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NCPA found three things that pharmacists desperately want changed. Here’s how they’re going to do it.

What Community Pharmacists Want-And How You Can Get It

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

With an estimated 75 million Americans living in areas of primary workforce shortages, health care experts and providers around the country are teaming up to address the issue. In a push to utilize the expertise of multiple providers, health care professionals believe it is necessary for pharmacists, physicians, and various other providers to work together in a team-based setting to ensure better outcomes and alleviate shortages.

“When we really think about the provider, the pharmacist [should] not [be] left out of that dialog, because we saw that also during the pandemic,” said Jonathan Watanabe, PharmD, MS, PhD, BCGP. “Pharmacists took on this heroic role, but that role, that emotional toll, the time, and the fatigue, those components weighed heavily. We have to be really strategic about incorporating that, otherwise the gains that we're going to have, potentially for pharmacists being involved, are going to be short lived.”

Watanabe was a contributing author for the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. The section he co-authored, titled “Addressing the Gap in Primary Care,” focused on identifying gaps within the primary care workforce, possible legislation to alleviate the issue, and the role pharmacists can play within a team-based practice to address shortages.

“How do we make sure that we make pharmacists whole for these contributions that they're making to primary care? I think a lot of that really needs to be looked at and there's groups that are doing it, but I think we need to enhance that,” he continued.

Listen to our full conversation with lead Pharmacy Forecast author Jonathan Watanabe as he discusses the scope of pharmacists’ practice, highlighting past instances of their unique skills within the community and their future potential to be key players within a primary care team.

“I think we're getting better at understanding how collaborative practice agreements can be best developed to maximize. I think it's almost the implementation science of it is now becoming very important. We know that it works, but how to do it in a way that's going to meet the needs of the setting, of the population, that we could show the benefit.”

Stay tuned for weekly podcast episodes on Over the Counter every Thursday afternoon. Check out our previous episode with 

, who also played a part in the 2025 Pharmacy Forecast as leading co-editor. In our ongoing podcast series on the ASHP 2025 Pharmacy Forecast, DiPiro introduced the industry-encompassing report and why it’s such a crucial resource for health-system pharmacy.

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

Jonathan Watanabe, PharmD, MS, PhD, BCGP, discussed gaps within primary care in the context of the American Society of Health-System Pharmacists 2025 Pharmacy Forecast.

Health System

Team-Based Care Crucial in Addressing Workforce Shortages

For pharmacists in both academic and practice settings, it’s important to stay ahead of the curve and keep up with the dynamic landscape of their profession. While it can be hard for them to juggle continued pharmacy education and day-to-day tasks behind the counter, the American Society of Health-System Pharmacists (ASHP) bridges that gap with its annual Pharmacy Forecast report.

The ASHP Pharmacy Forecast is “written to identify and contextualize emerging trends that will influence health care, health systems, and the pharmacy profession.” This year’s report delved into several key areas impacting the pharmacy profession, including generative artificial intelligence (AI), addressing health care workforce shortages, and so much more.

“We begin with a group of advisory committee members…who are experts in various aspects of the pharmacy field and enterprise,” said Joseph DiPiro, PharmD, FCCP, FAAAS. “They help us decide what domains to pursue. Then, a survey is constructed that goes out to 300 leaders in pharmacy around the country. The other parts of this survey [are] given to chapter authors who put together an analysis and interpretation from the survey results and put their spin on it as well. The final part of it is each of the chapters [have] recommendations that are meant for pharmacy leaders.”

Joseph DiPiro is a Professor in the Department of Pharmacotherapy and Outcomes Science at the Virginia Commonwealth University School of Pharmacy and he was one of the leading co-editors of the 2025 Pharmacy Forecast. He recently sat down with 

 to discuss overarching themes in this year’s report and why it’s such a useful resource for pharmacists looking to succeed in a challenging profession.

, President of the National Community Pharmacists Association’s (NCPA) Innovation Center. He discussed NCPA’s brand-new consortium for government engagement and how independent pharmacies are crucial resources during public health crises.

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

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

Joseph DiPiro, PharmD, FCCP, FAAAS, broke down the importance of the ASHP Pharmacy Forecast and the process in which its content is curated.

ASHP’s Outlook for the Pharmacy Profession in 2025

The National Community Pharmacists Association (NCPA) recently announced the formation of the Independent Community Pharmacy Consortium for Government Engagement. Designed to create a framework for pharmacies, organizations, and other entities within the pharmaceutical supply chain, NCPA is spearheading this consortium with hopes of alleviating future public health crises.

“Well, we're not trying to replace anything that exists and that functions well today,” said Kurt Proctor, PhD, RPh. “[The consortium] is more to be there and to be ready when something happens and somebody needs to engage independents broadly. Again, we’re the easy button for them to do that.”

To discuss this independent pharmacy “easy button,” Proctor joined 

. As President of the NCPA Innovation Center, he’s played a leading role in getting the consortium off the ground. From the COVID-19 pandemic’s direction on future public health issues to the constant readiness exhibited by independents across the country, Proctor explained exactly why he believes this is a win for patients and pharmacies in the US.

, also known as “The Nutrition Pharmacist.” She discussed new-year diets and the unique combination of pharmacy and nutrition.

PBMs Significantly Marked Up Specialty Generic Drugs

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

The new initiative is a way for NCPA to proactively engage its network of community pharmacies during a potential public health crisis.

NCPA's New Consortium Exemplifies Preparedness in Community Pharmacy

As the most frontward facing providers within health care, pharmacists are constantly looking for more ways to expand their ability to treat patients and serve the greater community. With expertise in medication first, as well as a unique ability to manage patients and garner meaningful relationships that result in better health outcomes, pharmacists have served as a bridge between health care and the patients who receive it.

Pharmacists’ expertise in medication has given them the ability to manage various disease states, procuring medication management regimens that ensure successful health outcomes in patients with diseases like diabetes, cardiovascular disease, and so much more. But for individuals without comorbidities simply looking to improve their overall health and lifestyle, a certified nutritionist may be their best option for counsel.

However, pharmacists with a desire to become experts in nutrition—according to Sarah Gray, PharmD, GAICD, also known as 

—have the ability to stand out even more among other providers and be a crucial source of guidance for any patient looking to improve their lifestyle.

“The combination of pharmacy and nutrition is a match made in heaven. For me, pharmacists have such great skills across many areas,” she said. “I think the key [area] I've found that really matches well with nutrition is our great patient-interviewing skills and being able to really consider all factors of a patient's life; so what medications they're taking, what medical conditions [and] symptoms they have. Now, adding the nutrition side, I can get a really good picture of all the areas of the person's health.”

 to discuss her career journey, starting as a pharmacist and eventually pivoting to nutrition counseling and helping patients with their lifestyle journeys. She then explored overarching opportunities for pharmacists to expand their roles within health care. According to her, the opportunities are endless within pharmacy because of the profession’s wide range of continuously increasing knowledge.

“Don't be afraid to add things in that might seem a bit strange, but also, as a pharmacist itself, you don't need anything else, really. You can offer so much to people as a profession,” she said.

Known as “The Nutrition Pharmacist,” Sarah Gray, PharmD, GAICD, recently joined Drug Topics to discuss her dual profession within health care.

David Smith, RPh

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