I can easily joke about that. You know what? We're in good shape because this is only being broadcast audio.
Yeah, that's true. That's true.
Now, these people have to work at it.
Yeah. I'm just kind of waiting on whoever the person is in this room to give me the thumbs up and we get started.
It was a lot nicer than what I looked at a week ago, where it was supposed to be cloudy and kind of sparse rain showers. Yeah, the sun outside. Yeah, there's a song on the weather thing. There's this big, huge glob of rain just north of us, through the northeast, and dodge the bullet.
You're going to have the CMAs tonight, too. Yeah, it is always over there.
Okay. It's tonight. It's our last night. Okay. That's going to be at the where?
The Grand Ole Opry.
Grand Ole Opry. Okay. Yeah, we had twice. We've had our big pharmacy management meeting here in Nashville. And it was people loved it. It was really good.
Because the company has a distribution center in Tennessee, right?
Three.
Three. Yeah.
Knoxville, Memphis, and just south of Nashville in Shelby.
Let's see here. Let me see.
You're now IT as well?
Yeah, I lost my TS was. Hopefully, that's working. Welcome, everyone, to day two of the Stevens 2025 Annual Investment Conference, live and in person in Nashville. I'm Raj Kumar, healthcare service analyst here at Stephens. We're pleased to host a fireside chat today with Guardian Pharmacy Services. Just for a little background, Guardian Pharmacy Services is a leading long-term care pharmacy provider with over 50 pharmacy operations nationally, primarily focused on the assisted living and memory care end markets. The company has roughly 13% market share nationally in servicing the assisted living end market and is targeting expanding roughly to 20-30% over a given horizon. Joined from the team today from Guardian are Fred Burke, President and CEO. We also in the audience have Kendall Farris, Executive Vice President of Sales and Operations, and Ashley Stockton, Head of Investor Relations.
I want to thank the team here for joining us at the conference today. Maybe to start off, we've kind of been going through this year-in-review kind of question. Clearly, Guardian has a very long, 20+ year operating history kind of in the private sector. You recently just hit your one-year anniversary as a public company. Kind of starting off in that limelight, would it be helpful to highlight the business model? What differentiates it from kind of larger peers and even regional kind of counterparts as well? How has that helped propel the growth story historically? How do you see that sustaining long-term?
Thank you, Raj. A pleasure as ours to be here. We appreciate you having us. You are honing in on essentially what is the secret sauce of Guardian. In our mind, what we have are a cadre of outstanding clinicians in the field that are highly focused on the special needs of these frail and elderly residents in assisted living that require a different type of service from other settings, such as skilled nursing facilities. What they need to do that job is for it to be a self-sustaining business. That is where the Guardian support operation comes into play. We are providing them with the tools needed to lever their scale that they create. That, in a nutshell, is the model. That scale comes from the purchasing side, the reimbursement side, the analytics tools, and the sales relationships we have with the national accounts.
They're out there creating the scale. Team in Atlanta is levering it.
Got it. Yeah, clearly, there's a lot of nuances, even compared to your peers. The assisted living end market is kind of your core bread and butter and the focus of all operations. Maybe kind of going back a little bit, why was that the focus for Guardian in terms of the end market to pursue? As we kind of think about the relative TAM, right? Clearly, skilled nursing has a much larger revenue base than kind of assisted living. Both are growing end markets, kind of similar trajectory when we think about overall spending on Medicare and then kind of private spending on the assisted living side. Maybe just kind of helping us kind of frame why did Guardian kind of choose to pursue the ALF end market?
ALF is in our DNA from the very beginning. The very first pharmacy in Guardian was in Phoenix, Arizona. This operator, we call him our spiritual founder, fantastic understanding through a long career in long-term care. His pharmacy had been acquired, and he actually went and ran assisted living homes. He was dismayed to find that the pharmacy service from his very own pharmacy did not meet his needs. We were fortunate to meet John just as he was launching a pharmacy that was engineered from scratch to serve assisted living. First point is assisted living requires a completely different type of service. It's very difficult for a pharmacy engineer to serve skill, to pivot and properly serve assisted living. Why is assisted living attractive? Virtually all the growth in long-term care over the past 20 years has been in assisted living.
