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. 2019 Apr 5;2(4):e192606.
doi: 10.1001/jamanetworkopen.2019.2606.

Association Between Pharmacy Closures and Adherence to Cardiovascular Medications Among Older US Adults

Dima M Qato  1   2 , G Caleb Alexander  3   4   5 , Apurba Chakraborty  1   2 , Jenny S Guadamuz  2   6 , John W Jackson  4   5   7
Affiliations

Association Between Pharmacy Closures and Adherence to Cardiovascular Medications Among Older US Adults

Dima M Qato et al. JAMA Netw Open. .

Abstract

Importance: It is unknown whether and how pharmacy closures alter medication adherence.

Objective: To examine the association between pharmacy closures and adherence to statins, β-blockers, and oral anticoagulants among adults 50 years or older in the United States.

Design, setting, and participants: In this retrospective cohort 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. Analyses included all prescription claims for individuals followed up between January 1, 2011, and December 31, 2016. Separate cohorts were derived for users of statins, β-blockers, and oral anticoagulants. The differential association of pharmacy closure was examined as a function of baseline adherence, pharmacy, and individual characteristics.

Main outcomes and measures: Difference in monthly adherence, measured as 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).

Results: Among 3 089 803 individuals filling at least 1 statin prescription between January 1, 2011, and December 31, 2016 (mean [SD] age, 66.3 [9.3] years; 52.0% female), 3.0% (n = 92 287) filled at a pharmacy that subsequently closed. Before closure, monthly adherence was similar in the closure and control cohorts (mean [SD], 70.5% [26.7%] vs 70.7% [26.5%]). In multivariable models, individuals filling 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. This difference persisted over 12 months of follow-up. A similar decline in adherence was observed when examining cohorts using β-blockers (-5.71%; 95% CI, -5.96% to -5.46%) or oral anticoagulants (-5.63%; 95% CI, -6.24% to -5.01%). 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.

Conclusions and relevance: Pharmacy closures are associated with persistent, clinically significant declines in adherence to cardiovascular medications among older adults in the United States. Efforts to reduce nonadherence to prescription medications should consider the role of pharmacy closures, especially among patients at highest risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Qato reported serving as a consultant to Public Citizen’s Health Research Group. Dr Alexander reported being chair of the US Food and Drug Administration’s peripheral and central nervous system advisory committee, serving as a paid adviser to IQVIA, serving on the advisory board of Mesa Rx Innovations, serving as a consultant to and owning equity in Monument Analytics (a health care consultancy whose clients include the life sciences industry and plaintiffs in opioid litigation), and being a member of OptumRx’s national pharmacy and therapeutics committee (this arrangement has been reviewed and approved by The Johns Hopkins University in accord with its conflict of interest policies). Ms Guadamuz reported receiving grants from the Robert Wood Johnson Foundation Health Policy Research Scholars program and receiving other support from an institutional T32 grant during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cohort Selection for Statin Users
aAn additional 884 patients with missing covariate data were excluded from the analysis. bAn additional 51 835 patients with missing covariate data were excluded from the analysis.
Figure 2.
Figure 2.. Pharmacy Closures and Medication Adherence
P < .001 for all linear trends.
See this image and copyright information in PMC

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