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Articles

Currently, blood-thinning medications are only prescribed to patients who have already had a heart attack or stroke, as the drugs can cause serious bleeding.

New Test Could Help Identify Patients That Would Benefit From Blood Thinners

The drug is the first rapid-acting insulin biosimilar product approved for use by the FDA, marking a significant milestone in diabetes treatment.

FDA Approves Merilog as Biosimilar to Insulin Aspart for Diabetes

Identifying women who are at risk for postpartum depression sooner can lead to quicker and possibly preventative treatment.

Neuroactive Steroid Levels May Indicate Risk of Postpartum Depression

Among providers who took part in a recent study, 57% reported increased vaccination rates after implementing a quality improvement initiative.

Learning Sessions, Shared Decision Making Could Help Increase Vaccinations Among Older Adults

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A unified data ecosystem will provide the foundation for the next generation of patient-care technology.

Data, Collaboration Can Help Unlock the Full Potential of Value-Based Care

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

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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

Understanding Flublok

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Understanding Flublok® (Influenza Vaccine)

Because manufacturers raised their prescription drug prices faster than the rate of inflation, Medicare Part B enrollees will see a decreased coinsurance rate for any of the 64 drugs that increased in price. This benefit, laid out by the Inflation Reduction Act (IRA) of 2022, will be available for beneficiaries from January 1 to March 31, 2025, according to a US Department of Health and Human Services (HHS) news release.

“The [IRA] is working to lower prescription drug costs for millions of people,” said HHS Secretary Xavier Becerra, JD. “By discouraging drug companies from raising their prices faster than inflation, we are keeping prices affordable for the people with Medicare who rely on these drugs to live healthier lives. The law has also capped out-of-pocket costs and finally allows Medicare the right to negotiate lower prices.”

Of the 64 drugs that saw recent price increases, a total of 850,000-plus Medicare enrollees consistently rely on at least 1 of these drugs. Thanks to the IRA’s Medicare Prescription Drug Inflation Rebate Program, patients with Medicare have seen price decreases and out-of-pocket caps since April of 2023. Furthermore, due to the IRA’s provisions, patients could save anywhere from $1 to over $10,000 a day on the included prescription drugs.

“The Inflation Reduction Act is lowering prescription drug costs so that people can access the medications they need,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “As we head into 2025, people with Medicare will feel substantial relief from high drug prices.”

PBM Reform Pulled Back in Late Change to Spending Package

With several narratives circulating regarding who’s to blame for increasing drug prices in the US, federal legislation is finally coming to fruition and saving thousands of US patients money at the pharmacy counter. And while over 50 life-saving drugs will be available for Medicare beneficiaries at lower prices than expected next year, there are even more IRA provisions that are set to benefit patients further.

“In addition to lower cost-sharing for certain drugs whose prices have increased above the rate of inflation, people with Medicare prescription drug coverage will have their annual out-of-pocket costs capped at $2,000 for the first time,” continued Brooks-LaSure.

 According to the HHS news release, this provision will yield the highest amount of cost savings compared with any other IRA statute yet.

Beneficiaries will also be met with a more efficient out-of-pocket payment option for their prescription drugs. Instead of having to cover all medication costs up front, patients will have the option to spread out their out-of-pocket costs throughout the calendar year. With some patients paying thousands of dollars a month for 1 medication, their ease of making the appropriate payments is set to increase.

The main hope of the aptly named Inflation Reduction Act was to reduce inflation within the US. While it has been enacted for nearly 2 years now, there is dual support and opposition from both sides of the aisle in Washington. With some policymakers praising the legislation and making it a key focus on the Hill, others—like US Representative Mike Kelly (R, Pennsylvania)—have opposed the bill in what they think is a “wasteful $740 billion.”

“Across the economy, the IRA is creating opportunities to build projects, hire workers, and manufacture equipment needed to strengthen domestic supply chains, lower household energy costs while reducing greenhouse gas emissions, and pay good wages for those efforts,” according to a US Department of the Treasury news release.

With the IRA dealing with inflation and the US’ multitude of supply chains in various markets, its impact on prescription drug prices is just 1 small part of the legislation’s provisions. And while other parts of the bill may not have a consensus of support from political leaders, what it’s doing for close to 1 million Medicare patients across the country is a meaningful win for the US economy and health care system as a whole.

“It is a success story for the American people,” concluded Becerra.