It's now a very large TAM for us, a million residents that we have to serve. You mentioned, gosh, with a 13% share, we can double, triple our business just focusing on this very large TAM. The other thing that's happened along the way is that the acuity level of assisted living has increased dramatically. Assisted living started sort of as a real estate play with some hospitality. It's evolved over time to something very different. Our average resident, the age of our average resident is 85 or more. They're taking 14 prescriptions. They're impaired in two or more ADLs. Today's assisted living is very different than when we started 20 years ago.
Yeah, that's probably certainly helped around kind of getting more and being the partner of choice. You've talked about regional and kind of national assisted living partners that have kind of you've grown with over the years. I want to kind of focus on the organic story. That is certainly one of the pillars that's kind of penetrating across your kind of regional and large ALF accounts. Kind of speaking to that, what makes kind of Guardian the partner of choice relative to someone that's maybe more hyper-localized and kind of maybe just a single operator that can maybe more specify needs? How do each operations differ on that regard when we think about serving the needs of each individual ALF?
Our key competitor is that independent operator who has, like we, engineered the pharmacy from scratch to serve assisted living. And our colleagues in the industry, by and large, do a really good job. They are a tough competitor because they are providing great service. Their problem is with no scale. They do not have the wherewithal and the resources to do the kind of things that we have been able to do with our very sophisticated data analytics platform and a sophisticated level of service that takes capital, which they do not have.
Got it. Kind of focusing on, we talked about this 13% market share nationally, but that might not be appreciated, the fact that you have much kind of density and scale amongst your local markets. When we think about your mature operations, and clearly over the past five years, Guardian has had a number of acquisitions and kind of greenfield startups. Maybe just kind of talk to the opportunity set that remains even within your most mature pharmacy to kind of drive that organic growth story.
We track our market share using the NICMAP data, which we have acquired, bought. What we find is that, yes, we have some markets where we are highly penetrated, more mature markets. By and large, we have many, many of our pharmacies are still in the 20-30% market share range. If we can achieve 50% or more in a mature market, that gives us the heart that we can do that in these others as well, driving organic growth. Our growth platform organically is based on the secular tailwind with growth in the industry, growing our market share. We do that both locally with sales teams in each pharmacy and, as you mentioned, with the national accounts.
Our pharmacies, we find, grow to a certain size that many of them have begun serving the next city, the next market, maybe three hours away, which is our radius that we can do a good job. They build enough critical mass in that adjacent market to the point that they're now building out bricks-and-mortar pharmacy. We refer to that as contiguous greenfield startups. It's been a really wonderful driver of our organic growth.
Got it. We talk about contiguous markets, but then sometimes there's optionality for the existing pharmacy to kind of increase its footprint and clinical capacity to kind of still serve that same market, but with greater density. Maybe just kind of walking us through that dynamic relative to pursuing a contiguous greenfield startup, what's the kind of criteria where you just kind of determine, "Yeah, this might be better to open up a new pharmacy rather than kind of expanding the current operation base"?
If you're operating at the fringe of our service area, we take our service model very, very seriously. At about three hours, after that, it becomes difficult to properly serve. If you've got, let's say, just a critical mass of assisted living facilities using the mothership pharmacy in the next city three hours away, a good example being currently where we've just launched in Columbus, Ohio. The Cincinnati pharmacy was serving assisted living market in Columbus, had enough critical mass to build out a new pharmacy that now will allow us to penetrate more fully that market in its entirety.
Great. Great. Now kind of wrapping it all up, the organic framework has three pillars. We've talked about the contiguous market adoption, kind of increased residents within current facilities is the other one. The third one we kind of want to touch upon is just on the large and regional ALF accounts. Thinking about that, I think it's helpful to kind of think about the diversity of your resident base, right? You kind of diversified across a lot of kind of small mom-and-pop senior living operators and kind of like the Brookdale Senior Living and the Sonida Senior Living and the Sunrise Senior Living of the world.
