OBJECTIVES: To quantify the effect of pharmacy closures on adherence to statins, b-blockers and oral anticoagulants among adults aged 50 years or older in the United States

METHODS: Retrospective comparative interrupted time-series analyses using a nationally representative 5% sample of anonymized, individual-level pharmacy claims from IQVIA LRx LifeLink. Analyses were conducted on continuously observed individuals from January 2011 through December 2015. Separate cohorts were derived for users of statins, b-blockers and oral anticoagulants, and the differential effect of closures was examined based on baseline adherence as well as pharmacy (e.g. independent vs. chain) and community (e.g. low vs. high pharmacy density) characteristics. Main outcomes and measures.

RESULTS: Among 3.1 million individuals filling at least one statin prescription between January 2011 and December 2015, 3.0% (N=106,150) filled at a pharmacy that subsequently closed. Prior to closure, monthly adherence was similar in closure and control cohorts (In multivariable models, individuals filling at pharmacies that closed experienced, on average, an immediate and significant decline (-5.0% absolute change, 95% confidence intervals [CI] -5.19 to -4.79) in statin adherence when compared to their counterparts that persisted over a 12-month period. A similar decline in adherence was observed among closure cohorts when examining use of b-blockers (-4.9%, CI –5.14 to –4.67) and oral anticoagulants (-4.5%, CI –5.10 to –4.61). The effect of pharmacy closures on adherence, on average, was greater among individuals using independent pharmacies (-7.1%, CI -7.47 to -6.67), filling all their prescriptions at a single store (-7.1%, CI -7.35 to -6.76) or living in neighborhoods with fewer pharmacies (-5.9%, CI -6.26 to -5.51).

CONCLUSIONS: Pharmacy closures are associated with persistent and clinically significant declines in adherence to essential cardiovascular medications among older adults in the U.S