Study Supports Critical Role of Pharmacy Access in Medication Adherence

Pharmacy closures negatively impact patients’ adherence to their heart medications, especially among those who regularly use independent pharmacies, according to a new study published in JAMA Network Open.

The findings underscore the importance of the role of community pharmacists in medication adherence, especially with the increasing cost of prescription drugs, and highlight the need for policy changes to support pharmacies.

Nonadherence occurs in approximately 50% of patients taking prescription medications, including cardiovascular drugs such as statins, beta-blockers, and oral anticoagulants. For the study, the researchers examined the association between pharmacy closures and adherence to these medications in adults 50 years or older in the United States.

To examine medication adherence rates, the researchers used information from a national all-payer pharmacy dispensing database that links patients across retail and non-retail channels. The study included data from more than 3 million adults 50 years and older who filled at least 1 statin prescription at a retail pharmacy between 2011 and 2016 and compared adherence among those who filled a prescription at a pharmacy that later closed with those whose pharmacy remained open.

Overall, pharmacy closures appeared to have negative effect on patient adherence to their medications. According to the researchers, statin users whose pharmacies had closed experienced an immediate and significant decline in adherence in the 3 months post-closure. Approximately 23.8% of statin users in the pharmacy closure group 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.

Patients who had been previously adherent to their medications prior to closure also showed a decline in adherence. Of the patients who were fully adherent at the start of the study, 15.3% in the closure cohort discontinued their statins, compared with just 3.5% in the non-closure cohort.

Although the risk of pharmacy closure was somewhat mitigated by the use of retail chains, the study found that declines in adherence after store closure were more prevalent among patients using chains rather than independent pharmacies. The researchers noted that this is likely because there may be fewer chain stores in low-access neighborhoods compared with independent stores. 

The researchers found that this decline in adherence due to pharmacy closure was most significant among individuals who used independent pharmacies, lived in neighborhoods with fewer pharmacies, and those who only used a single store. 

The report highlighted several potential policies that could reduce pharmacy closures. For example, policies that ensure sufficient pharmacy reimbursement for prescription medication may diminish the number of at-risk pharmacies from closing, the study authors noted. 

“In addition, provisions to increase the number and stability of preferred pharmacy networks, which often exclude many local (largely independent) pharmacies, are also important,” the authors wrote.

Expanding regulations that require plans to meet convenient pharmacy access standards to mandate minimum standards for reimbursement could be a potential policy option, the researchers suggested. Additionally, they recommended that policies should consider the role of pharmacy benefit managers (PBMs), due to the increasing role of PBMs in the pharmacy market.

References

Qato DM, Alexander GC, Chakraborty A, et al. Association between pharmacy closures and adherence to cardiovascular medications among older US adults. JAMA Network Open. 2019. Doi: 10.1001/jamanetworkopen.2019.2606