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OneroRx brings pharmacy services to underserved communities

Article from Business Record, May 31, 2024

Author: Kyle Heim

Model for West Des Moines-based group leans on expectation of expanded role for pharmacists

OneroRx team

Through rapid expansion, mostly driven by a flurry of acquisitions, OneroRx is focused on growth in underserved areas, or pharmacy deserts.

A pharmacy desert is defined as any geographic area located at least 10 miles from the nearest pharmacy, according to the National Institutes of Health. 

“We hope to continue to expand where it geographically makes sense and where telepharmacy regulations are allowed,” OneroRx President and CEO Joseph Dunham II said. “I could see us continuing to expand into South Dakota, Kentucky. But there are plenty of opportunities in these [current] markets. In Michigan, we’ve got one location, so we’re actively working on an opportunity [there]. We’d like to have seven to 12 locations at a minimum in each state. We have two in Indiana, we’re at seven in Illinois, two in Wisconsin, we’ll add two more. We’re trying to fill these markets up that we already have a presence in, and we also need to get to eastern Iowa, so plenty of opportunity.” 

After a pair of recent acquisitions – Bert’s Pharmacy in Hastings, Neb., and Touhy Family Pharmacy in Chicago – OneroRx, headquartered in West Des Moines, now operates 67 locations across seven states, including in-clinic or hospital-based pharmacies, telepharmacies, long-term care pharmacies, a durable medical equipment store and a regional compounding pharmacy.

Dunham, who was recently named as a finalist for the Ernst & Young’s Entrepreneur of the Year Heartland Award, expects to complete another five or six acquisitions by the end of the year.

“We try to differentiate ourselves by providing clinical pharmacy services,” he said. “So we’ve taken an integrated approach to pharmacy, making sure that we know the patient, we know the medication profile, we’re counseling them properly and providing vaccination services. And the market opportunity is significant. It’s significant for a number of reasons, but you can just see from our growth, the number of opportunities that have been presented to us are significant, and we continue to execute upon our model. We’ve also built out a proven, experienced, senior management team that can execute upon that strategy.” 

Dunham joined OneroRx in 2019 after helping Eurofins Scientific grow from $100 million in sales to $1 billion during a nearly 10-year period as the head of corporate development for North American operations. 

In May 2021, OneroRx had six pharmacies and 20 employees in one state, as well as $6 million in annual revenue. The company now has 650 employees and had nearly $300 million in revenue in 2023.

“Throughout ’24, we’re forecasting about just under $400 million in revenue,” said Austin Tolander, chief financial officer at OneroRx. “The organic growth that we’ve had the last three years has been substantial. I’d say [the] industry average is closer to that 6% number. And so in ’21 and ’22 we’ve been able to double that, and in ’23 had almost tripled that industry average number.” 

In October 2021, OneroRx expanded its Iowa portfolio by 22 with the acquisition of GRX Holdings, which had operated 22 Medicap pharmacies. In 2022, OneroRx added another 22 locations, including 15 Medley Pharmacy locations in Missouri. Nine more locations were tacked on in 2023. 

“Our footprint is very different from large chains,” Dunham said. “Our normal size is about 2,500 square feet for our stores, and 96% of our revenue comes from pharmaceutical sales; we don’t have a convenience store in front of our pharmacy. … Last year, we filled 3.7 million prescriptions across our locations.”

While OneroRx continues to expand its geographic footprint, large chains – particularly CVS, Walgreens and Rite Aid – have closed hundreds of stores in recent years. 

CVS, the largest U.S. chain, shuttered 244 stores between 2018 and 2020, and in 2021 it announced plans to close 900 stores by this year, according to the Washington Post. Walgreens said in 2019 it would close 200 stores and in June 2023 announced an additional 150 store closures. Rite Aid filed for bankruptcy in October 2023 and is expected to close 400 to 500 of its approximately 2,200 stores.

“I had a 25-year career with Walgreens, a lot of good years,” said Mike Fuller, OneroRx’s chief operating officer and president of GRX Holdings. “But really, toward the end of my career with Walgreens, I really came to the decision that some of the decisions that were getting made at higher levels were just not conducive to what I wanted to be involved in in terms of pharmacy. Joseph and I started talking, and I just really aligned with his vision for OneroRx and the idea of really being able to put patient outcomes first, be able to continue to have a community pharmacy in these underserved areas, both rural and urban areas, and have a good, solid quality of life for our pharmacists and pharmacy teams.” 

A survey by the Iowa Pharmacy Association in October 2023 found that 41% of independent pharmacies in the state expect to close by 2025. 

There are currently 177 counties in the United States with no pharmacy at all, according to, a geospatial data analytics company.


“So many people need access to their medications, and accessibility is actually decreasing in the United States right now,” Dunham said. 

OneroRx is focusing strategically on the belief that pharmacists will gain more prescriptive authority in the coming years because of the shortage of primary care physicians. 

It’s estimated that more than 83 million people in the U.S. currently live in areas without sufficient access to a primary care physician, according to the American Medical Association. 

“We believe that by 2030, the pharmacist will be recognized as a provider,” Dunham said. “And so some basic care options will actually be delivered in the pharmacy itself. You can take this from a sinus infection and be able to come in, present, have an intake form, do a  comprehensive medication review and then get your medication right there.” 

An aging demographic, combined with a lack of skilled nursing or assisted living facilities, has also led to the belief that more health care will be delivered in the home.

“We’re positioning ourselves through compliance packaging and home delivery services to make sure that medications are available for homebound patients,” Dunham said. “And then everybody’s being held to a different level of accountability within the health care system with value-based care programs. And we’re positioning our organization to participate in those risk-based contracts. So these are the three macro trends we see happening in the market, all surrounded by this number of pharmacies closing.”

With about 23,000 independent pharmacies dispersed nationwide, OneroRx is striving to be the preferred acquirer. 

“We’ve grown largely through acquisition, although we’ve opened up another eight or nine locations independent of acquisitions,” Dunham said. “… We will stay local in the market, we’ll keep the location, we’ll keep the people and we’ll help them grow their business. That’s why we believe that we are the preferred acquirer for small community pharmacies because, unlike another opportunity where they just sell their patient files and close the doors, we’re going to stay local in those marketplaces and continue to serve the communities that we’re in. And we’re in some small communities. We’re in Gowrie, Iowa, with 900 people; we’re in Sheffield, Ill., with 1,300 people. These are the markets that we’re operating in today providing pharmacy services.”

Once OneroRx completes an acquisition, it looks for opportunities to leverage technology to improve operations, whether that’s through pill counting technology, packaging technology or artificial intelligence technology, as well as customer service. 

“That’s how we start to drive the operational improvements,” Dunham said. “And we look to expand services.”

After acquiring Oakland Pharmacy in Oakland, Iowa, OneroRx kept the current location but expanded into vaccine services, which the pharmacy had historically not provided in that community. 

“Once we acquire one of these pharmacies, we really look at three things,” Dunham said. “We look to improve the patient outcomes, which is that medication adherence, making sure the patient gets their medication, help making sure they’re taking their medication to the best that we can. And that really improves the quality of life of the people and improves the patient outcome. We look to improve pharmacy efficiencies, so we take all the back-office technology. How are they doing their accounting? How are they doing their HR and standardizing all of that with technology? And then we look to improve the profitability of the business itself.”


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