Kind of framing what percentage of your resident count comes from those large and regional accounts, is there a long-term target on that regard where if you're at 30%, for example, you want to have that at 40% kind of long-term?
We'll grow as the market consolidates. We started with a very fragmented assisted living marketplace. I believe that real estate mindset is now transforming into more of a healthcare concept, and you're seeing consolidation. These consolidators appreciate Guardian's more sophisticated level of service. I think we'll continue our quest to establish relationships with these regional and national players. You'll see that growing as a % of our total.
I guess this kind of organic component, right, also kind of drives some of the inorganic story as well as we see in the Pacific Northwest throughout the last couple of years in Washington and Oregon, you've acquired pharmacies. Kind of how much is that really just driven by your existing ALF and regional or large ALF partners kind of saying, "Hey, we want you there"? And how much of it really is just kind of, "We want to just be in this market since it's an attractive long-term opportunity for us"?
It's both of those things, plus the most important one, which is the proper operator that fits our profile. Certainly, the example of Pacific Northwest was our expansion. There was driven by our larger national and regional accounts asking us, I'll put asking in quotes, telling us they would like us to be there. It's a very attractive market to operate in. Very importantly, the key is finding that right operator that fits our model. We did in this particular case. Very exciting with both the Oregon and the Seattle, Washington pharmacies that joined our network. Excellent operators. Very interested in continuing to grow their business and take advantage of all the scale opportunities that we can give them to improve their business.
Yeah. Maybe just touching upon those two recent acquisitions, I think it'd be kind of useful to go through kind of the milestones and the kind of operational framework and timeline around what it looks like from day one of the acquisition to year two and three. Clearly, there's probably going to be opportunities for contiguous market expansion as well that kind of drives the organic story. Clearly, there's a lot of positive flows that come from just the initial acquisition. It would be helpful to kind of frame and contextualize that.
Okay. Usually, it takes us about four years to bring one of these pharmacies up to our corporate average profitability. It's a complex business. There are a lot of moving pieces. We're a high-volume, lower-margin business. It's a four-year program. In this particular case, I'll knock on wood, predict that maybe these could move a little more quickly. The reason for that is, first, they were on our preferred pharmacy operating system, so we didn't have to change that, which is a very difficult job. Secondly, we were able to implement our purchasing scale immediately in both cases. Certainly, our reimbursement is implemented from day one. In both cases, in both Oregon and Seattle, these are excellent teams that have been in business for 20 years or more. They provide a great level of service.
Kendall was comfortable in allowing them to essentially immediately take on some of our national accounts. They are growing quickly with scale organically from the get-go. As a result, we are really excited about our initiative out there.
Great. Great. Maybe kind of circling back on the regional accounts, I think Brookdale is an important partner. They've kind of had some portfolio optimization. Some of their Ventas leases, they kind of have foregone. Is there kind of any volatility to your operations in that footprint that we should be kind of on the lookout for? Is it kind of just business as usual?
That is a great question because obviously that at first is concerning to us. What has happened is it has turned out to be an opportunity because we get introduced to new operators. They are able to see our service because they will take over the operations of a building where we are providing the pharmacy service. The last thing they are going to want to do is immediately change. They experience the Guardian difference. As a result, we have been able to actually gain new relationships through that.
Got it. Great. Great. Maybe on the third piece of the organic story is kind of resident adoption. I think the metric sits at 89%, if I'm remembering that correctly. What are some of the distinguishing factors if we think of a facility-by-facility basis? Clearly, each facility has different needs, and the level of extent to where they're becoming more healthcare-oriented could also differ. I think if we think about your newer markets and what that resident adoption rate is relative to your more mature markets, how does that look like from our standpoint when we think about what the opportunity is ahead?
It does represent a growth lever for us because when we take over a new assisted living facility, we oftentimes find the adoption rate, that what we mean by that is the percentage of residents using the preferred pharmacy. It might be 50%, 60%, or 70%. That is not a good thing for the resident or for the operator. We have built out the tools and the program whereby we and the assisted living operator can over time bring that adoption rate up to the 89%-90% level, which is our corporate average. In so doing, yes, it's a growth opportunity, but much more importantly, it's a huge element of the service that we render to assisted living.
