How Pharmacy Closures Impact Medication Adherence

When a pharmacy shuts its doors, it can negatively impact medication adherence, according to a new study.

The study, published in JAMA Network Open, shows that when pharmacies close, people stop taking widely used heart medication that have known cardiovascular and survival benefits.

Related article: Top 5 Therapeutic Areas for 2019

In a national cohort study, researchers from the University of Illinois at Chicago used information from a national all-payer pharmacy dispensing database that links patients across retail and non-retail channels. They analyzed data collected from more than 3 million adults aged 50 years and older who filled at least one statin prescription at a retail pharmacy between 2011 and 2016. They compared medication adherence among people who had filled a prescription at a pharmacy that later closed-about 93,000 people-with adherence among people whose pharmacy remained open.

Patients filling a statin prescription, beta-blockers, or oral anticoagulants at pharmacies that closed experienced an immediate statistically and clinically significant decline in adherence during the first three months after closure compared with their counterparts. This difference persisted over 12 months and was greater among older adults living in neighborhoods with fewer pharmacies.

Among statin users, about 23.8% of people in the pharmacy closure cohort did not refill their prescription at any point during the 12-month follow-up period, compared with only 12.8% in the non-closure cohort. A decline in adherence also was observed among people who had been adherent to their prescription medications the year prior to the closure. Among those who were fully adherent at baseline, 15.3% in the closure cohort discontinued their statins, compared with only 3.5% in the non-closure cohort.

The findings show declines in adherence-including the complete discontinuation of medication-were highest among people using independent pharmacies, filling all their prescriptions at a single store, or living in low-access neighborhoods with fewer pharmacies.

“Pharmacy closures contribute to non-adherence to prescription medications, particularly for older individuals living in neighborhoods that have fewer pharmacies,” says lead study author Dima M Qato, PharmD, MPH, PhD, associate professor at the University of Illinois at Chicago. 

Implementing strategies that directly target patients most at-risk for experiencing a pharmacy closure are important to consider, according to Qato.

“These include pharmacy outreach to patients in advance of a planned closure, more flexibility from health plans on which pharmacies are preferred, and expanding coverage to include home-delivery by pharmacies to offset potential access barriers,” she says.

In addition, policies should consider the role of pharmacy benefit managers, or PBMs, the authors suggest. “For example, Medicare Part-D and Medicaid managed care plans should pay attention to the role their PBMs have not only on the cost of prescription drugs to patients but also on the impact of PBM contract on pharmacy reimbursement and maintaining convenient pharmacy access and preventing pharmacy closures,” Qato says.

Related article: The Blood Pressure Drugs that are Linked to Lower Mortality

Qato wants healthcare executives to know four things about the impact of pharmacy closure on patient adherence:

• There is a substantial influence of system-level factors on non-adherence and access to prescription medications that extend beyond the high cost of prescription drugs.

• Declines in adherence were most pronounced among older adults using independent pharmacies, living in communities with fewer pharmacies, or using a single store to fill all their prescriptions, and were consistent across several classes of cardiovascular medications. 

• Pharmacy closure may undermine adherence benefits derived from value-based insurance designs, including low cost-sharing, and preferred pharmacy networks for which managed care executives are increasingly promoting.

• Ensuring sufficient pharmacy reimbursement rates for both preferred and non-preferred pharmacies may prevent some pharmacies from closing.