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Pharmacy closures lead to nonadherence for CV medications
Older patients who filled prescriptions for CV medications had significant declines in adherence when their pharmacy closed, according to a study published in JAMA Network Open.
“Although ongoing efforts to improve medication adherence focus on improving affordability, this study suggests that policies aimed at reducing nonadherence to prescription medications should also address system-level barriers beyond the high cost of prescription drugs, like pharmacy access,” Dima M. Qato, PharmD, MPH, PhD, associate professor of pharmacy systems, outcomes and policy at University of Illinois at Chicago, said in a press release. “These findings provide strong evidence that pharmacy closures contribute to nonadherence, including among insured older adults.”
Researchers analyzed data from 3,089,803 patients (mean age, 66 years; 52% women) who filled at least one prescription for statin therapy between 2011 and 2016. Other therapies included in the study were beta-blockers and oral anticoagulants.
Pharmacy closures were also assessed, defined as those no longer in operation at a brick-and-mortar location. Patients were categorized as the closure cohort (n = 92,287) or the control cohort (n = 2,997,516).
The primary outcome measure of interest was medication adherence, which was measured 12 months before and 12 months after a pharmacy closed.
There were no differences in adjusted monthly adherence in the closure and control groups before pharmacies closed (70.5% vs. 70.7%, respectively). During the 12 months after pharmacies closed, patients in the closure group had an immediate and significant decline in adherence in the first 3 months compared with those in the control group (absolute change = –5.9%; 95% CI, –6.12 to –5.69). The decline persisted throughout the 12 months of follow-up.
Similar declines in adherence were also seen in patients in the closure group for oral anticoagulants (–5.63%; 95% CI, –6.24 to –5.01) and beta-blockers (–5.71%; 95% CI, –5.96 to –5.46).
Patients who filled prescriptions for statin therapy had greater declines in adherence if they lived in neighborhoods with fewer pharmacies (–7.98%; 95% CI, –8.5 to –7.47) or used independent pharmacies (–7.89%; 95% CI, –8.32 to –7.47).
“To our knowledge, this is the first assessment of the association of pharmacy closures with medication adherence,” Qato and colleagues wrote. “Efforts aimed at reducing barriers to prescription medication adherence should consider the role of pharmacy closures, especially in patients at highest risk.” – by Darlene Dobkowski
Disclosures: Qato reports she served as a consultant to Public Citizen’s Health Research Group. Please see the study for all other authors’ relevant financial disclosures.