May 01, 2019
By Carolyn Crist
(Reuters Health) - People are less likely to take their heart medicine when their local pharmacies close, and the drop-off persists for at least a year, according to a U.S. study.
The effect is especially noticeable in neighborhoods with fewer pharmacies, including rural and lower-income areas, and when the local pharmacy was not part of a chain or network, the study authors reported April 19 online in JAMA Network Open.
"Given the changing pharmacy landscape, pharmacies are not only critical in facilitating access to prescription medications, but increasingly, preventive care as well," said lead study author Dima Qato of the University of Illinois at Chicago.
"Pharmacy closures have increased substantially over the last 10 years," she told Reuters Health by email. "It's important to understand whether and how closures impact access and use of medications."
Qato and colleagues analyzed insurance claims for prescription refills by more than 3 million patients over age 50 taking anti-cholesterol statin drugs, anticoagulants and blood pressure medications in the beta-blocker class between 2011 and 2016.
The researchers tracked monthly medication adherence, calculated as the proportion of days for which the patient had a supply of medicine to take. Then they compared the entire group to the 3 percent of patients who were using one of 3,600 pharmacies that closed during the study period.
At the outset, monthly adherence averaged about 70 percent for all the patients and all three types of medication. During the first three months after a pharmacy closed, however, its customers' adherence to their medications dropped by about 6 percentage points. This change also persisted during the 12 months after closure.
For those who used independent pharmacies or lived in neighborhoods with fewer pharmacies, adherence dropped the most, by nearly 8 percentage points, while for those who used mail order pharmacies, adherence declined 3 percentage points.
"Low-access neighborhoods were most affected when a pharmacy closes," Qato said. "In addition, individuals filling at chain stores, particularly in low-access neighborhoods, also experienced a decline."
The research team found the most substantial declines in adherence among patients whose prescription was scheduled for a refill within 14 days of a pharmacy closure, and the smallest decline occurred among those with an expected refill 30 days or more after the closure. This indicates that efforts to increase patient awareness of a coming pharmacy closure might help, they note.
"Efforts to improve access to prescription medication should incorporate the role of pharmacy closures," Qato said. "The failure to prioritize such efforts will likely worsen non-adherence given the expected rise in closures over the next several years."
Now Qato and colleagues want to study whether incorporating planned closures into refill management and home-delivery programs would be an effective outreach strategy for older adults.
One strategy to avoid a break in medication use is for consumers to use "preferred pharmacy" networks, in which patients pay lower co-pays when they fill their prescriptions at certain connected pharmacies, said Dr. Troyan Brennan, chief medical officer for CVS Health, who wasn't involved in the study. For instance, he noted, patients pay less when they fill at independently-owned pharmacies that make up about 40 percent of CVS Caremark's pharmacy network.
"Our research shows that implementation of these networks improved medication adherence as the patients are more likely to establish a pharmacy home where they can receive coordinated pharmacy care and disease management support," he told Reuters Health by email.
In addition, pharmacies that are closing should carefully handle the transfer of their prescription records to a nearby operating pharmacy, referred to as a "file buy" transition, to maintain patient continuity of care, Brennan said. If coordinated with a planned closure, for instance, mail-order or home-delivery could also help, which can be done through both independent and chain pharmacies, he added.
"Offering patients the flexibility to pick up their medications in-store or receive them by mail (for the same copay) can lead to improved medication adherence," he said.
JAMA Network Open 2019.(c) Copyright Thomson Reuters 2019. Click For Restrictions - https://agency.reuters.com/en/copyright.html