Long-Term Care Pharmacy Market Shares and Differences in Skilled Nursing Facilities Served

ABSTRACT

Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC) pharmacies that provide them. We estimated the market shares of LTC pharmacies and how SNFs differed between pharmacies. This cross-sectional study used data from SNFs that provided PAC services in Rhode Island (RI) in 2019. We applied the parametric g-formula to compare SNF pharmacy-related deficiencies and medication use measures between LTC pharmacies while standardizing for SNF membership in a chain and number of beds. Among 75 SNFs, 68 (91%) were served by either Omnicare (n = 32, 43%) or PharMerica (n = 36, 48%), and 7 (9%) by other LTC pharmacies. After covariate adjustment, PharMerica SNFs had the lowest prevalences of any pharmacy-related deficiency (PharMerica, 63.2%; Omnicare, 80.2%; other LTC pharmacy, 69.1%) and antianxiety medication use (PharMerica, 9.7%; Omnicare, 13.6%; other LTC pharmacy, 13.5%), but estimates were imprecise. The RI market is highly concentrated between LTC pharmacies. If similarly high LTC pharmacy market concentration exists nationally, there is enormous promise for efficiently delivering interventions to improve medication management in SNFs. However, it may also present a risk of harm if policies do not maintain sufficient competition and innovation is stifled.

KEY POINTS

• Little is known about long-term care pharmacies serving skilled nursing facilities

• These pharmacies may have a strong influence on quality of care and outcomes

• Two pharmacies dominate 91% of the Rhode Island skilled nursing facility market

• Skilled beds, pharmacy deficiencies, and medication use may differ by pharmacy

• Pharmacy market concentration creates opportunities for both big benefits and harms

KEYWORDS:

• Marketing of health services
• nursing homes
• pharmacists
• pharmacy
• post-acute care
• skilled nursing facilities

Acknowledgments

The authors thank Dr. Vincent Mor, Professor of Health Services, Policy and Practice and the Florence Pirce Grant University Professor in the Brown University School of Public Health, for his feedback on early versions of the manuscript.

Authors’ contributions

ARZ led the conception of the current work, acquisition of the data, analysis of the data, and initial drafting of the manuscript. All authors were involved in the design of the study, interpretation of the data, substantial revision of manuscript drafts, and have given approval of the submitted version of the manuscript. All authors also take full responsibility for the accuracy and integrity of the work.

Disclosure statement

Drs. Zullo and Beaudoin have been doing collaborative research with CVS Health Corporation that leverages Omnicare data (Omnicare Inc. is a wholly owned subsidiary of CVS Health Corporation) to study medication use and effects during post-acute care in skilled nursing facilities after a hip fracture hospitalization. Brown has not provided grant funding to Omnicare for this work or vice versa. Dr. Zullo receives grant funding paid directly to Brown University by Sanofi for collaborative research on the epidemiology of infections and vaccine use among nursing home residents. Dr. Goldberg served on an advisory panel for TerSera Therapeutics, which examines the use of intravenous cetirizine for the treatment of urticaria. The other authors have no relevant conflicts of interest to disclose.

Consent for publication

Consent for publication was not required because this manuscript does not use person-level data.

Data availability statement

The datasets generated and analyzed during the current study are not publicly available at a persistent web link in accordance with the policies of our health system partner, but the datasets are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This study does not use person-level data from human subjects. Therefore, neither ethics approval or consent to participate were required.

Additional information

Funding

This work was supported by the National Institute on Aging under grant R21AG061632. Dr. Zullo was also supported by National Institute on Aging under grant R01AG065722. Dr. Goldberg is also supported by the National Institute on Aging under grant K76AG059983. Dr. Beaudoin is also supported by grants from the Centers for Disease Control and Arnold Ventures.