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A conversation with Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, at the American Associated Pharmacies 2025 Annual Conference.

Preparedness Key For Delivering Excellent Patient Care in Pharmacies | AAP 2025

Articles

Collaborative practice agreements enable pharmacists to leverage their expertise beyond traditional dispensing, but barriers continue to limit their implementation.

Expanding the Pharmacy: How Collaborative Practice Agreements Can Improve Patient Outcomes

Researchers explored the association of a pneumococcal polysaccharide vaccine booster and health care utilization in children with sinusitis and low pneumococcal antibody titers.

PPSV23 Decreased Sinusitis, Antibiotic Use in Pediatric Patients

Dae Lee, PharmD, Esq, CPBS, discusses the legal and billing challenges hindering pharmacy practices and opportunities to overcome them.

Navigating Legal and Billing Challenges in Pharmacists’ Clinical Services

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Using healthcare professionals to market products is not illegal, but has gained considerable scrutiny from authorities.

Opinion: Avoiding "White Coat Marketing" Accusations 

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

Pharmacies are emerging as trusted health care hubs, with over 50% of consumers now viewing them as primary health care destinations.

At-Home Testing: How Can Pharmacy Play a Role?

The Total Pharmacy Solutions Summit session explored the transformative potential of at-home testing and how pharmacies can become comprehensive health care service providers in the post-COVID era. Jenna Anderson, CEO of KiHealth, and Amanda Wiley, marketing manager of HealthSource Marketing, highlighted the significant shifts in consumer health care preferences and the expanding role of pharmacies in preventative care.

The COVID-19 pandemic dramatically changed health care consumption, with 76% of Americans now interested in at-home testing and 61% reporting they make healthier decisions. Pharmacies are emerging as trusted health care hubs, with over 50% of consumers now viewing them as primary health care destinations. Anderson and Wiley emphasized that pharmacies are uniquely positioned to fill critical gaps in preventative care, especially given the shortage of primary care physicians and increasingly brief medical consultations.

At-home testing evolved significantly, with a wide range of diagnostic options now available, including tests for diabetes, gut health, cancer screening, fertility, and sexually transmitted infections. They showcased specific products like KiHealth's comprehensive health tests and Reese Pharmaceuticals' colorectal cancer screening test, highlighting the accuracy and convenience of these diagnostic tools. Notably, these tests are becoming more affordable and accessible, with many priced under $200 and available directly on pharmacy shelves.

Anderson and Wiley outlined key opportunities for pharmacies, including expanding diagnostic services, generating new revenue streams, and leveraging technology like artificial intelligence to improve patient engagement. Pharmacists can play a crucial role in guiding patients through at-home testing, providing education, and supporting follow-up care. They stressed that pharmacies are evolving from medication dispensaries to comprehensive health care service providers, with the potential to significantly impact preventative health and chronic disease management.

By embracing these innovations, pharmacies can not only improve patient outcomes but also position themselves at the forefront of a rapidly changing health care landscape.

Total Pharmacy Solutions Summit Spring 2025: Clinical Practice Expansion

Jenna Anderson, CEO of KiHealth Inc, and Amanda Wiley, marketing manager of HealthSource Marketing, discuss the evolving role of pharmacies in at-home testing.

Nearly one-third of patients place very high trust in pharmacists.

Expanding Pharmacy Services: Unlocking Clinical Workflow Efficiency and Revenue Growth

In this Total Pharmacy Solutions Summit session, Stephanie Downing, MBA, senior product manager at Outcomes, highlighted the transformative shift in pharmacy services, emphasizing how pharmacists are evolving from traditional medication dispensing to becoming critical health care providers. She underscored significant industry trends, including growing consumer expectations, clinician shortages, and the transition to value-based care, which are driving pharmacies to expand their clinical service offerings.

Downing shared compelling data demonstrating pharmacists' increasing importance in health care. Nearly one-third of patients place very high trust in pharmacists, and studies suggest that empowering pharmacists with greater clinical authority could save millions of lives and potentially generate over $1 trillion in health care cost savings. However, pharmacies face substantial challenges in implementing these expanded services, including complex medical billing processes, fragmented state regulations, and operational workflow inefficiencies.

The Outcomes clinical solution addresses these challenges by providing an integrated platform that streamlines clinical workflows, simplifies medical billing, and supports pharmacies in navigating regulatory complexities. Key features include step-by-step guided clinical encounter workflows, automated medical billing, real-time eligibility checks, and patient engagement tools. The platform aims to remove administrative barriers, allowing pharmacists to focus on patient care while creating new revenue streams through services like chronic disease management, vaccinations, and point-of-care testing.

