Chicago—The last decade has been especially tough for independent pharmacies, and a sizable number have been forced to throw in the towel, according to a new study.

An article in JAMA Internal Medicine determined that, while the number of pharmacies went up overall, in the United States from 2009 to 2015, one in eight—representing nearly 10,000 drug stores—had closed over the time period.

In light of that, University of Illinois at Chicago–led researchers examined how pharmacy, community, and market characteristics influenced the risk of a pharmacy shutting down. The analysis found that independent pharmacies in both urban and rural areas were three times more likely to close than chain pharmacies.

“Independent pharmacies are often excluded from preferred pharmacy networks and 340B contracts, which are both increasingly important aspects of the pharmacy market, so it is not surprising that independent stores are at greater risk for closure,” explained senior author Dima Mazen Qato, PharmD, PhD, MPH, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy.

“Efforts to improve access to prescription drugs have focused almost exclusively on reducing drug costs, but affordable medications aren’t easily accessible when a local pharmacy closes. We need policies that specifically address pharmacy closures because such closures negatively impact access and adherence to prescription drugs,” Qato said.

The authors note, “Despite the critical role of pharmacies in the pharmaceutical supply chain and evidence that pharmacy closures contribute to nonadherence of prescription medications, there is limited information on the prevalence and risk factors for pharmacy closure.”

To remedy that, the team examined trends in pharmacy closures in the U.S., hypothesizing that pharmacies disproportionately serving publicly insured populations were at increased risk for closure because of lower pharmacy reimbursement rates from Medicaid and Medicare. In addition, the study posited that independent pharmacies were more likely to close because they often do not participate in preferred pharmacy networks.

Data from the analysis came from the National Council for Prescription Drug Programs, where data was used to determine the number and type of pharmacies—whether chain, independent, mass merchandise, grocery, government, and/or clinic based—that closed during the study period. Pharmacy addresses also were geocoded using ArcGIS, version 10.4 and linked to the American Community Survey 5-year data (2011- 2015), Health Resources and Service Administration (HRSA) data, and U.S. Census data was employed to determine community factors, such as urbanity, percentage minority, percentage living in poverty, medically underserved area status, as well as market type—i.e., the ratio of public versus privately insured individuals, percentage uninsured, and number of pharmacies per 10,000 persons.

Results indicate that about one in four pharmacies located in urban, low-income neighborhoods closed, compared with one in seven pharmacies located in rural, low-income neighborhoods.

In urban areas, pharmacies serving disproportionately more uninsured or publicly insured residents with Medicare or Medicaid were twice as likely to close than other pharmacies, although those market factors did not influence the risk of closure in rural areas.

“Pharmacies located in rural areas may have financial incentives, including tiered pharmacy reimbursement rates for Medicaid prescriptions and critical access pharmacy payments, that are lacking in urban areas,” Qato suggested.

The authors call for policies to reduce pharmacy closures such as payment reforms, including increases in pharmacy reimbursement rates for Medicaid and Medicare prescriptions. They explain that the findings also suggest the importance of understanding the influence of preferred pharmacy networks in order to protect independent pharmacies most at risk for closure, especially in urban areas.

“Such efforts are important because pharmacy closures are associated with nonadherence to prescription medications, and declines in adherence are worse in patients using independent pharmacies that subsequently closed,” the researchers emphasize.

 « Click here to return to Weekly News Update.