Independent pharmacies, especially those located in urban areas, are at a greater risk for closure, a new study finds.

Published in JAMA Internal Medicine, the analysis determined that 1 in 8 pharmacies closed from 2009 to 2015, even though the overall number of pharmacies increased during this time. Independent pharmacies in both rural and urban areas were found to be 3 times more likely to close than chain pharmacies.

To determine the reason for these closures, the researchers sought to examine attributing pharmacy, community, and market factors.

In a press release about the findings, senior study author Dima Mazen Qato, associate professor of pharmacy systems, outcomes, and policy at the UIC College of Pharmacy, said that the struggles of independent pharmacies are not surprising since they are often excluded from preferred pharmacy networks and 340B contracts.

“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,” Qato said in a statement. “We need policies that specifically address pharmacy closures because such closures negatively impact access and adherence to prescription drugs.”

It is well established that pharmacy closures lead to non-adherence to prescription medications, with worsening adherence seen in patients using independent pharmacies that subsequently closed.

A previous study led by Qato found that when pharmacies close, patients are more likely to become nonadherent to heart medications that have known cardiovascular and survival benefits. These findings reported higher discontinuation rates among those who used an independent pharmacy, filled their prescriptions at a single store, or lived in low-access neighborhoods with fewer pharmacies.

In the current study, Qato and her team determined that approximately 1 in 4 pharmacies located in urban, low-income neighborhoods closed, compared with 1 in 7 pharmacies located in rural, low-income neighborhoods. Additionally, pharmacies in urban areas who served disproportionately more uninsured or publicly insured residents with Medicare or Medicaid were 2 times more likely to close than other pharmacies.

This may be because pharmacies in rural areas have more financial incentives, such as tiered pharmacy reimbursement rates with Medicare or Medicaid and critical access pharmacy payments, according to Qato.

The authors suggest that policies involving payment reforms and strengthening the regulation of pharmacy access standards, preferred pharmacy networks, and the 340B Drug Pricing Program are important for protecting pharmacies at risk for closure.

“Our findings also indicate that pharmacy retailers, in partnership with health plans and pharmacy benefit managers, may need to consider more innovative, targeted and efficient strategies in the delivery of pharmacy services,” Qato concluded in the release.  

References

Guadamuz JS, Alexander GC, Zenk SN, et al. Assessment of pharmacy closures in the United States from 2009 through 2015. JAMA Internal Medicine. 2019. Doi:10.1001/jamainternmed.2019.4588

Closures affect 1 in 8 pharmacies in the US [news release]. University of Illinois at Chicago’s website. https://today.uic.edu/closures-affect-1-in-8-pharmacies-in-the-us. Accessed October 22, 2019.