It's so important to reduce the risk of passing the meds and also improve the efficiency of the caregiver moving through the home to have all the residents on the preferred program.
As we think about structurally, kind of what is kind of the upper limit of that resident adoption rate, how would you kind of frame that?
It's going to be in the mid 90%. It's pretty hard for us to compete with free. A VA, for example, if someone can get their meds from the VA for free. Some states allow us to repackage them into the program. Others don't, but we still wouldn't be able to dispense those meds.
Yeah. Certainly, kind of the organic story has benefited from just kind of a higher acuity trend, better kind of uptake on kind of drug regimen adherence, and better kind of formulary management as well. I guess kind of when we think about the residents and kind of the rising acuity factor, how much of that is a sustainable factor kind of to the organic story? Is it just kind of like once you get into the facility, you figure out what the drug regimens are needed for each of the individual residents, and that's kind of the initial bump, and from there on, it kind of smooths out?
We're seeing increased acuity, and that follows really the age progressing. It's very difficult to forecast that. We don't build any of that into our structural forecast. You've seen our organic growth rate significantly above the high single digit that we got to. This acuity point is a piece of that, a point or two, perhaps, of that higher growth rate.
Are you seeing kind of more specialty drug utilization, typically kind of lower margin, although higher dollars associated with it? Are you kind of seeing that as a factor as part of the kind of higher acuity?
Not as much. No. Not to be morbid, but most of the specialty drugs are for a disease state or condition that probably has terminated one's life before this stage of care. We do. We have some. There are some coming, particularly in the Alzheimer's arena, that would be very, very interesting and attractive to us.
I think it'd also be kind of helpful to maybe kind of remind us just what's kind of the generic versus branded mix for the business, especially when we're 25 minutes in, we haven't talked about the IRA, right? That should be an amazing feat.
What's wrong with you?
Yeah. Exactly. Especially with that kind of dynamic, I think it'd be helpful to frame what that kind of dispensing mix is for Guardian.
Our dispense rate is 92% generic, slightly a little bit above the industry average. We think of generics as the life system of our residents. Chronic meds that are now generic, augmented, of course, by the brands that continue to come. Some, like Eliquis, are very important in this setting. It's a magical drug for AFib, and it really has a large position. It so happens that the IRA, the Inflation Reduction Act, which called for the government to negotiate prices for Medicare, and of course, Medicare is our predominant payer, happened to hit long-term care very strongly in 2026. Eight of the ten drugs are huge for us. I'll say that in 2027 and beyond, it drops way down.
There is a very large and unintended consequence of the IRA related to our business that when we decided to pursue being a public company in 2024, we wanted to make sure that our investors knew about that. We potentially made a mountain out of a molehill. It has led to usually the question is in the first five minutes, not the 25 minutes in, but we set about the task of offsetting that headwind. I think you'll agree that with each successive quarter, I've struck an ever more positive tone that we're going to be able to eliminate that headwind on the EBITDA line. We'll still suffer the revenue decline, but not the EBITDA. We are ever more confident that we'll be able to do that.
Okay. And then when we think about kind of switching to the kind of inorganic M&A kind of side of the story, clearly lots of acquisitions in just the past couple of years, especially a portfolio in the kind of Denver, Utah area, with Heartland. And then when we think about the integration efforts, does that kind of elongate the timeline because of the IRA headwind for at least those operations?
Not really. We've got the systems and the programs to take care of it because there are some logistical things that have to be done. Heartland, in contrast to what I said about the Pacific Northwest, did require a pharmacy operating system change, which is very difficult, and we could not implement our purchasing synergies on day one. That one is going to be more in the four-year timeframe that we typically see.
Got it. Maybe kind of just moving on to other kind of drug pricing and policy kind of standpoints. Medicaid is a small part of your business, but there's kind of been negotiation types of aspects around that and even around kind of rebates in the One Big Beautiful Bill. I think kind of more broadly on kind of the economic policies around tariffs, kind of any exposure from that standpoint, maybe just kind of disclosing some of kind of your acquisitions in terms of what's kind of North America/US or what's kind of beyond that that would kind of be impacted from a tariff standpoint.
