Adherence to heart medications plummets with pharmacy closures

Pharmacy closures have a significant impact on adherence to essential heart medications among older U.S. adults, according to a new study published in JAMA Network Open on April 19. 

Using the IQVIA LRx LifeLink database, the retrospective cohort study—the first of its kind—analyzed data from a nationally representative 5% random sample of individual pharmacy claims from 2011 to 2016. The study focused on claims from patients 50 years and older who filled prescriptions for cardiovascular medications such as statins, beta-blockers, and oral anticoagulants at both independent and chain community pharmacies. Researchers continuously followed the patients’ prescription fills across all pharmacy types—including chain, independent, mass merchandiser, or food—as well as mail service.

Of the 59,375 pharmacies observed, 3,622 (6.1%) closed. Independent pharmacies bore the brunt of these closures, making up 41.9% of the 3,622. Among the nearly 3.1 million individuals who filled at least one statin prescription during the study period, 3% used a pharmacy that subsequently closed.

Before pharmacy closure, heart medication adherence was similar among patients using pharmacies that stayed open and those using pharmacies that closed. However, after the pharmacies shut their doors, adherence to statin, beta-blockers, and oral anticoagulants in the closure group immediately and significantly plummeted by 5.90%, 5.71%, and 5.63%, respectively, within the first 3 months. These differences persisted even after 1 year of closure.

Drops in adherence were greatest among patients using independent pharmacies, filling prescriptions at a single store, or living in low-access areas with fewer pharmacies. Closures disproportionately affected pharmacies and patients located in predominantly black, urban, and low-income neighborhoods.

Although independent pharmacies took the biggest blow, chain pharmacies were not immune from closures and nonadherence. The researchers speculated that, while chains are often better equipped to electronically transfer prescriptions from closed to open chain establishments, the transfer pharmacies may be farther away and less accessible, especially in low-access neighborhoods where chains may be “less prevalent than independent stores.”

“Efforts to reduce nonadherence to prescription medications should consider the role of pharmacy closures, especially among patients at highest risk,” the study authors emphasized. They also stressed the importance of pharmacy reimbursement for prescription medications as a way to reduce the number of at-risk pharmacy closures.

To offset access barriers and lighten the burden of pharmacy closures, the authors also encouraged “direct outreach” to patients living in locations disproportionately affected by pharmacy closures; conversion by health plans to an open pharmacy network; or use of mail service to fill prescriptions.