Nav: Home

People with heart disease at risk when pharmacies close

April 19, 2019

New research from the University of Illinois at Chicago shows that when pharmacies close, people stop taking widely used heart medications -- like statins, beta-blockers and oral anticoagulants -- that have known cardiovascular and survival benefits.

The researchers, led by UIC's Dima Qato, report that declines in adherence -- including the complete discontinuation of medication -- were highest among people using independent pharmacies, filling all their prescriptions at a single store, or living in low-access neighborhoods with fewer pharmacies.

The findings are published in JAMA Network Open.

"Although ongoing efforts to improve medication adherence focus on improving affordability, this study suggests that policies aimed at reducing non-adherence to prescription medications should also address system-level barriers beyond the high cost of prescription drugs, like pharmacy access," said Qato, associate professor of pharmacy systems, outcomes and policy at the UIC College of Pharmacy. "These findings provide strong evidence that pharmacy closures contribute to non-adherence, including among insured older adults."

Using information from a national all-payer pharmacy dispensing database that links patients across retail and non-retail channels, the researchers analyzed data collected from more than 3 million adults 50 years and older who filled at least one statin prescription at a retail pharmacy between 2011 and 2016. They compared medication adherence among people who had filled a prescription at a pharmacy that later closed -- about 93,000 people -- with adherence among people whose pharmacy remained open.

The researchers found that statin users in the closure cohort experienced "an immediate and significant decline in statin adherence" in the three months post-closure that was "largely due to the complete discontinuation of medication." Among statin users, about 23.8% of people in the pharmacy closure cohort did not refill their prescription at any point during the 12-month follow-up period, compared with only 12.8% in the non-closure cohort.

A decline in adherence also was observed among people who had been adherent to their prescription medications the year prior to the closure. Among those who were fully adherent at baseline, 15.3% in the closure cohort discontinued their statins, compared with only 3.5% in the non-closure cohort.

Qato and her colleagues observed similar trends for beta-blockers and anticoagulants.

Among those least likely to experience a decline in adherence were people who regularly used multiple retail stores.

"We found that declines in adherence were almost double among patients 'loyal' to a single store when compared to those using multiple stores," Qato said. She says this finding is important because retail pharmacies, particularly chains, often promote loyalty programs that encourage patients to fill all their prescriptions at one of their stores.

The authors recommend several strategies to prevent at-risk pharmacies from closing, including policies that ensure sufficient pharmacy reimbursement for prescription medications.

"Expanding regulations that require plans to meet convenient pharmacy access standards to also mandate minimum standards for reimbursement is a potential policy option," Qato said.

Strategies that directly target patients most at-risk for experiencing a pharmacy closure are also important to consider, the authors note. Potential strategies include pharmacy outreach to patients in advance of a planned closure, more flexibility from health plans on which pharmacies are preferred, and use of home-delivery by pharmacies and health plans to offset potential access barriers.

In addition, policies should consider the role of pharmacy benefit managers, or PBMs, the authors suggest.

"Pharmacy closures are expected to increase due to the expanding role of PBMs in the pharmacy market, largely as a result of an uptick in mergers and acquisitions. Therefore, failure to incorporate PBMs in efforts to improve access to prescription medications will likely worsen non-adherence among older adults in the U.S.," Qato said.
-end-
Co-authors on the study, which was funded by the National Institutes of Health's National Institute on Aging (R21AGO04923), are Dr. Apurba Chakraborty and Jenny Guadamuz from UIC, and Drs. Caleb Alexander and John Jackson from Johns Hopkins.

University of Illinois at Chicago

Related Statins Articles:

Statins starve cancer cells to death
More than 35 million Americans take statin drugs daily to lower their blood cholesterol levels.
New cholesterol-lowering drug could help patients unable to take statins
A new class of oral cholesterol-lowering drug could help patients unable to take statins due to side effects.
Statins linked to higher diabetes risk
Individuals who take cholesterol-lowering statins may be at higher risk for developing high blood sugar levels, insulin resistance, and eventually type 2 diabetes, according to an analysis published in the British Journal of Clinical Pharmacology.
Statins could protect against motor neurone disease
High cholesterol has been found to be a possible risk factor for the development of motor neurone disease (MND), according to a large study of genetic data led in the UK by Queen Mary University of London, in collaboration with the National Institutes of Health in the USA.
Statins are more effective for those who follow the Mediterranean diet
For those who have already had a heart attack or a stroke, the combination of statins and Mediterranean Diet appears to be the most effective choice to reduce the risk of mortality, especially from cardiovascular causes.
Statins have low risk of side effects
Cholesterol-lowering statin drugs are associated with a low risk of side effects.
Statins overprescribed for primary prevention
Taking cholesterol-lowering drugs, or statins, as a preventive measure can reduce the risk of cardiovascular disease.
Many older adults do not take prescribed statins properly
In a British Journal of Clinical Pharmacology study of older adults prescribed statins, first-year nonadherence and discontinuation rates were high.
Statins show little promise for conditions other than heart disease
Medicines commonly prescribed to reduce people's risk of heart attack may have limited use for treating other diseases, research suggests.
Statins associated with improvement of rare lung disease
Researchers have found that cholesterol-lowering statins may improve the conditions of people with a rare lung disease called autoimmune pulmonary alveolar proteinosis.
More Statins News and Statins Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.