Earlier this month a team lead by Dr. Kelly Anderson of the University of Colorado (disclosures at the end) published an article in big JAMA looking at anti-convulsant drug use among Colorado residents who had their primary pharmacy closed relative to Colorado residents who did not have their primary pharmacy closed.
There were three basic stories that we could have anticipated ahead of time:
1) No big deal — people could move their prescriptions to another pharmacy or mail order ahead of a known closure and we won’t see much happening
2) One time shock and recovery — People would change pharmacies after the closure and we might see a drop in prescription pick-up rates in the month or two after but a quick rebound.
3) Permanent pick-up loss — people stop picking up their prescription from anywhere and this drop is persistent.
#1 and #2 aren’t bad. #3 is a huge potential problem.
Below is one of her slides from a conference we were both attended last week:
The TLDR: Story 3 with a 15.6% drop in pick-up rates six months after a closure
This is a big deal. Mail order pharmacy was not picking up the slack. Instead 1 in 6 prescriptions that typically would have been picked up just disappeared.
More scarily was some of her unpublished work on other drug classes. One slide made me exclaim louder than I intended “Holy Shit.”
From a policy perspective, perhaps we think about pharmacy closures along the same lines as rural hospitals as key infrastructure that might need additional support as the health effects could plausibly easily dominate the cost of subsidies.
I am both excited and terrified to see what the rest of this research agenda finds.
***DISCLOURES***: Dr. Anderson and I are co-authors, collaborators, co-consultants and co-grant writers on non-related work. I’ll talk about that work in a few months
H.E.Wolf
Thanks – this is very interesting. I can understand why you said holy shit.
Eunicecycle
RiteAid just recently up and left Ohio. It was very sudden; at first only certain stores were closing, then more and more and finally they were all closed. There were insurance companies that required customers to use RiteAid and there was no provision for these people at first. People went without medication until this was straightened out. I’m sure it resulted in health consequences for some.
Old School
Am I right in assuming the drop-off was even larger for other drug classes in the unpublished work?
trollhattan
We (norCal) had a crapton of chain pharmacy stores magically airdropped in the last decade and peculiarly enough, many are now empty because they just as magically went {poof}. Walgreen’s? Rite Aid? CVS? Thrifty? Who the hell can keep track? I also don’t know which simply left, which went out of bidnez and which got gobbled up “Feel the synergy! Pack your things.”
Want to fix the housing shortage? Move people into dead chain pharmacies.
Ang
Definitely an “Oh Shit” outcome. Is there any way to differentiate for loss of only local in-network pharmacy (causing longer drive times, need for transport and other actual physical barriers) vs geographic areas where other local pharmacies are available but the need for the patient to actively switch creates a mental barrier. In both cases the patients need and deserve care, but I would think any proposed solution would have to account for both.
David Anderson
@Ang: that is both ongoing and future work.
Old Man Shadow
Rural voters just recently decided they’d rather fuck over other people than have nice things.
Steve LaBonne
I would rather get my prescriptions by mail as I did for many years when I was working, but post- DeJoy I don’t trust the mail. Picking up prescriptions is a pain, and I am not surprised at this result if people are having to drive a significant distance.
Raven
I am up to 5 gabapentins a day. I hope they don’t run out!
WereBear
We had a delightful, family run, pharmacy downtown. We were in the delivery distance and he was just a top notch person about interactions and everything you’d want in a pharmacist.
He was forced out of business by a Walgreens a couple of years ago. He worked there as a pharmacist for six months and we showed up for him, but when he left, so did we. Now they are closing it. No one wants to work there.
Now I hear Walgreens is closing because they can’t get anyone to work there. Now people who lived in that downtown neighborhood don’t have a downtown pharmacy at all, and some of them can’t drive.
Kayla Rudbek
@Steve LaBonne: I have had to raise hell with my local post office at least once about my mail order soltamox shipments. Fortunately it’s a quarterly supply so I don’t have to worry every single month, just every 3 months. The one advantage of working for a company that has its own account with CVS Caremark is that I can dump problems onto the specialized Caremark account.
WereBear
@Raven: I was on those for nerve pain, now fortunately resolved. You sure don’t!
Raven
@WereBear: With this MS diagnosis I really need them to sleep but it’s not helping the persistent butt pain.
Layer8Problem
@Old Man Shadow: But this will affect other rural voters, some of whom might have loved ones who use pharmacies! That can’t possibly be.
Percysowner
I’m lucky. In my city we still have CVS, Walgreens, Kroger, Giant Eagle and Meijer all of which are considered in network under my pharmacy plan. However, that is because I am in a big city. Obviously, the study shows a problem of people not getting their long term prescriptions, but the other issue of not having a local pharmacy is when you need a one time deal. Last year I had an ear infection that needed antibiotics and prednisone. All I had to do was have them called into my local pharmacy and within a couple of hours I had both. How do people without a local pharmacy get these prescriptions filled? Mail order would take at LEAST 24-48 hours.
