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Measuring Medication Adherence: Exploring Issues and Better Solutions

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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 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

LucyRx’s Role in Supporting the Pharmacist Profession

Between a primary care shortage persisting in the US and the pharmacist’s positioning within their respective communities, the pharmacy profession has separated itself apart from other provider roles. However, David Blair, CEO of 

, a new-wave independent pharmacy benefit manager (PBM), still believes pharmacists are being underutilized because of declining reimbursement and antiquated provider regulations.

“We need to do a better job leveraging their experience because they're a trusted resource. Particularly, when you start thinking about the shortage in primary care physicians that we're facing as a country, we need to better benefit from what a pharmacist can offer,” he said.

In part 3 of our interview with Blair, he focused on the utmost importance of pharmacists within the drug supply chain. With their perspective as patient-facing providers interacting with the community, Blair believes prescription drug benefits should not be distributed without pharmacists in mind.

He discussed new initiatives designed to improve challenges within pharmacy deserts and ultimately improve the bottom lines of pharmacies struggling the most. Not only is LucyRx set out to revolutionize how pharmacies are paid for dispensing, but they’re also benefiting patient outcomes with their increased focus on pharmacists’ capabilities.

Watch the full video to find out about LucyRx’s mission to support pharmacies and the employees that support their efforts. Also, stay tuned for the full-length podcast version of our conversation with Blair, releasing on Drug Topics’ Over the Counter podcast channel this coming Thursday afternoon.

Pharmacists’ Expertise Can Improve Patient Outcomes in Transitions of Care

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

The use of medications for treating acute or chronic pain has become a taboo subject in the US as of recent history. Amid a nationwide opioid crisis and the potential rescheduling of drugs like cannabis, the options patients have for treating their pain are vast but not standardized—whether they are prescription drugs or over-the-counter (OTC) products.

In other words, there is a plethora of options for treating pain, but no one option is significantly preferred over others.

“When it comes to the OTCs, the over-the-counter pain management options, we really do have a decent amount of them,” said Mark Garofoli, PharmD, BCGP, CPE. “An individual scenario is going to come down to what a patient has going on, and as health care professionals, we're patients too, so whatever is in our head.”

Garofoli, a certified pain expert, recently joined 

 to discuss common trends in OTC medication use for pain as he’s been working in the pharmacy industry since 2001.

What Pharmacists Should Know About Psychedelic Medicine | APhA 2025

“Most folks, if not all, don't really think about this, but analgesia, where'd that come from?” he continued. “The name just rolls off the tongue now, after [about] a century of experience, but it's derived from Greek to mean ‘without pain.’ So, we literally put out in the aisle a sign that says, ‘Without Pain,’ making that the goal.”

In part 1 of our interview with Garofoli, he delved into current understandings of the OTC space in treating pain. He also discussed emerging OTC options, specifically topicals, that have potential to make waves in the marketplace but are still lacking in efficacy and safety research.

: In your experience as a pharmacist, what are the most common and effective OTC medications that have been used to treat acute pain?

When it comes to the OTCs, the over-the-counter pain management options, we really do have a decent amount of them. An individual scenario is going to come down to what a patient has going on, and as health care professionals, we're patients too, so whatever is in our head. We have those biases based on direct-to-consumer advertising, word of mouth, you name it. Usually we're talking about a pharmacy, but it could also be a grocery store, convenience store, gas station, dollar store, whatever type. [In those places,] we have that analgesics aisle. Most folks, if not all, don't really think about this, but analgesia, where'd that come from? The name just rolls off the tongue now, after [about] a century of experience, but it's derived from Greek to mean “without pain.” So, we literally put out in the aisle a sign that says, “Without Pain,” making that the goal. We have to keep that in mind with folks too. Is that the goal? We certainly want to be compassionate here but is it always the goal is a really good conversation question, of course.

When we're thinking about what people are looking for, it's typically the pill formulations. We have OTC non-steroidal anti-inflammatory drugs (NSAIDs), our most common being ibuprofen, naproxen, and, of course, aspirin in there as well, too. Then [there’s] acetaminophen, or as the entire rest of the world calls it, paracetamol. Good golly, it's like the metric system, but with a pain medicine. We're the only ones. We drive our own truck here in that regard. But those are a lot of the common ones. Topicals: It seems like a new frontier; takes up a lot of the aisles, lots of options out there. And boy, it gets confusing really quick, because it's like, which one, when there's 15 different versions, maybe 10, of each individual product. At least in our society, our culture, it's typically the pill formulations, but our horizons are expanding these days.

: What are the most notable trends you’ve seen in patient preferences for specific over-the-counter pain relief products?

I alluded to the idea of, we typically go to the pill formulations, sometimes liquid as well, too; it depends on the scenario. When our kiddos are in pain or having fevers, oh my goodness, it's like we make it Calc 3 for dosing and we don't even put it on the label. As far as trends overall, you have pill formulations, oral formulations. But then there's a growing trend, and this is observational, don't necessarily have a study, they're out there, but what about topical formulations? It's growing. That being said, are we catching up with the rest of the planet? I mean, when you go to a different continent—not necessarily just outside of our country—it's a very different landscape. The preference, the trends in many other continents would be topical first. Is that right, wrong? It depends on the scenario, of course, too, but we're starting to see some of that shift overall, because there's more education. Yes, there's more marketing out there too, but there's more education as to how to go about pain management when you, I, as the patient, are in charge over the counter.

I think it remains to be said, of course, cannabis and CBD, everything these days, on the tips of everyone's tongue. So topical CBD seems to be a thing. We've had some interesting recent articles with that. Probably one of the most in-our-faces titles and headlines I've seen, a study came out, and literally, the title was like, “Hey, topical CBD, not really working out for pain,” and boy, that catches headlines. It's like the media didn't even have to change the headline; the title was right there. Again, that's one study; there are many others. We have to stop that insanity of going by one study, unless it's quite the profound one. So, those are some of the big-picture trends overall, I'd say.

Stay tuned for more from our conversation with 

, as he further explains OTC medications used for treating pain and the importance of pharmacist counseling among patients using these products.

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our 

Expert on pain medicine, Mark Garofoli, PharmD, BCGP, CPE, CTTS, joined Drug Topics to discuss trends in the safety and efficacy of OTC pain medications and what products patients often seek at the pharmacy.

Q&A: What are the Current, Emerging Trends in OTC Pain Management?

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. 

James Lee, Director, Innovation Solutions – Medication Adherence Jones Healthcare Group

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