Let's start with Medicaid. The general reimbursement algorithm has very little, if any, spread on branded drugs for Medicaid. Any activity there is not going to be impactful. It is, what, 8% of our total. Moving to tariffs, most of the tariff activity impacts generics. It can be API or the finished product. Remember that the value of these is very, very low. We initially thought that there might be some impact. I think the administration has backed off a lot on their tariffs with pharmaceuticals. We are not seeing much impact from that at all.
Got it. Maybe just kind of thinking about specialty or even biosimilars. You guys kind of have a legacy kind of SNF book of business that isn't where you particularly with a growth mindset is, but I think it would be helpful kind of from our perspective to see how that compares relative to the larger nationals if we think about kind of Omnicare or PharMerica that kind of have more larger SNF portfolios and really just on the basis of if there's kind of higher uptake on specialty and biosimilars on that front.
You're exactly right. There are in SNF. And there's the biosimilars coming, particularly in the insulin marketplace. We'll see what the effect is. We've already, one of the headwinds, tailwinds, puts, takes that we deal with every year has already occurred with insulin. We've been dealing with that this year. And you've seen our margin profile. So you can see that we've been able to deal with that quite nicely. I don't see a huge impact with that going forward. It is more in SNF than out. We're very, very happy and pleased to serve skilled. I don't want people to misinterpret that. We just do so selectively. Those patients do have a higher uptake of specialty products than the residents of out.
Right. Kind of now maybe thinking about the payer mix, right? We talked about the ALF partners on that front, so kind of from the demand side, but then on the payment side, right, with Part D, and you kind of deal with the payers and the PBMs. Clearly, when we go into 2026, there is a lot of changes happening across just MAPD and Part D on that front. Are you seeing anything from the formulary benefit perspective that is kind of concerning on your part that will kind of drive volatility or changes in kind of drug regimens for kind of your current residents based on kind of how plans are tweaking their formularies?
Not yet. We got that data set from CMS late this year because of the shutdown. I think week before last, our teams are working at no real issues. Certainly, the Part D versus Advantage is not an issue for us. The reimbursement is the same. Most of our residents are Advantage. We bring great benefits to the PBMs on Advantage in that we're essentially delivering 100% adherence. And as you know, adherence is a really big element of stars, which are very valuable to the Advantage plan. That plays to us, and a benefit we bring to them very nicely.
Got it. Clearly, adherence and then also network adequacy.
Definitely.
That's definitely a huge component. With your scale, clearly, you think there would be some kind of foresight or just kind of maybe some leg room for kind of negotiations on that front from a pricing perspective. I think kind of maybe on one last point around kind of the payers and the PBMs, I know that's a key strategy to kind of hoping to offset some of that impact from the IRA from an earnings standpoint. Maybe just kind of any incremental updates that you can provide on that front.
I will remind you that five years ago, we made the decision that we wanted to establish direct relationships with all of our payors. That is to say, not rely on a network to negotiate on our behalf. We have accomplished that. We are proud of that. The second chapter of that story was to then establish a collaborative partnership with our payors and help educate them on the value add that we are bringing. That chapter two occurred in conjunction with the IRA negotiations, which turned out to be very helpful because I will say that our payors have been very collaborative in understanding the value add that we are bringing and therefore have been willing to engage in discussions.
Great. Great. Maybe now just focusing kind of on the near term, you increased guidance after your three-year print. You saw some just favorability on the organic side, a little bit of more uptake relative to last year on the flu vaccine clinics in September. As we kind of think about that profitability trajectory, at least kind of related to that specific program, how has that been trending kind of relative to what's kind of embedded within guidance? Is there a particular part within the guidance range that you would be comfortable kind of calling out as we're kind of seeing low-end, high-end type of framework relative to kind of what you're seeing on that front?
