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Articles

At AAP 2025, Melanie Maxwell, president of AlignRx, discussed the intent, benefits and consequences of the IRA.

Inflation Reduction Act’s Impact on Independent Pharmacies | AAP 2025

On behalf of 39 state and territory attorneys general, the National Association of Attorneys General issued a letter to Congress regarding major PBMs’ conflicts of interest.

National Association of Attorneys General Urges Congress to Prohibit PBM-Owned Pharmacies

Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, discusses effective strategies for balancing excellent patient care with strict regulations surrounding controlled substances.

Q&A: Balancing Patient Care, Compliance Amid Controlled Substance Challenges | AAP 2025

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David Blair, CEO of LucyRx, joined Drug Topics to discuss the initiatives his company is conducting in support of a struggling pharmacy profession.

LucyRx’s Role in Supporting the Pharmacist Profession

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Nearly 25% of people “have vitamin D blood levels that are too low or inadequate for bone and overall health,” according to the NIH.

Vitamin D Maintenance May Benefit Patients With Advanced Melanoma

journal explores issues within pharmacy, from the impact advocacy can have in community pharmacies to staffing shortages across multiple sectors within pharmacy. This month’s issue also explored the importance of disease awareness months and how they are opportunities to maximize valued care. Check out a preview of this month’s issue here.

download the PDF of the Total Pharmacy August 2024 issue here

Don’t get left behind: Sign up today for our 

 and get the latest drug information, industry trends, and patient care tips delivered straight to your inbox.

See what’s trending in pharmacy with a preview of the Total Pharmacy August issue.

Total Pharmacy

In This Issue: Total Pharmacy August 2024

Combining sodium glucose co-transporter 2 inhibitors (SGLT2is) with glucagon-like peptide-1 receptor agonists (GLP-1RAs) may offer additional protection against cardiovascular and kidney disease in patients with type 2 diabetes (T2D), according to the results of a new meta-analysis published in 

 and presented at the 61st European Renal Association Congress in Stockholm, Sweden.

Separately, SGLT2is and GLP-1RAs have demonstrated cardiovascular benefits. However, little clinical literature has focused on outcomes associated with using the medicines together. Due to the growing prevalence of GLP-1RAs in the 

 and obesity landscape, accelerated by an increasing number of indications for the agent class, this is a crucial area for further study.

The SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) is the largest assessment of outcomes for the combined therapeutic use of SGLT2is and GLP-1RAs. The study gathered data from 12 large-scale, placebo-controlled trials of SGLT2is involving 73,238 patients with diabetes. Of these, 3065 were already receiving GLP-1RAs.

Overall, SGLT2is lowered the risk of major adverse cardiovascular events by 11% and hospitalization for heart failure or cardiovascular death by 23% compared to placebo. Notably, this benefit was seen regardless of whether patients were also taking GLP-1RAs.

When used together with GLP-1RAs, SGLT2is reduced the risk of chronic kidney disease progression by 33% and slowed the annual loss of kidney function by nearly 60%.

The study found no additional safety concerns when SGLT2is were used in combination with GLP-1RAs.

Study Reveals Robust Benefits of Semaglutide in Protecting Against Kidney, CV Events in Patients With T2D

Current meta-analysis results build off positive results of the landmark FLOW trial (

). Published earlier in May, results of the international, double-blind, randomized, placebo-controlled phase 3 trial spotlighted semaglutide’s effectiveness in lowering the risk of kidney failure, decelerating worsening kidney function, and protecting against the risk of cardiovascular events and death, in patients with T2D.

“SGLT2 inhibitors have clear protective effects against heart failure and chronic kidney disease, while GLP-1 receptor agonists can reduce the risk of heart attack, stroke, and also kidney disease—as recently demonstrated in the landmark FLOW trial,” said Brendon Neuen, lead author, clinical associate professor, senior research fellow at The George Institute for Global Health, and director of kidney trials at Sydney’s Royal North Shore Hospital, in a news release.

 “Our findings support using this combination to further improve outcomes in patients with type 2 diabetes who meet guideline recommendations for both therapies.”

Elevated glucose from diabetes can damage blood vessels in the heart and kidneys, increasing the risk of 

 and kidney disease. In fact, diabetes is the most common cause of chronic kidney disease.

