Allergy

Autoimmune Diseases

Biosimilars

COVID-19

Cannabidiol (CBD)

Cardiology

Compounding

Continuous Glucose Monitoring

Dermatology

Diabetes

Digestive Health

Endocrinology

Eye Health

Generics

Headache and Migraine

Immunization

Infectious Disease

Influenza

Medical Devices

Mental and Behavioral Health

Neurology

Obesity Management

Oncology

Nonopioid Pain Management

Pain Management

Pediatrics

Public Health

Rare Diseases

Respiratory

Rheumatology

Shingles

Substance Use Disorder

Technology and Data

Veterinary Pharmacy 

Women's Health

News

FDA Updates

Law and Advocacy

Technology Trends

Viewpoints

All News

Media

Around the Practice

In-Depth Insights

K-Casts

Script-Ed

Expert Interviews

Podcasts

Conferences

Conference Coverage

Conference Listing

Resources

Disease Awareness 

White Board Video

American Pharmacists Month

CME/CE

Partners

Publications

Drug Topics Journal

Total Pharmacy Journal

Events

Virtual Events

Total Pharmacy Solutions Summit

Business

Business Strategies

Patient Services

Pharmacy Inventory

Law and Regulations

All Business News

Practice Type

Independent Pharmacy

Chain Pharmacy

Specialty Pharmacy

Health System Pharmacy

Pharmacy Technicians

Subscribe

Articles

XG005 from Xgene Pharmaceutical is a novel, non-opioid chemical entity that targets anti-nociceptive and anti-neuropathic pain pathways.

Non-Opioid Analgesic Shown to Reduce Post-Surgical Pain in Phase 2 Trial 

Check out this list of our top 5 most read immunization stories from the year 2024.

Immunization: Most Read Stories From 2024

Check out this list of our top 5 most read nonopioid pain management stories from the year 2024.

Nonopioid Pain Management: Most Read Stories From 2024

Check out this list of our top 5 most read obesity stories from the year 2024.

Obesity: Most Read Stories From 2024

About

Advertise

Editorial

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Drug Topics

Facebook

LinkedIn

Spotlight

ASHP Midyear 

NCPA Annual Convention

1rem

Authors

Migraine is one of the most common neurologic disorders in children and adolescents with a prevalence of 7.7%.

Evidence-Based Treatment for Pediatric Migraine Prevention

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

From collaboration between various providers in an ambulatory care setting, pharmacists can take a significant workload burden away from primary care providers (PCPs) while simultaneously increasing patient access to care and other necessary medical services.

“Ambulatory care pharmacists provide clinical services as members of population health (PH) and direct patient care (DPC) teams. The value of pharmacists’ services in these 2 common practice models is typically assessed by the achievement of patients’ clinical outcomes, financial savings, and patient satisfaction,” wrote authors of a poster presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana.

To further understand the value of an ambulatory care team—and the role of pharmacists within that team—researchers observed how each team’s operations impacted patient access to care and PCP workload burden. While access to care and workforce burnout continue to plague the health care industry, researchers hoped to use their successful findings to inform further collaborative approaches to providing care.

Pharmacists as Key Players in Managing Chronic Conditions | ACCP 2024

Indeed, according to the Health Resources & Services Administration, primary care physicians will reach a total shortage of over 87,000 full-time equivalent providers. Furthermore, over half of all primary care physicians included in the report (279,194) said that they felt burned out in 2022. Although the report focused on a year impacted by unprecedented events such as the COVID-19 pandemic, PCP burnout is a real issue that experts believe can be fixed by a more collaborative approach.

“This study was conducted at a federally-qualified health center with a PH team pharmacist who served 14 statewide practices and 200 PCPs, and an academic-affiliated physician organization with a pharmacist who provided DPC services at 3 physician practices with 25 PCPs,” they wrote.

Comparing the DPC and PH practice models, researchers attempted to better understand the full extent of ambulatory care pharmacists’ role in improving care, access, and workforce burnout. In providing contrast between these 2 models, researchers were able to highlight where exactly pharmacists stood out in the process.

“The [PH] model dynamically simulates individuals’ disease states, risk factors, and health determinants in order to describe and project health outcomes, including disease incidence, prevalence, life expectancy, health-adjusted life expectancy, quality of life, and health care costs,” according to authors of a study published in 

The DPC model, however, is not based on specific fee-for-service assistance from PCPs. Rather, DPC has more of what experts would call a longitudinal approach to care, where family physicians are typically common and they help their patients over a longer period of time.

 With the DPC model being more common in frequent visitors to various health care destinations, its PH counterpart focuses on real-world data to inform one-time PCP decisions.

“For both pharmacist practice models, we calculated: pharmacist workload capacity as the number of patients receiving medication reviews or pharmacist-patient visits annually; PCP time saved or required for the implementation of the pharmacist recommendations; and additional PCP appointments opened up to improve patient access,” they continued.