Federal Bill Reintroduced to Strengthen Pharmaceutical Supply Chain

1. HHS announces cost savings for 64 prescription drugs thanks to the Medicare Prescription Drug Inflation Rebate Program established by the Biden-Harris Administration’s lower cost prescription drug law. News Release. US Department of Health and Human Services. December 20, 2024. 

https://www.hhs.gov/about/news/2024/12/20/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-prescription-drug-inflation-rebate-program-established-biden-harris-administration-lower-cost-prescription-drug-law.html

2. Kelly opposes democrats’ wasteful $740 billion so-called “Inflation Reduction Act.” Office of US Representative Mike Kelly. August 12, 2022. Accessed December 23, 2024. 

https://kelly.house.gov/media/press-releases/kelly-opposes-democrats-wasteful-740-billion-so-called-inflation-reduction-act

3. Inflation Reduction Act. US Department of the Treasury. Accessed December 23, 2024. 

https://home.treasury.gov/policy-issues/inflation-reduction-act

Provisions under the Inflation Reduction Act have ensured cost savings for patients prescribed drugs covered under Medicare Part B. 

Drug Price Increases Lead to Future Cost Savings for Medicare Beneficiaries

Stevie Veach, PharmD, BCACP, is a clinical pharmacist at MercyOne Pharmacy in Dubuque, Iowa. Receiving her Doctor of Pharmacy degree from the University of Iowa in 2006, she has had a first-hand experience of the 21st-century evolution of pharmacy in the past 20 years or so.

Aside from specific areas of expertise, like medication synchronization and immunization services, Veach’s focus is on helping pharmacies and their pharmacists provide valued care to their patients in a community setting. On top of her work at MercyOne Pharmacy, she is also a Clinical Associate Professor at the University of Iowa College of Pharmacy and a member of multiple state and national professional pharmacy organizations.

Read about Veach’s life as a pharmacist and how she is making a difference not only within her community but in her state and country as well.

: What is the newest offering at your pharmacy that you think will increase customer engagement and/or overall revenue?

 MercyOne Pharmacies have continued to expand their medication synchronization and immunization services over the past few years. Medication synchronization has helped reduce our inventory needs and streamline our staffing which has helped revenue-wise. As immunization recommendations have continued to expand, such as the new approvals for the respiratory syncytial virus (RSV) vaccine in adults, MercyOne has promoted these vaccines and has been a referral source from other providers.

While it has not been implemented at MercyOne Pharmacies, I have also seen several community pharmacies in Iowa implement test-and-treat services for influenza and group A strep pharyngitis within the past year. By expanding these types of services, especially in rural communities in Iowa, pharmacies can increase patient access to care and timely treatment while also increasing revenue opportunities.

: What is one of the biggest challenges you face in today’s pharmacy industry?

 Declining reimbursement for the drug product continues to challenge community pharmacy’s viability. In 2024, we are seeing more and more pharmacy claims reimbursed below the cost of the drug and this is not sustainable. We have also faced challenges with staffing shortages. Due to these 2 factors, we have seen pharmacy closures or a reduction in hours open both within our own organization and amongst other community pharmacies in our area and state.

Despite these challenges, we continue to look for other opportunities to diversify our revenue streams. With the passage of the Iowa Pharmacy Practice Act Modernization Bill this year, we hope to be able to continue to expand our pharmacy service offerings.

: What are some things your pharmacy does to make the community feel welcomed?

 MercyOne Pharmacy strives to meet the needs of the patient and our community. Some of the services that our pharmacies offer to meet these needs are home delivery of medications to local residents, medication synchronization, medication compliance packaging, and compounding of medications. Our pharmacy also offers delivery of meds to beds for patients discharging from the hospital. The pharmacy is able to triage any issues with drug availability and address any formulary or cost issues before the patient even leaves the hospital, which creates one less hurdle that the patient and/or their caregiver might need to overcome before arriving home.

: Can you explain what it’s like to serve the community of Dubuque, Iowa? Is there something about this area that stands out compared to other parts of the country?

 One service and partnership that MercyOne Pharmacy has maintained for many years is providing pharmacy services for our local Hospice of Dubuque. Our pharmacy stocks and provides hospice medication kits to the hospice nurses, completes hospice medication order billing, delivers medications to patient homes as needed, and compounds medications that might not be commercially available in a dosage form needed for a patient. MercyOne’s clinical pharmacists also consult with the hospice team. It has been rewarding to serve the community in this capacity; to assist in easing some of the burden—even if just a small fraction—that patients and caregivers are experiencing during these difficult end-of-life situations.

: What are some things that have noticeably changed within the pharmacy community since you’ve started the profession in the early 2000s?

 There have been many changes that I could potentially comment on, from changes to the insurance and reimbursement to changes in technology used in pharmacy. Not to mention the numerous new medications that have been approved since I graduated from pharmacy school that I need to keep current on.

