare made the new company a preferred provider to the majority of its hospitals, and it still accounts for 10% of the company's sales. Also as part of the deal, PharMerica agreed to purchase a certain percentage of its prescription pharmaceuticals from AmerisourceBergen for five years, ending in 2012. Apparently the deal between the two was going so well that in 2011 they extended it to 2013.
The company received an unsolicited offer to be acquired by rival institutional pharmacy operator Omnicare in mid-2011 in a $716 million deal ($441 million in cash, plus debt assumptions). PharMerica promptly rejected the bid, stating the offer undervalued the company. It also cited regulatory concerns over whether a merger of the top two industry players would be approved. Omnicare remained persistent, however, and took the bid directly to PharMerica's shareholders through a hostile tender offer. The FTC filed suit to block the deal over anticompetition concerns in early 2012, and Omnicare eventually dropped the bid as a result.