Moreover, estimates predicting that T2D prevalence will more than double in the next 30 years, surpassing 1 billion global cases by 2050, further strengthen the need for research into diabetes care.

 According to Neuen in an interview with 

 conducted over email, the current study offers valuable insights for developing global treatment strategies for the condition.

"These findings, which represent the largest and most comprehensive evaluation of the combined use of SGLT2i and GLP-1RA, provides the clearest evidence yet that combined use of both medicines can further reduce cardiovascular and kidney disease," said Neuen. "We anticipate that these findings will inform how people with diabetes are treated worldwide, including influencing major clinical practice guidelines.

Although current results suggest that using SGLT2is and GLP-1RAs in tandem may offer robust protection against cardiovascular and kidney disease, further research is needed to fully understand the long-term effects of the combination therapy.

Pharmacy practice is always changing. Stay ahead of the curve: Sign up for our 

 and get the latest drug information, industry trends, and patient care tips, straight to your inbox.

1. Apperloo E, Neuen BL et al. Efficacy and safety of sodium glucose co-transporter 2 inhibitors with and without glucagon-like peptide-1 receptor agonists: A SMART-C collaborative meta-analysis of randomised controlled trials. 

. 2024. doi: 10.1016/S2213-8587(24)00183-9

2. Massaro L. Study reveals robust benefits of semaglutide in protecting against kidney, CV events in patients with T2D. 

https://www.drugtopics.com/view/study-reveals-robust-benefits-of-semaglutide-in-protecting-against-kidney-cv-events-in-patients-with-t2d

3. Combining popular diabetes drugs offers complementary heart and kidney benefits. News release. The George Institute for Global Health. July 9, 2024. Accessed July 10, 2024. 

https://www.georgeinstitute.org/media-releases/combining-popular-diabetes-drugs-offers-complementary-heart-and-kidney-benefits

4. Mayo Clinic Staff. Chronic kidney disease. Fact sheet. Accessed July 8, 2024. 

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

5. Klein HE. Diabetes prevalence expected to double globally by 2050. 

https://www.ajmc.com/view/diabetes-prevalence-expected-to-double-globally-by-2050

When used together, sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were able to lower the risk of major adverse cardiovascular events and kidney disease by 11% and 33%, respectively.

Clinical

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

Navigating Legal and Billing Challenges in Pharmacists’ Clinical Services

The legal and billing challenges within the business of pharmacy have historically served as road blocks for independents looking to maximize revenue. While the end goal of independent pharmacy business is to bring valued care to the community, navigating these challenges is almost just as important in order to financially support a pharmacy’s ability to deliver care.

 Solutions Summit Spring 2025 event, Dae Lee, PharmD, Esq, CPBS, and shareholder at Buchanan, Ingersoll & Rooney PC, hosted a session titled Navigating Legal and Billing Challenges in Pharmacists’ Clinical Services: Compliance, Reimbursement, and Opportunities.

During the session, Lee went into detail about compliance, credentialing, and provider status of pharmacists. With his background in law, he provided a unique perspective, offering real-world evidence of the success, challenges, and opportunities often presented to community pharmacies.

“Pharmacies delivered millions of vaccines, testing services, [and] clinical consultation during [the COVID-19 pandemic]. Several states are qualifying that expanded scope and letting pharmacists initiate treatment, order labs, [and] bill insurers directly,” said Lee. “I think this is a chance to redefine our role of community pharmacies in care delivery, especially in the underserved area. We all need to take advantage of that [and] put a lot of pressure on those positive movements.”

Check out Lee’s full presentation from the 

Total Pharmacy Solutions Summit Spring 2025: Clinical Practice Expansion

Dae Lee, PharmD, Esq, CPBS, discusses the legal and billing challenges hindering pharmacy practices and opportunities to overcome them.

Transforming Pharmacy Practice to Deliver Value

The Pharmacy Quality Alliance (PQA) consists of various pharmacy experts and staff members with the mission of improving pharmacy quality across the country on a daily basis. PQA’s CEO, Micah Cost, PharmD, MS, CAE, hosted a session at the 

Solutions Summit Spring 2025 to discuss his company’s work, as well as how to transform pharmacy practices while simultaneously delivering value to patients.