Starting with pharmacists’ workloads, the PH model allowed pharmacists to conduct 1664 more comprehensive medication reviews per year, compared with pharmacists from the DPC team. As previously mentioned, the key factor allowing the PH model to complete more reviews is the DPC model’s longitudinal approach.

Moving to PCP workload burden, the PH model required an increase of 384 hours per year for PCPs, mainly due to the PCP having to review all pharmacist recommendations. The DPC model, however, was able to reduce the PCP workload by 640 hours per year because of collaborative practice agreements (CPAs) that don’t require PCP approval.

Finally, the DPC model was also successful in opening up 1920 PCP appointments each year for patients in need of immediate care or consultation. “Given the shortage of primary care physicians and long patient wait times to get a PCP appointment, it is important to recognize that pharmacists can provide medication management services in ambulatory care settings,” continued the authors.

While each ambulatory care model has its advantages and disadvantages, experts agree that pharmacists can step up to both provide greater access to care and relieve the burdens of thousands of PCPs. With more and more collaborative practice settings proving to be beneficial for various populations, researchers believe these models are crucial for making patient care accessible.

“When using a PH practice model, additional PCP workload is required to review and implement the pharmacists’ recommendations. In contrast, expanding ambulatory/primary care teams with pharmacists using a DPC model and CPAs can reduce PCP clinical workload burden. Also, patient access can be improved by opening up PCP appointments as a result of shifting,” concluded authors of the study.

2024 ASHP Midyear Clinical Meeting and Exhibition here

1. Smith M, Mulrooney M. A comparison of ambulatory care pharmacist practice models on patient access and primary care provider (PCP) workload burden. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA. Poster 8-007.

2. State of the primary care workforce, 2024. Health Resources & Services Administration. November 2024. Accessed December 16, 2024. 

https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/state-of-the-primary-care-workforce-report-2024.pdf

3. Hennessy DA, Flanagan WM, Tanuseputro P, et al. The Population Health Model (POHEM): An overview of rationale, methods and applications. 

https://doi.org/10.1186/s12963-015-0057-x

4. Direct primary care. American Academy of Family Physicians. 2024. Accessed December 16, 2024. 

https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/direct-primary-care.html

Experts conducted a study to better understand how ambulatory care pharmacist services impacted patient outcomes, provider workload, and access to care.

Health System

Ambulatory Care Pharmacists to Decrease PCP Workload, Increase Patient Access | ASHP Midyear

With biosimilar medications standing out as a cost-effective option for brand-name prescription drugs, they have garnered speculation among both patients and providers regarding efficacy and safety. Coupled with their recent introduction into the pharmaceutical space, experts believe education on these newly adopted medications is key to improving patient outcomes.

“Educating patients and making sure that we address their concerns is key,” Amanuel Kehasse, PharmD, PhD, Director of Clinical Programs and Drug information at Clearway Health in Boston. “Providers [are] the same. A lot of providers have concerns to use biosimilars, especially for the non-medical switch. Educating providers why this will be important clinically and financially for the health care system would be key.”

Check out Kehasse’s exclusive interview with 

, discussing the common barriers providers face when looking to encourage the use of biosimilars and how pharmacists will be able to maneuver these issues going into 2025.

: What are the key barriers to biosimilar implementation and how can those barriers be addressed?

There are several barriers to biosimilar implementation to clinical practice. The first is the perception or knowledge gap that exists in providers and patients themselves. Speaking of the patients, they are the final step of biosimilar conversion and implementation and they are the ultimate users of this medication. We know from [a] survey stance, so far, there is a gap in their knowledge about biosimilars. Some of them do not understand what [a] biosimilar is. Some of them may think this is an inferior medication because they always hear the lower cost. So, this is for us to educate: Always, health care should be a cost-effective care provision without compromising the safety and efficacy of the medication. Biosimilars give us that alternative cost-effective care to reference products, so [it’s] educating them that the lower cost does not mean the biosimilar is inferior. We can also share some real-world evidence to show patient experience after the transition to biosimilar. What happened? Are they happy with it clinically? How did they do? That's when the real-world evidence data comes to play to make sure that patients are comfortable to switch. Educating patients and making sure that we address their concerns is key. Providers [are] the same. A lot of providers have concerns to use biosimilars, especially for the non-medical switch. Educating providers why this will be important clinically and financially for the health care system would be key.

The other one is system barriers. Health systems need to make sure that they build the infrastructure to adopt biosimilars. It's a blessing in disguise for operational complexity in pharmacies. When you have multiple biosimilars coming to the market, then you have to have inventory that will have to [be addressed] efficiently. It opens up for errors, so they have to build infrastructure [on] how to manage multiple [inventories] for multiple biosimilars. Pharmacists need to be sure that they are using the right medication and [electronic medical records] (EMR) for physicians to make it easier to prescribe biosimilars. You have to build the structure and [EMR] to make sure that the ease of ordering is put in place, because you don't want them to struggle to find which medication will be appropriate to them. Formulary decisions [are] also important. Not only insurance but health systems have to put this medication in their formulary so that acquisition will be easier. A third is the pair themselves. So once biosimilars are coming to the market—we've seen back in 2020, 2021, up to 2023—there was a significant delay in adoption of biosimilars. Part of that has to do with the patent litigation of manufacturers, but part of that has to do with the pairs; not adapting these biosimilars into their formulary. Or even if they do, they make [it] non-preferred. All these things will delay or impede the adoption of biosimilars into the market.

