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Pharmacy closures put heart patients at risk

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CHICAGO — Research from the University of Illinois at Chicago shows that when pharmacies close, people stop taking widely used heart medications — like statins, beta-blockers and oral anticoagulants — that have known cardiovascular and survival benefits.

The researchers, led by UIC’s Dima Qato, reported that 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. The findings were 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,” said Qato, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy. “These findings provide strong evidence that pharmacy closures contribute to nonadherence, including among insured older adults.”

Using information from a national all-payer pharmacy dispensing database that links patients across retail and nonretail channels, the researchers analyzed data collected from more than 3 million adults 50 and older who filled at least one statin prescription at a retail pharmacy between 2011 and 2016. They compared 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.

The researchers found that statin users in the closure cohort experienced “an immediate and significant decline in statin adherence” in the three months post-closure that was “largely due to the complete discontinuation of medication.” 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 compliance also was observed among people who had complied with 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.

Qato and her colleagues observed similar trends for beta-blockers and anticoagulants.

Among those least likely to experience a decline in adherence were people who regularly used multiple retail stores. “We found that declines in adherence were almost double among patients ‘loyal’ to a single store when compared to those using multiple stores,” Qato said. She said this finding is important because retail pharmacies, particularly chains, often promote loyalty programs that encourage patients to fill all their prescriptions at one of their stores.

The authors recommend several strategies to prevent at-risk pharmacies from closing, including policies that ensure sufficient pharmacy reimbursement for prescription medications. “Expanding regulations that require plans to meet convenient pharmacy access standards to also mandate minimum standards for reimbursement is a potential policy option,” Qato said.

Strategies that directly target patients most at-risk for experiencing a pharmacy closure are also important to consider, the authors note. Potential strategies include pharmacy outreach to patients in advance of a planned closure, more flexibility from health plans on which pharmacies are preferred, and use of home delivery by pharmacies and health plans to offset potential access barriers.


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