“Our founding CEO, Laura Cranston, quite literally founded PQA out of her basement and has stood it up into a nonprofit organization,” said Cost during his presentation. “We're based in Alexandria, Virginia. We're a 501(c)(3) charitable research organization, and we're dedicated to improving safe, effective, and appropriate medication use and addressing issues that impact a person's ability to access and use medications.”

From challenges in pharmacy now to his look toward the future, Cost touched on many important issues within pharmacy and how his company is working together with other partners to address ongoing pharmacy challenges. In his session, titled Transforming Pharmacy Practice to Deliver Value, Cost provided insights into differences between pharmacies and health systems, PQA’s ongoing initiatives, innovation in pharmacy practice, and so much more.

Micah Cost, PharmD, MS, CAE, CEO of the Pharmacy Quality Alliance, hosted the keynote session at the Total Pharmacy Solutions Summit Spring 2025 event. 

Nearly one-third of patients place very high trust in pharmacists.

Expanding Pharmacy Services: Unlocking Clinical Workflow Efficiency and Revenue Growth

In this Total Pharmacy Solutions Summit session, Stephanie Downing, MBA, senior product manager at Outcomes, highlighted the transformative shift in pharmacy services, emphasizing how pharmacists are evolving from traditional medication dispensing to becoming critical health care providers. She underscored significant industry trends, including growing consumer expectations, clinician shortages, and the transition to value-based care, which are driving pharmacies to expand their clinical service offerings.

Downing shared compelling data demonstrating pharmacists' increasing importance in health care. Nearly one-third of patients place very high trust in pharmacists, and studies suggest that empowering pharmacists with greater clinical authority could save millions of lives and potentially generate over $1 trillion in health care cost savings. However, pharmacies face substantial challenges in implementing these expanded services, including complex medical billing processes, fragmented state regulations, and operational workflow inefficiencies.

The Outcomes clinical solution addresses these challenges by providing an integrated platform that streamlines clinical workflows, simplifies medical billing, and supports pharmacies in navigating regulatory complexities. Key features include step-by-step guided clinical encounter workflows, automated medical billing, real-time eligibility checks, and patient engagement tools. The platform aims to remove administrative barriers, allowing pharmacists to focus on patient care while creating new revenue streams through services like chronic disease management, vaccinations, and point-of-care testing.

Downing emphasized that clinical services represent more than just additional work—they are a strategic path to growth, revenue diversification, and elevating the pharmacist's role in health care. By leveraging technology and comprehensive support, pharmacies can overcome operational challenges, improve patient outcomes, and position themselves as essential health care partners in an evolving medical landscape.

Stephanie Downing, MBA, discusses expanding pharmacy services, clinical workflow efficiency, and revenue growth, highlighting the shift from traditional pharmacy roles to providing expanded clinical services.

Transform Your Pharmacy into a Thriving Community Health Hub

Since the COVID-19 pandemic, the health care community’s opinions of pharmacists have notably shifted as they took on life-saving roles and provided necessary services to millions in the US. Before, during, and after the pandemic, the pharmacists’ role in health care has only increased as they face industry pressures on a daily basis.

At the Total Pharmacy Solutions Summit Spring 2025, Ashley Keller, CPhT, Senior Product Manager at XiFin Pharmacy Solutions, hosted a session titled Transform Your Pharmacy into a Thriving Community Health Hub. She began her presentation by framing pharmacists’ role in health care in relation to the COVID-19 pandemic. She then pivoted to post-pandemic trends leading up to present day.

“What we've seen post pandemic is just this continued expansion of legislation that's allowing for pharmacists to have more opportunities to medically bill for services,” said Keller. “We're seeing legislation expand to things like hormonal contraceptive, test and treatment, HIV pep and prep, and others. One of the key things about what we're seeing in legislation across the country is that it's not just allowing the pharmacist to perform these services, but it's often mandating payment models, specifically at the Medicaid level, for these services.”

Throughout her presentation, Keller provided pharmacy industry insights, explored ways to “future proof” pharmacy businesses, and offered some easily adapted strategies to help pharmacies move forward clinically and financially. Watch Keller’s full presentation here and learn how to execute unique services at the pharmacy that further drive the business’ bottom line.

Ashley Keller, CPhT, hosted a session at the Total Pharmacy Solutions Summit Spring 2025 exploring the services and strategies community pharmacies can employ to make their businesses thrive.

Alex Biese

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