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Articles

Researchers determined the prevalence of weight management interventions among patients who were obese and received an obstructive sleep apnea diagnosis.

Patients with Obesity, Sleep Apnea Rarely Received Weight Management Services

Doug Hoey is CEO, National Community Pharmacists Association.

If CMS doesn’t reconsider its mandate, which forces independent pharmacies to go deep into a hole and lose money, many of them will close.

Alarm Bells are Ringing: Medicare Drug Price Negotiation Program Will Fail Without Changes 

Researchers explored the differences in off-label prescribing between pharmacists and physicians among a cohort of patients in pediatric palliative care.

High Prevalence of Off-Label Prescribing in Pediatric Palliative Care

Denosumab-Bmwo is approved for all indications of the respective reference products, including osteoporosis and high-risk of fracture due to chemotherapy.

FDA Approves Denosumab-Bmwo as Biosimilar to Prolia, Xgeva

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Policymakers have the power to get pharmacy benefit managers under control. 

Opinion: PBM Hocus Pocus Harming Seniors, Small Business Pharmacies

What one pharmacist says the AAOA Pharmacy Toolkit can do to help combat the opioid epidemic. 

Opinion: A New Toolkit to Fight Opioid Abuse 

The time has come for pharmacists to work on reforming the maximum allowable costs put forth by the pharmacy benefit managers

The MAC pricing system must be fixed

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

According to community-driven pharmacist Crystal Zhou, PharmD, APh, AHSCP, BCACP, holding nontraditional health care roles is one of the best ways to reach more patients within a community while also exhibiting expertise as a pharmacist.

“I'm an advocate for nontraditional roles,” she said. “I [thought], let's try to expand and think outside the box and see what else pharmacists are capable of doing. Because of my position here at [the University of San Francisco], I think I'm very fortunate and able to meet the right people and make this [program] happen.”

The program Zhou referred to was the Cut Hypertension Program operating in communities throughout the Bay Area in California. After connecting with other providers during her professional career, Zhou has since signed on as lead pharmacist of the Cut Hypertension Program, which is a collaborative health care practice focused on hypertension services geared toward underserved communities and patient populations.

“But if you as a patient are in the community, and you don't regularly see your health care team, then you'll never know that these types of pharmacists even exist. I think the beauty of my role in the Cut Hypertension Program is I am interfacing with community members who otherwise may not have even met their health care team.”

As the program’s lead pharmacist, Zhou has the dual purpose of utilizing her expertise in a nontraditional setting and helping patients of a low socioeconomic status receive valued care at an affordable price. Read about her role within the Cut Hypertension Program and how experiences like hers can allow emerging pharmacy leaders to separate themselves amongst their peers.

Q&A: How Barbershops Are Transforming Hypertension Management

: What about the Cut Hypertension Program made you want to get involved as lead pharmacist?

My passion has always been to try to bring pharmacy services into the community. When I first started at UCSF as an assistant professor, I didn't really know where that community spot would be. Initially, I was thinking community pharmacies, but over the years, and even now more recently, a lot of community pharmacies have been closing. I thought we really have to pivot. What are these more sustainable community spaces that are here to stay? It just so happened, a year into my role here at UCSF, the barbershop study down in Los Angeles was published in 2018. I got together with Kenji, our original program founder, Tem Woldeyesus, our current physician, and we just brainstormed and thought about how we could actually bring this model to life here in the Bay Area.

It was really my love and motivation of bringing medicine into the community and just trying to innovate for pharmacists, because pharmacists are capable of doing so much more than just standing behind the counter at a pharmacy dispensing medications. Patients, even to this day, see us as drug handlers: We just work in the pharmacy and we provide their drugs. It was really funny because I called a patient just a couple days ago, and this was one of my remote patients that I'm calling to manage blood pressure for. It was a new patient that I never met. I say, ‘I'm Crystal. I'm a pharmacist calling from the UCSF Hypertension Program.’ And he goes, ‘Oh, are you calling from my Walgreens Pharmacy?’ Because that's the first thing they think about when they hear pharmacist. I think as we continue to advance and move into the community to try to serve these more forward-facing medication management roles, more patients will see us as part of their health care team and reach out to pharmacists for more questions.