Drug Topics met with Amanuel Kehasse, PharmD, PhD, to discuss the barriers surrounding biosimilar implementation in the prescription drug market.

Q&A: Educating Patients, Providers to Increase Biosimilar Implementation | ASHP Midyear

When it comes to medication that protects patients against chronic obstructive pulmonary disease (COPD) symptoms, certain inhaler therapies commonly stand out as the first line of defense. However, for patients who may not be aware of this defense, or for patients who don’t know how to use an inhaler device, pharmacists are the best-positioned providers to help patients with COPD.

“[It’s] going to be important that we continue to reinforce education on how to use these devices appropriately. There are studies out there showing that even if patients have perfect inhaler device technique at a visit, up to half of them will introduce some sort of error into that technique at a subsequent visit,” said Lourdes Cross, PharmD, BCACP, CDCES.

Cross is an Associate Professor at Sullivan University College of Pharmacy and Health Sciences. 

 caught up with her at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana. Read through our conversation with Cross to learn more about COPD therapies and how pharmacists can go above and beyond in this space specifically.

: How can pharmacists help educate patients around COPD therapies?

There are a lot of times where we can provide really good education and reinforce that education throughout in our face-to-face interactions with our patients. So definitely demonstrating how to use these various inhaler devices; there are so many out there. Ensuring that a patient is comfortable in using their device is going to be key in having good efficacy and good patient outcomes. [We’re] also allowing them to work with those practice demo devices. We don't want patients to pick up their prescriptions, go home, and to start messing with the inhaler, which they can inadvertently end up wasting doses of that inhaler. So being able to have them in clinic, use those practice devices, and to be able to correct them and to reinforce education is going to be super important.

: What is the pharmacist’s role in helping patients manage COPD exacerbations?

We want to prevent the exacerbation from happening. As pharmacists, we're often the first health care professionals to notice that there's some sort of issue happening, that an exacerbation is occurring or has occurred. Things we can look out for include increased use of rescue inhalers, as well as maybe a deterioration in their symptoms, because oftentimes in these routine visits, we can notice differences in things like their breathing.

[We’re] also ensuring that they have access to rescue inhaler therapy. So again, cost can be a barrier related to inhaler therapies, but also, do the patients know how and when to use those therapies is going to be important. After the exacerbation, [it’s] going to be important that we continue to reinforce education on how to use these devices appropriately. There are studies out there showing that even if patients have perfect inhaler device technique at a visit, up to half of them will introduce some sort of error into that technique at a subsequent visit. I can't reiterate enough importance, reassessing inhalers every time we have a face-to-face interaction with a patient.

Drug Topics met with Lourdes Cross, PharmD, BCACP, CDCES, to discuss pharmacists’ role in managing patients’ chronic obstructive pulmonary disease.

Q&A: How Pharmacists Can Help Patients with COPD, Inhaler Misuse | ASHP Midyear

Kelly Malkamaki: Part 1

Kelly Malkamaki: Part 2

Kelly Malkamaki: Part 3

Kelly Malkamaki: Part 4

Community pharmacies have been dealing with a variety of financial pressures that have led to decreased profit margins. According to data from the 2024 NCPA Digest, gross profit margins fell to 19.7% this year for pharmacies, the lowest point in the report’s 10-year lookback window.

 A key reason for this decrease is low medication reimbursement rates by third-party payers.

Although dispensing prescription medications is a primary income source for most community pharmacies, the continued decrease in reimbursement rates necessitates a move towards other ways to increase the bottom line. Offering additional clinical services, such as vaccine programs, point-of-care testing, and long-term care services, are great ways to do this. Another innovation that can help independent pharmacies is incorporating technology into workflows, which can help improve business efficiency and increase the patient experience.

AssureCare, a population health management company, is working to provide software that connects payors, providers, and pharmacies. The company’s goal is to help these parties work efficiently and effectively together to improve patient outcomes by managing medication-related risks. AssureCare’s technology solutions automate complex tasks, optimize workflows, and offer deep analytics, enabling informed decisions and cost-effective care delivery. AssureCare offers a wide range of solutions for community pharmacies including medication management, ONC certified EHR medical billing, credentialing and revenue cycle management services.

, Kelly Malkamaki, senior product pharmacy analyst at AssureCare, discussed how pharmacies dealing with decreased medication reimbursement rates can incorporate different revenue streams into their business, what role technology plays in pharmacies today, and how AssureCare can assist pharmacies.

Drug Topics talked with Kelly Malkamaki, pharmacist, former independent community pharmacy owner, and senior product pharmacy analyst at AssureCare, about how community pharmacies can continue to thrive with decreased medication reimbursement rates.

Christina Graley, MD

Articles

Latest Updated Articles