Date of Award
1-1-2025
Document Type
Dissertation
Degree Name
Ph.D. in Pharmaceutical Sciences
First Advisor
Sujith Ramachandran
Second Advisor
John P. Bentley
Third Advisor
Meagen Rosenthal
School
University of Mississippi
Relational Format
dissertation/thesis
Abstract
This dissertation achieved the following objectives: (1) developed a patient-centered access to pharmacies framework; (2) evaluated the impact of pharmacy closures on immunization rates among Medicare beneficiaries; and (3) examined the influence of state-level pharmacy benefit manager (PBM) regulations on rates of pharmacy closures.
For objective 1, a grounded theory methodology was used to identify a patient-centered access to pharmacies framework (PcAP). This framework asserts that patients determine whether they have access to a pharmacy through evaluation of their characteristics, the characteristics of pharmacies, and their own needs or values within the context of a health-related need. This evaluation of access to pharmacies may be best captured by the question, “Does it work for me?”. Ultimately, the PcAP suggests that access to pharmacies exists on a continuum, may vary across time, and may be best evaluated as a patient-reported measure.
For objective 2, a two-group two-period difference-in-differences (DiD) analysis was used to identify the impact of pharmacy closures on receipt of influenza immunizations among Medicare beneficiaries using the Medicare 5% national sample data paired with IQVIA LRx Lifelink data from 2012 to 2019. Results of the DiD analysis showed that pharmacy closures are associated with a non-significant decline in influenza immunization compared to what was observed for those who did not experience a pharmacy closure across the study period.
For objective 3, a controlled interrupted time series analysis was conducted evaluating the effect of state-level PBM-related legislation on the rate of pharmacy closures across a 48-month time period. Information on state-level PBM-related legislation was obtained from the National Academy for State Health Policy’s PBM Legislation tracker and information on pharmacy closures was obtained from IQVIA LRx Lifelink Data. Results from this study suggest that, among included states, PBM legislation did not produce a statistically significant impact on the level or trend change in pharmacy closure rates when compared to a group of states not exposed to PBM legislation.
These studies provide valuable insight into how to better study access to pharmacies, the impact of pharmacy closures on patients, and the effectiveness of states’ PBM-related legislation to prevent pharmacy closures.
Recommended Citation
Gravlee, Emily, "Access to Pharmacies: Implications for Theory, Outcomes, and Policy" (2025). Electronic Theses and Dissertations. 3286.
https://egrove.olemiss.edu/etd/3286