Feature

US pharmacies closing at high rate, potentially impacting patient health

Photo of Jing Luo 
Jing Luo
Dima M. Qato, Pharm, MPH, PhD 
Dima M. Qato

Nearly one in eight pharmacies in the United States closed between 2009 and 2015, with independent pharmacies and those in low-income areas facing the highest risk for closure, according to study findings published in JAMA Internal Medicine.

Jing Luo, MD, MPH, an assistant professor of medicine at the University of Pittsburgh who was uninvolved in the study, told Healio Primary Care that pharmacy closures in rural areas, where a limited number of pharmacies are available to patients, can be particularly devastating.

For instance, if an independent pharmacy closes and the nearest open pharmacy is a few towns away, “that adds to inconvenience, costs, gas mileage, all sorts of things that would probably make it more likely for someone not to fill their medicine on a regular basis,” Luo said.

Pharmacies most likely to close

A photo of a pharmacist speaking with a customer 
Nearly one in eight pharmacies in the United States closed between 2009 and 2015, with independent pharmacies and those in low-income areas facing the highest risk for closure, according to study findings published in JAMA Internal Medicine.
Source: Adobe Stock

In the study, Dima M. Qato, MD, associate professor of pharmacy systems, outcomes and policy at University of Illinois at Chicago, and colleagues used several databases to collect information on pharmacies in operation in the U.S. between 2009 and 2015. They analyzed the data to determine the prevalence of pharmacy closures during the study period and identify risk factors stratified by urbanity. The authors explained that pharmacies in rural areas may have different financial incentives than urban pharmacies, such as tiered reimbursement rates for Medicaid prescriptions.

During the study period, the total number of pharmacies in the U.S. increased by 7.8%, from 62,815 to 67,721. However, researchers found that 74,883 pharmacies were open at any point during the study period and 9,564 (12.8%) of those — approximately one in eight — were closed by 2015.

Urban pharmacies had a significantly greater risk of closure compared with those in nonurban areas (cumulative HR from bivariate analyses: 16.2% vs. 13.2%; multivariate HR = 1.1; 95% CI, 1.04-1.17).

Compared to an 8% closure rate in both urban and nonurban chain pharmacies, independent pharmacies were more likely to close, with a 27.2% rate in urban areas (HR = 3.15; 95% CI, 2.89-3.43) and a 23% rate in nonurban (HR = 2.9; 95% CI, 2.72-3.08) areas.

Pharmacies that served more low-income, uninsured and publicly insured people had higher risks for closure in urban but not nonurban communities, the researchers said.

Implications for patients

Qato told Healio Primary Care that “pharmacies play an important role in the provision of prescription drugs and increasingly other health care services, including immunizations and over-the-counter products.”

Their closures could have a potentially negative health impact on patients.

Additionally, she said, “pharmacy closure could lead to nonadherence, even in patients who were otherwise fully adherent to their prescription medications.”

Qato said providers should be more aware of the pharmacies that most of their patient use and know when they close to ensure that their patients are still able to fill their medications.

Luo recommended that physicians aware of pharmacy closures in their community ask patients to search online for another pharmacy to send prescriptions, or to simply switch to a mail-order pharmacy retailer.

If physicians know a pharmacy is closing ahead of time, he suggested that they advise patients to ask their current pharmacist where they recommend transferring prescriptions. – by Erin Michael

Reference:

Guadamuz JS, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2019.4588.

Disclosures: Luo reports no relevant financial disclosures. Qato reports being a paid consultant for Public Citizen’s Health Research Group, receiving funding from Blue Cross Blue Shield and Cardinal Health, being supported in part by grants from the Robert Wood Johnson Foundation as part of the Clinical Scholars Leadership program and being a fellow of the National Academy of Medicine. Please see study for all other authors’ relevant financial disclosures.

Photo of Jing Luo 
Jing Luo
Dima M. Qato, Pharm, MPH, PhD 
Dima M. Qato

Nearly one in eight pharmacies in the United States closed between 2009 and 2015, with independent pharmacies and those in low-income areas facing the highest risk for closure, according to study findings published in JAMA Internal Medicine.

Jing Luo, MD, MPH, an assistant professor of medicine at the University of Pittsburgh who was uninvolved in the study, told Healio Primary Care that pharmacy closures in rural areas, where a limited number of pharmacies are available to patients, can be particularly devastating.

For instance, if an independent pharmacy closes and the nearest open pharmacy is a few towns away, “that adds to inconvenience, costs, gas mileage, all sorts of things that would probably make it more likely for someone not to fill their medicine on a regular basis,” Luo said.

Pharmacies most likely to close

A photo of a pharmacist speaking with a customer 
Nearly one in eight pharmacies in the United States closed between 2009 and 2015, with independent pharmacies and those in low-income areas facing the highest risk for closure, according to study findings published in JAMA Internal Medicine.
Source: Adobe Stock

In the study, Dima M. Qato, MD, associate professor of pharmacy systems, outcomes and policy at University of Illinois at Chicago, and colleagues used several databases to collect information on pharmacies in operation in the U.S. between 2009 and 2015. They analyzed the data to determine the prevalence of pharmacy closures during the study period and identify risk factors stratified by urbanity. The authors explained that pharmacies in rural areas may have different financial incentives than urban pharmacies, such as tiered reimbursement rates for Medicaid prescriptions.

During the study period, the total number of pharmacies in the U.S. increased by 7.8%, from 62,815 to 67,721. However, researchers found that 74,883 pharmacies were open at any point during the study period and 9,564 (12.8%) of those — approximately one in eight — were closed by 2015.

Urban pharmacies had a significantly greater risk of closure compared with those in nonurban areas (cumulative HR from bivariate analyses: 16.2% vs. 13.2%; multivariate HR = 1.1; 95% CI, 1.04-1.17).

Compared to an 8% closure rate in both urban and nonurban chain pharmacies, independent pharmacies were more likely to close, with a 27.2% rate in urban areas (HR = 3.15; 95% CI, 2.89-3.43) and a 23% rate in nonurban (HR = 2.9; 95% CI, 2.72-3.08) areas.

Pharmacies that served more low-income, uninsured and publicly insured people had higher risks for closure in urban but not nonurban communities, the researchers said.

Implications for patients

Qato told Healio Primary Care that “pharmacies play an important role in the provision of prescription drugs and increasingly other health care services, including immunizations and over-the-counter products.”

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Their closures could have a potentially negative health impact on patients.

Additionally, she said, “pharmacy closure could lead to nonadherence, even in patients who were otherwise fully adherent to their prescription medications.”

Qato said providers should be more aware of the pharmacies that most of their patient use and know when they close to ensure that their patients are still able to fill their medications.

Luo recommended that physicians aware of pharmacy closures in their community ask patients to search online for another pharmacy to send prescriptions, or to simply switch to a mail-order pharmacy retailer.

If physicians know a pharmacy is closing ahead of time, he suggested that they advise patients to ask their current pharmacist where they recommend transferring prescriptions. – by Erin Michael

Reference:

Guadamuz JS, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2019.4588.

Disclosures: Luo reports no relevant financial disclosures. Qato reports being a paid consultant for Public Citizen’s Health Research Group, receiving funding from Blue Cross Blue Shield and Cardinal Health, being supported in part by grants from the Robert Wood Johnson Foundation as part of the Clinical Scholars Leadership program and being a fellow of the National Academy of Medicine. Please see study for all other authors’ relevant financial disclosures.