One exciting change is the expanded role of pharmacists and pharmacy technicians. Since the time I graduated, the pharmacist role to recommend and administer vaccines has expanded immensely and even pharmacy technicians can assist in the administration. Most states have authorized pharmacists to test and treat for influenza or strep throat. In 2024, the state of Iowa followed the lead of a few other states and passed the adoption of a modernized Iowa Pharmacy Practice Act, which expands the scope of pharmacy practice. Many other states have enacted provider status legislation for pharmacists. Technician product verification is another expansion of the role for our pharmacy technicians allowed by many states. I am hopeful that these policy changes will allow pharmacists to practice at the top of their license.

If you or a pharmacist colleague is interested in being featured in Drug Topics’ 5 Questions With a Pharmacist series, please send all inquiries to 

5 Questions With a Pharmacist: Anthony Minniti from Bell Pharmacy

In an installment of Drug Topics’ 5 Questions With a Pharmacist, Stevie Veach of MercyOne Pharmacy in Dubuque, Iowa, talked about her pharmacy’s offerings and how they serve her community’s patients.

5 Questions With a Pharmacist: Stevie Veach from MercyOne Pharmacy

Henry, PharmD, and Jade, PharmD, Ranger have been the co-owners of The Prescription Shoppe in Williamsburg, Virginia, for 5 years. While ultimately focusing on providing their patients with valued care, Henry and Jade have also made it their duty to create a strong presence in their community. From their experience operating a Black-owned business to industry challenges they face on a daily basis, learn about what goes on behind the scenes at The Prescription Shoppe.

Henry was born in Beaufort, South Carolina, and graduated from the Hampton University School of Pharmacy in 2011. He then took to Williamsburg to continue his pharmacy career, opening a Walmart Neighborhood Market pharmacy that won Pharmacy of the Year among all Walmart pharmacies in the country. Jade is from Bowie, Maryland, and is touted as an accomplished scholar, entrepreneur, and community leader. She too graduated from Hampton University School of Pharmacy and worked in big chain pharmacies for almost 10 years until she and her husband opened up their own business.

Read about their journey to success in the Virginia area and what it’s like owning a business as a husband-and-wife team.

: We opened a second location in September 2023—the closed-door, long-term care pharmacy is our newest endeavor. Whether partnering with local senior living communities, group homes, or serving our long-term care at-home patients, The Prescription Shoppe has increased our revenue while filling a serious need within our community.

 Without question, our biggest challenge is PBMs and their DIR fees. We are constantly having to reinvent the wheel and incorporate additional cash-based services to combat the detrimental effects of unfair reimbursement practices.

 At The Prescription Shoppe, we make it a point to engage with our community outside of the 4 walls of our full-service pharmacy. We do this by playing an active role within our community on a regular basis. If there’s a health fair, career day, or community event, we are there. Because our community has an opportunity to interact with us in various settings, they have come to know and trust us on a deeper level. For them, entrusting us with their pharmaceutical care is a no-brainer.

: Both on the business and personal side of things, what is it like to operate a business with your spouse while living in the Greater Williamsburg community?

 Owning and operating a small business together has been both challenging and rewarding at the same time. We are able to collaborate in so many ways and we consistently fill in the gaps for each other. What one may be lacking, the other overcompensates for and vice versa. Sharing this experience has definitely brought us closer together as a couple and as a family. We work hard and push each other harder, but when it’s all said and done, we have a common purpose and we are each other’s biggest cheerleaders.

: What does it mean to you to be a successful Black-owned business?

 Opening the first, Black-owned pharmacy in Williamsburg, Virginia, was no easy feat. In fact, we often wondered if we’d be accepted and supported as a young Black couple from a Historically Black College & University (HBCU), with no roots in the Greater Williamsburg area. While we had our doubts initially, this community has completely embraced us and cheered us on. Although Williamsburg is increasingly becoming more diverse, it is still predominantly white. The success of The Prescription Shoppe has shown us the value of how you treat people. When you show folks genuine love and respect, and you take good care of them, the outcome transcends race and ethnicity, social status, religious background, and sexual orientation. We have definitely played a role in bringing our community together—especially throughout the pandemic and the racial reckoning that took place after the murder of Mr. George Floyd. Everything hasn’t been smooth sailing. We’ve definitely had our fair share of critics, doubters, and haters. With that being said, the overwhelming majority of our community has consistently supported us and wished us well.

In an installment of Drug Topics’ 5 Questions With a Pharmacist, Henry and Jade Ranger of The Prescription Shoppe in Williamsburg, Virginia, discussed their practice and what it’s like operating a business together.

Anne Chau

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