Nuclear Pharmacy is a small specialized niche in the field of pharmacy. Some states have as many as 20 Nuclear Pharmacies, some just one, and some dont even have any. To get a better idea you can check out the website nuclear.pharmacy.purdue.edu and click the link where it shows all the Nuclear Pharmacies in the United States. Per the website there are about 423 Nuclear Pharmacies in the United States, but I dont think it has been updated in a while.
The major chains in Nuclear are Cardinal Health, GE, Triad, PETNET and they operate about 50%, maybe more, of the Nuclear Pharmacies. The are basically centralized pharmacies, i.e. central fills for a certain geographic area. The rest of the Pharmacies are Independent or in Institutions.
Nuclear Pharmacy can be broken down into two groups. Pharmacies that compound/dispense SPECT (Single Photon Emission Computed Tomography) radiopharmaceuticals and those that compound/dispense PET (Positron Emission Tomography) radiopharmaceuticals. I dont know the exact percentage, but I would say 90% of the Pharmacies are SPECT. 90% of radiopharmaceuticals are diagnostic, 10% therapeutic
Cardinal Health, GE, and Triad for the most part are SPECT. Cardinal is trying to go more into PET. PETNET only does PET, dropping SPECT a couple years back (they saw the writing on the wall). SPECT facilities on average have lost 50% of their profit margin in the past 3 years.
SPECT is no longer profitable due to many factors, including higher costs for materials, lower reimbursement, alternative modalities that are not only cheaper but more effective. SPECT in the near future will also be replaced by PET. PET is the future of the industry, and the bread and butter of SPECT, Cardiolite/Myoview (70% of the doses on a given day), already has a replacement in Phase III trials. If cardiolite/myoview go, so does SPECT.
This past year Triad closed down a number of pharmacies with ~60 pharmacists getting laid off (each pharmacy has usually 1-4 pharmacists). GE wants to get out of the compounding/dispensing side of the business and is trying to sell their SPECT labs. Cardinal is also downsizing their SPECT pharmacies with a handful closed this year with more possibly in the future. This past August Cardinal Health reported that they took a loss in its fiscal fourth quarter after writing down the value of its nuclear pharmacy business by $829 million. All pharmacies are also cutting staff, including pharmacists! The working conditions now match retail; less help, more work, critical management and fear of being fired/laid off at any moment. Again at its peak there were only about 400 Nuclear Pharmacies, 5-10% have closed in the past 3-4 years.
PET is the future, however that future in uncertain. PETNET is fairing better, but the profit margin of the main PET radiopharmaceutical , FDG, has dropped significantly. New agents are in the pipeline, however , the fear is that you will have a great drug that will give you a beautiful diagnostic image, but does the cost of the drug justify getting the image? Will insurance companies even pay for it? PET facilities also do not need as many pharmacists as SPECT and in reality dont even need a pharmacist (they could in actuality just be run by engineers). They are also more expensive to build, so less will be built to cover the same geographic area. (yes, yes, those that are more familiar with PET may say well the half life of most of the radiopharmaceuticals does not allow for that, you need more facilities. My answer is that I know PET facilities that deliver to hospitals 4-5 hours away!)
What I see in the future is the majority of Nuclear Pharmacists getting laid off, with the few remaining working at the few PET facilities, independent SPECT facilities that are able to stay in the black, and some in Institutions.