No, not really. We are still finishing up the flu clinics. Just to back up, this has turned out to be a really valuable service that we could render to our residents and our assisted living operators. The government originally with COVID contracted with the retail pharmacies who obviously could not do this, conduct a clinic inside of assisted living. Our pharmacists, our technicians, our nurses, own staff rallied, and I think performed a fantastic service. When all the dust was settled, we had done something really good for our constituents, but we also realized that we need to do it better. Because in 2023, it was a headwind, profitability headwind. There is logistics on the supply side. There is just the logistics of arranging the clinics and then getting reimbursed. Very difficult. We implemented a task force. They did a great job.
Last year, what you're referring to is the headwind profitability turned into a tailwind. That was really good because now at least we're not losing money providing this valuable and needed service. How's it going to turn out this year? We're in the middle of it. Give us a month or two and we'll report back. I'm not prepared to say whether it's even better than last year. It's just we're in the middle of it and it's going well.
Perfect. I think that frames that really well because there's certainly incremental opportunities across different areas of pharmacy when we think about IDD, PACE, or even kind of hospice. I know on the hospice reimbursement front, it's kind of not been as favorable for long-term care pharmacies to pursue that end market. I guess it's like if we think about the analogy of the flu clinics and how you got to work and kind of figured out a way to profitability, how can we see something like that on the kind of the IDD, PACE, or hospice side that can kind of help accelerate or even kind of sustain this high single digits or plus types of organic growths that you guys have been printing?
Great question. Before I answer that, I'm going to remind you that we have a 13% share of a very large TAM. That tells me there's 87% left to go. Our main focus will continue to be on assisted living. There are some adjacent market segments that need a similar type of service. You mentioned PACE, not a huge TAM, but we did start serving some PACE programs. I think we're serving eight of them now. We've developed an analytics tool to do the CMS reporting for them. I think they're really enjoying having that local service where we can do a better job than a mail order pharmacy, which is the way they've been served heretofore. Hospice, similar story. We serve a lot of hospice residents as they transition from assisted living into hospice, but in the assisted living. The reimbursement model is broken.
What we've realized is if there may be an opportunity there, Kendall has been leading an effort. We'll let you know how it goes. We're taking a big think with respect to pharmacy service for hospice and doing some experimenting. It may represent a good opportunity. It does have a large TAM, roughly half the size of assisted living. Stand by. We'll keep you posted.
Perfect. Maybe we're coming up on five minutes here, but maybe just to wrap it up, I think it kind of speaks to the importance of the competitive dynamics. You had 13% today. You said there's 87% right to go after. Clearly, I think some of your peers are seeing how attractive this end market is and maybe want to expand shares themselves. One of your public peers have called out pursuing, especially pursuing growth in the assisted living end market. Maybe kind of speak to is that a real concern from a competitive dynamic? I think you previously called out where mainly your main competition is the regional and the locals, but just kind of want to get your take on that.
There have been such pronouncements over a long period of time, 5, 10 years. And it has not happened. That does not mean it cannot and will not. I think there is plenty of room for multiple competitors. I think you are referring to PharMerica. We think a lot of that business. They are really good people, do a great job serving skilled. They are valued industry colleagues of ours in our trade group. Go for it. I think there is plenty of room for us all.
Great. Perfect. I think that wraps it up pretty nicely. Thank you, everyone, for joining us here today. I want to thank the Guardian team for being here.
Thank you, Roger. Really appreciate it.
All right.
You enjoyed being here.
Absolutely. Thanks.
Distance to one of your pharmaceutical facilities?
About three hours.
Three hours?
We can go further, but our sweet spot in providing the service is about a three-hour radius from our pharmacy. The reason for that is that the acuity level of these assisted living residents is such that there are a lot of changes going on.
I'm in one of them.
Is that right?
I'm standing track of the Morning Pointe facility in Knoxville.
Okay.
Medication needs to change every month.
That's right. And that's because of the acuity level. And so that's why we feel comfortable three hours away, but after that, it gets hard to really do a good job. You might have to use a retail pharmacy to handle something that's needed immediately.
If you're three hours away, how often are you on that site then?