That's kind of what's been happening. Anytime I introduce myself as a pharmacist at the barbershop now, they ask me all types of questions. ‘Oh, should I be taking this medication? My friend's taking this, should I take this medication as well?’ So, I think that's how I landed myself in this position. But the other thing I just wanted to share is that I'm an advocate for nontraditional roles. I didn't want to take the easy way and just have a traditional ambulatory care pharmacist job. I was like, let's try to expand and think outside the box and see what else pharmacists are capable of doing. Because of my position here at UCSF, I think I'm very fortunate and able to meet the right people and make this [program] happen.

: Whether it’s your expertise in treating complications like cardiovascular disease or your forward-facing positioning within the community, how does an initiative like the Cut Hypertension Program highlight the importance of pharmacists within health care?

Like I mentioned earlier, I think a lot of patients still see pharmacists as these drug dealers or drug handlers that are just waiting behind the counter to give them their medications. But with these more advanced roles in the community, I think we can really reshape and rewrite the story of a pharmacist. Pharmacy management happens in a lot of clinics already. In a lot of outpatient medicine clinics, cardiology clinics, even some specialty transplant clinics, there are pharmacists there who see patients independently, and they're titrating medications and ordering labs for them. But if you as a patient are in the community, and you don't go to these clinics, and you don't regularly see your health care team, then you'll never know that these types of pharmacists even exist.

I think the beauty of my role in the Cut Hypertension Program is I am interfacing with community members who otherwise may not have even met their health care team. They don't know about who else is on their health care team. I think of myself as an extension to the physician that I work with because, when we work together, he's able to see his patients, I'm able to see the patients in the barbershop. We're able to be so much more effective with blood pressure management and also efficient. [We can] see twice the number of people in the same day as one person would be able to see. I do think more roles like mine in the Cut Hypertension Program would be very, very beneficial to the community and also helping to promote the role of an advanced-practice pharmacist.

Team-Based Care Crucial in Addressing Workforce Shortages

Are you ready to elevate your pharmacy practice? Sign up today for our 

Crystal Zhou, PharmD, APh, AHSCP, BCACP, joined Drug Topics to further discuss the Cut Hypertension Program and nontraditional roles within health care. 

Q&A: Advanced Practice Pharmacist on Nontraditional Roles in Health Care

Pharmacists’ expertise in medications and managing patients’ prescription regimens makes them the authority, among other providers, for helping patients use and access ultra-high-cost drugs.

Because of their reach in such small amounts of the population, gene and cell therapies have skyrocketed in price, leading to the coining of the term “ultra-high-cost drugs” (UHCDs). According to the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast, UHCDs are commonly reserved for rare and orphan diseases, showing little pharmaceutical demand and driving prices up to the millions.

Erin Fox, PharmD, MHA, BCPS, FASHP, was a co-author for the latest edition of the ASHP’s Pharmacy Forecast, contributing to a section titled “Managing Ultra-High-Cost Drugs.” She joined 

 to dive deeper into this section of the report and gave us her thoughts on the pharmacist’s role in helping patients manage these costs.

“Pharmacists can help patients end up being able to access those products, if we can think of good terms that are agreeable to [the] payer as well as the health system,” said Fox. “Pharmacists uniquely—maybe even different than providers—are very familiar with the payer side as well as the clinical side. I think that ability to have that broad view makes them a really helpful asset to the folks at the health system that might be working on that specific contract.”

Stay tuned for weekly podcast episodes on 

 every Thursday afternoon. Check out our previous episode with 

, who also co-authored a section of the ASHP 2025 Pharmacy Forecast

In our ongoing coverage of the forecast, Watanabe discussed workforce shortages and the role pharmacists play in alleviating them.

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. AJHP. 2024;82(2). doi.org/10.1093/ajhp/zxae280

Erin Fox, PharmD, MHA, BCPS, FASHP, joined Drug Topics to discuss ultra-high-cost drugs and the American Society of Health-System Pharmacists 2025 Pharmacy Forecast.

Health System

Pharmacists as the Authority on Ultra-High-Cost Drugs

Despite artificial intelligence (AI) setting itself apart as commonplace within society, according to industry experts, the health care sector tends to adopt new technologies at a more gradual pace. With its slow but inevitable implementation into pharmacy practice, pharmacists hope that AI can give them back the joy of working in their profession.

“Long term, I really hope that AI can humanize care again and address some significant issues like burnout and just bring back kind of that human element into health care that it feels like we've lost over the years,” said Scott Nelson, PharmD, MS, FAMIA, ACHIP. “I would love to see AI bring joy back into the practice of pharmacy.”