JCJ
Does the study indicate what these anticonvulsants were prescribed for? If for seizures then that is potentially a huge problem. If for bipolar disorder also potentially a huge problem. If restless leg syndrome (gabapentin) perhaps troublesome but not potentially deadly like having a seizure while driving. If fibromyalgia (gabapentin, pregabalin) also perhaps troublesome, perhaps worse. Perhaps a person was taking gabapentin for fibromyalgia and was unsure of the amount of benefit so when the pharmacy closed and it became less convenient (distance, lack of transportation) to pick up a prescription they took a pass.
Harrison Wesley
I guess I’m lucky that warfarin is the only prescription drug I take. It’s available pretty much everywhere.
David Anderson
@JCJ: No, claims data is not particulary good at that question. I know there is a grant application to tie in data that is able to answer that question so best case we’ll know in 2027
MobiusKlein
Is this the kind of result that Insurance Companies and other folks focused on cost alone look at and say “Great, how can we do more of this?”
I suspect the takeaway for many in the heathcare business is “Friction Works$”
Wapiti
Anecdata: here in Seattle there was a big push by Walgreens to add more stores, local chain Bartell’s was bought up by RiteAid (iirc), and most of the little independents are gone in the last 10-15 years. Now Bartell’s/RiteAid and Walgreens are closing stores left and right.
I think it was a big bid by the suits to grab market share, and once that was done, they got their bonuses and moved on. Taking care of people is secondary.
In North Seattle every other supermarket also has a pharmacy – I’d wonder what their market share is. Because out in the rural areas, the dollar stores or quick marts don’t have the space or staff for that.
Obvious Russian Troll
@Eunicecycle:
Not just Ohio; the Rite Aid near my mother-in-law’s assisted living facility in Kentucky across the river from Ohio closed, too (and there’s no longer any within at least 50 miles). Fortunately we’d finally convinced her to move to a mail order pharmacy before then.
The mail order pharmacy was a big help in the last couple of years before we finally talked her into moving into the assisted living facility.
She moved into the memory care section during the pandemic.
Edited to clarify location.
Ruckus
I wonder if Target pharmacies are counted because every Target I’ve been to has a pharmacy. I also wonder if some of the old – older pharmacy chains are going the way a lot of older companies do after the second or third or fourth owner of the chain dies off. Walmart has a pharmacy listed for it’s stores. We have Rite Aid drugstores all around SoCal.
Think about these big stores that sell a lot of different things and the pharmacy is likely a small part of the concept but the overall concept of these stores is that they provide most everything you need. In my part of the world they are reasonably busy during week days and overly busy on weekends because in many respects they are one stop shopping. And yes we still have a few pharmacy only stores in LA County because the population of LA County is bigger than 40 of the states. List_of_U.S._states_and_territories_by_population
Ruckus
As a prior owner of a corporation and an old, I have seen change in many, many aspects of business life. Much of retail has changed to big stores such as Target and Walmart. And many branded stores, such as Kmart have changed hands and do not sell the same things or in the same locations they used to. There isn’t a Kmart within 100 miles of me. Of course they were brought out/up by Sears a few years ago so the likely hood of seeing both in the same area is slim at best.
SoundArts
As long as the Fox News continues to get delivered, who really cares?
/s
Miss Bianca
You know, I opposed it when our medical clinic in my little town wanted to add a pharmacy, because the regional medical center we are part of delivered prescriptions every day, and I figured the space they were talking about renovating would be far more useful as, say, a 24/7 emergency clinic (Still think so, btw, but I do understand that that wasn’t going to be a cash cow for the medical center, unlike a new pharmacy). Plus, we just got a new, non-chain pharmacy opening up here as well.
So, we are covered better here in my tiny rural community than a lot of people out there. Good for us, but scary/sad for others. :(
Anonymous At Work
What’s the range or radius of the “pharmacy deserts” being created?
My primary pharmacy is an academic center across the street from a Walgreens and within spitting distance of a CVS, so losing my primary still keeps 2 secondary, plus the in-store pharmacy .5 miles from my home. I am urban for a good many reasons.
For rural voters, are we talking 1 in town closing, drive 25 miles to next town? Or just “primary closed, secondaries available at non-preferred place”?
Ruckus
@Miss Bianca:
I live in a huge population area and the number of pharmacies has gone down in the almost 9 yrs I’ve lived in this location. However there still are a number of them around and for me as all my prescriptions come from the VA they are mailed to me. I mean I have to walk up to the community mailbox(es) 6 days a week to get my mail and it is a very laborious to walk 250-300 feet…….(that is snark, just in case…)
SteverinoCT
Here in suburban SE Connecticut the Target pharmacy is now branded and run by CVS. There are CVS in plenty, also Walgreens. I am happy that the CVS I use is 1.3 miles away. I am also happy that my 90-day prescription for Mounjaro (diabetes) was filled over a weekend. Locally, at least, the story that the supply shortage is over, is true. The weight loss effect has been helpful.
AnonPhenom
PBMs.
Most (but not all) of retail Pharmacy’s current problems can be traced back to PBMs.
The professional are trying to get government to address the issue.
AnonPhenom
…and please be patient with the pharmacy staff behind the counter and cut them a lot of slack, they really need it right now.