It certainly depends, but multiple times a day.
Oh, really?
Yeah.
Super. Thank you. Could you speak to sort of the value proposition that you bring to the health partner? When they choose to go with you over one of the competitors or you unseat them, what's really driving that from there?
You start with the basic level of service. You got to get the right meds there at the right time. Okay? That's the base level that you start with. That's the foundational element. That's a complex thing to do because of the last question. You add on to that the platform, the tech-enabled platform that allows the caregiver to safely and effectively administer the meds in the home. That's a very important element of the service. In assisted living, the caregiver is not a nurse, typically. They have gotten an eight-hour training class in how to be a medical technician, but they're not a healthcare professional. We provide this tech-enabled platform to allow them to safely and effectively administer the meds to all the residents 4x a day. Then we bring the data analytics.
Our analytics group is a very important part of our company because we learned early on that to run an efficient operation, we needed data. Over time, they've migrated now to providing products that help our customers, the assisted living operators, run their operation. An example of that is the newest that we're testing is a falls risk program that provides an assessment of the risk associated with each resident for a fall. As you know, a fall is a really bad thing. It's the start of something bad. Fortunately, if the fall hadn't broken a hip or something, but if it does, that's the start of a very difficult series of events that drive poor outcome. It usually means the resident will move to another setting. The operator loses that resident. For the insurance company, it's a massive cost.
This is the kind of value add that we're bringing to the market over and above just dispensing meds. That's why people gravitate to our service.
Are you delivering bulk or amounts? You'll have a kit for her ready to?
Yes. What we're doing is think of it this way. Our average resident has 14 prescriptions. You line up 14 bottles. The instructions would be morning, noon, and night with meals at bedtime, etc. We are dividing the day up into four med passes where the caregiver will go through the facility to administer the meds. We are using robotic dispensing equipment in the pharmacy to package the relevant pills from the 14 prescriptions for that med pass. The caregiver arrives at room 101. Up on the screen comes a picture of Mrs. Smith. It says, "This is the morning med pass. Here are the four pills of the 14 that you need to administer." There they are packaged for the caregiver. As the pills are administered, they are barcoded into the EHR system, which circles back to the pharmacy.
We therefore know that we have 100% adherence to the drug regimen.
When you find this really interesting, you've been able to go from your pitching your services, look, we've taken mistakes down from one in a thousand to one in 10,000.
I think our customers tell us that. It's hard for us to know what the incumbent pharmacies' error rate was.
Yeah. Probably not going to offer you that.
What our customers tell us is that the level of noise of erroneous not getting the meds at the right time. Another thing they tell us is that the noise related to complaints about drug cost go way down. One of the reasons for that is that part of our service that we realized early on is that since there is no one coordinating the med regimen except us, we go the extra mile, not just to dispense what the doctor has written, but to make sure that it is on the formulary for her insurance plan. We will go back to the prescriber and suggest a therapeutic interchange because it will save our resident $400, $500 a month. Our customers tell us when we take over because of this service, the noise level related to people complaining about drug costs goes way down.
Have you ever maxed out? Where are you now?
Where do we have 100%?
Yeah. Like I said, you're in a retirement area in part of Florida where plenty of folks that sell this service too. I mean, you have to buy land next to your existing pharmacy and blow out a wall.
Oh, yeah. Every one of our pharmacies has moved or expanded multiple times. We typically start at the beginning with about 10,000 sq ft. The average pharmacy size for the whole network is about 20,000. We've got several that are 30,000 or more. As they grow, we have to expand the footprint.
Do you see any value for them? National pharmacies are probably overfilled but do not have your business. Can you utilize those footprints at all?
Maybe. One of our big competitors, Omnicare, is undergoing a bankruptcy. We will be participating in that process. There may be some facilities or assets that would be attractive to us.
All right. Do you ever get bored going to New York and Boston? There's quite a bit of small-cap money in Milwaukee. Please stay out of the winter.
Oh. We'd love to talk further. Come see us or get us information.
I'll get my business card from the fossil and still carry these things.
Cutting into your lunch, Damir. I swear I'll shut up.