People stop taking their CV drugs when pharmacies close

Pharmacy closures across the U.S. are driving significant declines in medication adherence among Americans, a recent study has found, especially those who are older and live in neighborhoods with low accessibility.

Around half of patients taking prescription medications—including CV drugs like statins, beta-blockers and oral anticoagulants—skimp on their daily drug routines, Dima M. Qato, PharmD, MPH, PhD, and colleagues wrote in JAMA Network Open April 19. That statistic isn’t helped by the fact that local pharmacies are struggling to keep up with the growth of pharmacy benefit managers and preferred pharmacy networks, resulting in closures all over the country.

“Despite ongoing efforts to improve the affordability of prescription medications among older adults (e.g. Medicare Part D), nonadherence persists as an important public health problem,” Qato, an assistant professor at the University of Illinois at Chicago, and co-authors said. “It is increasingly recognized that older adults may encounter system-level barriers to adherence beyond the high cost of prescription drugs.”

Qato and her team used individual-level pharmacy claims data from IQVIA LRx LifeLink to study a nationally representative sample of 3,089,803 individuals who filled at least one statin prescription between 2011 and 2016. Of that pool, 3% filled their prescriptions at a pharmacy that subsequently closed.

Considering statins as well as beta-blockers and oral anticoagulants, authors said baseline monthly medication adherence was similar between patients whose pharmacies eventually closed and those whose pharmacies stayed open—70.5% and 70.7%, respectively. Three months after closure, though, affected individuals saw an immediate and sharp 5.9% decline in statin adherence compared to controls.

The difference persisted over 12 months of follow-up, and similar declines were experienced with beta-blockers (-5.7%) and anticoagulants (-5.6%). Qato et al. said the issue was most noticeable among patients using independent pharmacies, who saw a 7.9% decline in medication adherence, and those living in neighborhoods with fewer pharmacies, who experienced an 8% reduction in adherence.

“Declines in adherence were most pronounced among older adults using independent pharmacies, purchasing from a single store to fill all their prescriptions or living in low-access neighborhoods with fewer pharmacies and were consistent across several classes of cardiovascular medications,” the authors wrote. “Our findings underscore the substantial influence of system-level factors beyond the high cost of prescription drugs on medication nonadherence, especially among patients at highest risk.”

They said other studies have suggested ways to improve adherence—eliminating copays for CV medications among patients with a recent MI improved adherence to statins and beta-blockers by up to 10%, value-based insurance designs improved adherence by 5% to 6% and preferred networks improved adherence by 1% to 2%, for example. But changing policy is a slow process.

While insurers and policymakers tackle the details of improved access and adherence, Qato and colleagues suggested less extensive interventions, like direct outreach to patients in low-income neighborhoods, conversion of health plans to open pharmacy networks or encouraging the use of mail-order medications might mitigate the downward trend.

“These interventions are supported by our findings that individuals using mail order or filling at multiple pharmacies were least influenced when one of their pharmacies closes,” the team wrote. “Providing transportation services to and from patients’ pharmacy of choice may also be helpful for some select populations, particularly those with Medicaid coverage, as would increasing patient awareness of planned pharmacy closures and incorporating closure dates into refill management programs.”