Low-income urban communities are seeing much higher rates of pharmacy closures than other areas, which researchers worry will widen socio-economic health disparities.
According to a new analysis published Monday in JAMA Internal Medicine, 1 in 8 pharmacies closed between 2009 and 2015. Most of those closures involved independently owned pharmacies and providers located in poorer urban areas.
It's a troubling indicator for pharmacies serving communities where out-of-pocket prescription costs can already make it difficult for low-income patients to access their medications, according to study senior author Dima Qato, associate professor of pharmacy systems, outcomes and policy at the University of Illinois at Chicago's College of Pharmacy.
"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. "We need policies that specifically address pharmacy closures because such closures negatively impact access and adherence to prescription drugs."
Approximately a quarter of pharmacies in low-income areas closed from 2009 to 2015, with pharmacies located in those communities two times more likely to close than those in other areas, the study found.
The payer mix of the community that an urban pharmacy served was a strong predictor for whether it was more likely to close. Urban pharmacies that served a disproportionate share of uninsured and publicly insured individuals closed more often. But those same factors did not predict closure risk among pharmacies in rural areas.
Qato said urban pharmacies might be more susceptible because they don't have the same financial incentives as rural pharmacies. Many states have established programs that provide higher reimbursement prescriptions rates for rural pharmacies that serve fewer patients to ensure those areas don't become pharmacy deserts.
Smaller pharmacies have also felt pressure from the continued growth of giant retail drug chains such as Walgreens and CVS Health. Many independent pharmacy advocates say the increased role of pharmacy benefit managers within state Medicaid and Medicare prescription drug programs has also presented a huge challenge by lowering reimbursement rates.
"We are at the mercy of the pharmacy benefit managers," said Ronna Hauser, a pharmacist and vice president of policy and government affairs operations for the National Community Pharmacists Association. "We are unfortunately beholden to them, and it's become increasingly difficult."
Raising Medicare and Medicaid prescription reimbursement rates could help address the disparity in pharmacy closures, Qato said. She also suggested examining whether the exclusion of independent pharmacies from preferred pharmacy networks and from the 340B drug pricing program has driven their increased risk for closure and, in turn, created a barrier for low-income patients to access their medications.
"These findings suggest that policies aimed at reducing pharmacy closures should consider payment reforms," the study concluded.
Reversing the rate of pharmacy closures in low-income areas could play an important role in addressing the wide health gap that exists between poorer and more affluent communities.
A previous study Qato authored that was published in JAMA Network Open in April found pharmacy closures were associated with "significant declines" in older patients adhering to regularly taking their heart medications. That study found the decline in adherence was worse among patients who were using independent pharmacies that closed.
"Closures are important from a clinical perspective as well as a public health perspective," Qato said. "Since we know closures impact adherence it's really important to address closures in these neighborhoods."