Chicago—When pharmacies close in a community, adherence to cardiovascular medications drops among older adults, according to a new study.

The study in JAMA Network Open reports that adults aged 50 years or older in the United States who had filled statins, beta-blockers, or oral anticoagulants at pharmacies that later closed experienced an immediate statistically and clinically significant decline in adherence during the first 3 months after the closure, compared with their counterparts.

Furthermore, in the national cohort study involving 3.1 million adults, the variation persisted for a year and was intensified when older adults lived in neighborhoods with fewer pharmacies, according to the study led by University of Illinois at Chicago researchers.

“Efforts to reduce nonadherence to prescription medications among older U.S. adults should consider the role of pharmacy closures, especially among patients at highest risk,” the study authors suggest.

For the study, comparative interrupted time series analyses were performed using a nationally representative 5% random sample of anonymized, longitudinal, individual-level pharmacy claims from IQVIA LRx LifeLink. With separate cohorts for users of statins, beta-blockers, and oral anticoagulants, analyses included all prescription claims between January 1, 2011, and December 31, 2016.

Researchers tracked the difference in monthly adherence, measured as the proportion of days covered, during 12-month baseline and follow-up periods among patients using a pharmacy that subsequently closed (closure cohort) compared with their counterparts (control cohort).

Before closure, monthly adherence was similar in the closure and control cohorts (mean [SD], 70.5% [26.7%] versus 70.7% [26.5%]), according to the report. Results show, however, that in multivariable models, individuals filling prescriptions at pharmacies that closed experienced an immediate and significant decline (on average, an absolute change of -5.90%; 95% CI, -6.12% to -5.69%) in statin adherence during the first 3 months after closure compared with their counterparts—which continued over the 12 months of follow-up.
Similar declines in adherence were observed in analyses of cohorts using beta-blockers (-5.71%; 95% CI, -5.96% to -5.46%) and oral anticoagulants (-5.63%; 95% CI, -6.24% to -5.01%).

The researchers emphasize that the mean association of pharmacy closure with adherence was greater among individuals using independent pharmacies (-7.89%; 95% CI, -8.32% to -7.47%) or living in neighborhoods with fewer pharmacies (-7.98%; 95% CI, -8.50% to -7.47%) compared with their counterparts.

The study authors point out that one of the barriers to good medication adherence is pharmacy accessibility, explaining, “The geographic accessibility of pharmacies varies substantially across communities in the United States, and pharmacy closures may decrease pharmacy access and thereby limit patients’ ability to fill and adhere to prescribed medications. Such closures, which disproportionately influence independent pharmacies located in low-income urban and rural neighborhoods, have increased significantly since the implementation of Medicare Part D.”

The authors add that pharmacy closures are “expected to further increase due to the expanding role of pharmacy benefit managers (PBMs) in the pharmacy market because of mergers and acquisitions and the growth of preferred pharmacy networks, which often exclude independent stores.”

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