Contributing to a section titled “Navigating Generative AI: Opportunity and Risk,” Nelson helped co-author the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. He recently caught up with 

 to discuss developments regarding AI and how they will impact the pharmacy profession in 2025 and the long-term future.

Stay tuned for more Drug Topics interviews regarding the ASHP 2025 Pharmacy Forecast. As we meet with authors and industry leaders that contributed to the report, we will discuss some of its most important sections.

Q&A: The Rise of AI in Alleviating Health Care Workforce Challenges

: Can you briefly explain where we’re at now as far as AI within pharmacy practice? How are pharmacists using it now and to what extent has AI become commonplace in pharmacy?

AI is already here and already being used. Most of the space is in predictive models. It's also being used a lot with drug discovery, research, purchasing, and inventory management; those kinds of things. Within the clinical context, it's also used in some decision support tools for identifying adverse drug events or even providing more context for alerts and drug information. So, there’re little pieces where it's being used.

The generative AI space is still pretty new, and I would say health care lags behind pretty much everybody else in how quickly we adopt things. But there's been a lot of uptake with the generative AI models. [We’ve] been seeing more of that with like electronic prior authorization, chart summary, helping facilitate writing notes, ambient scribe kinds of things. [This is] where that's starting to take off, but it's all kind of still a work in progress.

: We know that the advancement of AI inside and outside of the health care sector is considerably gradual. By the time AI is fully integrated into the pharmacy profession, what are your long-term hopes for what AI can accomplish in future pharmacy practices?

Long term, I really hope that AI can humanize care again and address some significant issues like burnout and just bring back kind of that human element into health care that it feels like we've lost over the years. I would love to see AI bring joy back into the practice of pharmacy. Not just make it so that we can push more widgets through or move more scripts but have more time connecting with people and less time doing administrative tasks; more time doing those things that we do really well as humans, connecting with others.

: Regarding the current state of AI, what advice would you give pharmacists struggling to understand its capabilities and successfully adapt it within their pharmacy setting?

There's a lot of opportunity to learn more about AI; what it is, what it's capable of, what it can do, and what it can't really do. I think that there's a lot of science fiction and a lot of stuff that's kind of hyped up that just isn't really practical. [It’s] kind of understanding the limitations of both. I think if we really understood better as a profession how we could leverage the technology at what it's really good at, then we could see a lot more success. There are a lot of resources available for learning more about the topic on AI. There’re articles in various journals, certificate programs, CE programs, a lot of different resources. I recently did some work with ASHP and they have a resource page that they've been putting together for AI. There was an article that a group of us put together on demystifying AI in pharmacy. It was a primer published in AJHP. There’re other things out there to learn more.

I also think just experimenting with the technology is also important. We have the opportunity to play around with a lot of these large language models and generative AI tools. Things like CoPilot, Gemini, you name it—there's so many different models now—[it’s] just kind of playing around with it, being careful to not submit [protected health information] to those environments. You can use it for a lot of different things, for creating simulations of cases, for education, help make synthetic data, help write queries for different things, help brainstorm, and think about problems in different ways. There're lots of different fun ways to play with the technology, and just see what works, what doesn't work. Get more familiar with its strengths, its limitations, and see where it can fit into your workflow.

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. 

. 2024;82(2). doi.org/10.1093/ajhp/zxae280

Scott Nelson, PharmD, MS, FAMIA, ACHIP, joined Drug Topics to discuss the 2025 Pharmacy Forecast and AI’s role in the future of pharmacy practice.

Q&A: How Pharmacists Can Use AI to Humanize Care

The Cut Hypertension Program was established with the goal of bringing care to underserved communities within the Bay Area of California. Offering hypertension management services for patients and health coach training for barbers, the program’s coordinators have worked to make barbershops in their community a health care setting for all local residents.

“What we're trying to do is bring medicine to the community instead of the other way around,” said Crystal Zhou, PharmD, APh, AHSCP, BCACP. “It could be a barbershop, it could be a nail salon, it could be a church. I think this model of bringing care into the community for the people who need it most is what's really important and could make a huge impact in public health and really improve people's blood pressures.”

Crystal Zhou, PharmD, APh, AHSCP, BCACP, discussed her role as Lead Pharmacist of the Cut Hypertension Program. 

B. Douglas Hoey, RPh, MBA

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