Downing emphasized that clinical services represent more than just additional work—they are a strategic path to growth, revenue diversification, and elevating the pharmacist's role in health care. By leveraging technology and comprehensive support, pharmacies can overcome operational challenges, improve patient outcomes, and position themselves as essential health care partners in an evolving medical landscape.

Stephanie Downing, MBA, discusses expanding pharmacy services, clinical workflow efficiency, and revenue growth, highlighting the shift from traditional pharmacy roles to providing expanded clinical services.

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. 

Stemming from lessons learned during the COVID-19 pandemic, the National Community Pharmacists Association (NCPA) announced on Thursday the formation of the Independent Community Pharmacy Consortium for Government Engagement—a network designed to engage community pharmacies and other pertinent drug supply chain entities during future public health emergencies.

“[The Consortium] is bringing together pharmacy services administrative organizations, wholesale distributors, and pharmacy management system vendors to streamline the engagement of community pharmacies in public health initiatives,” read an NCPA news release. “Building on the vital role played during the COVID-19 pandemic, independent community pharmacies across the United States are taking proactive steps to enhance their readiness for future public health emergencies.”

Kurt Proctor, PhD, RPh, President of the Innovation Center and Senior Vice President of Strategic Initiatives at NCPA, recently joined 

“It's an effort to make it easier to include independents because that could be challenging,” he told us. “It could be challenging for those who don't understand how independents are organized and aggregated, and who serves them for what functions, etc. It's meant to be a one-stop-shop for engaging independents.”

Read on to learn more about the NCPA’s Independent Community Pharmacy Consortium for Government Engagement. Also, stay tuned for a full-length podcast version of our conversation with Proctor, touching on several themes highlighted by the NCPA Innovation Center’s brand-new initiative.

Community Pharmacy’s Future Hangs on Advocacy, Support From All Healthcare Professionals

: Can you start by discussing what the consortium is and how it came to be?

We worked with a number of entities as we went through the COVID-19 pandemic, and lots of them worked with each other and helped each other as we went through it. If you go back to the beginning, we learned quickly that we needed to help make including independents easier for government entities. They could call a chain and get whatever stores they have, but it's a different type of entity to engage the independents. As the experience came out of that, we spent a lot of time educating the government about independents—how they're aggregated, how they contract, etc—as we got into the pandemic. As we were winding down in the pandemic, we said, “Okay, we need to be even better prepared as we go forward to meet the needs of the public, independent community pharmacies’ customers, and the communities that they serve.” Therefore, we have to take yet another step forward in making it easy to do business with independents and easy for government entities to include independents in their response. I think independent pharmacies really proved to many that they reach very important populations and that they're a very integral part of an overall response to [an] emergency situation.

In the pandemic, we [didn’t] know what the next response [needed] to be. We started out the pandemic needing to contract and needing to figure out how we're going to engage. The federal government was putting together a federal retail pharmacy partner program. They had contracts that were written for chains and they weren't written for independents or aggregators of independents. We had to kind of educate them about what that was like, what these entities are like, what it takes to engage them, and what relationships exist between aggregators and independent pharmacies. We got over that hump and we [we're] doing the vaccinations. Then, all of a sudden, we had free masks to distribute. It became not a contracting issue as much as it was a physical distribution issue. We went beyond the partners that were in the federal partnership program, certainly included them, but we got the 6 regional wholesalers involved in distributing the free masks and connected them with the strategic national stockpile and arranged for those certain pharmacies who are served by those 6 regional wholesalers to participate and be able to reach their pharmacies and their pharmacies’ customers. Again, it's an effort to make it easier to include independents because that could be challenging. It could be challenging for those who don't understand how independents are organized and aggregated, and who serves them for what functions, etc. It's meant to be a one-stop-shop for engaging independents.

: Aside from the pandemic and independent pharmacies shining as a valuable resource for public health, is there another factor or event that spurred a need for this consortium?

No, I don't think so. Not anything specific. We go back in history to other pandemics, other responses, but it was really this one. One of the events that caught our attention quite strongly was, at the beginning of the pandemic, seeing just the big change represented in the White House Rose Garden ceremony. [We were] saying, “Okay, how are they not engaging independents in this?” Because, especially with the populations that they were most concerned about reaching, that's who our members and independent pharmacies serve to a great degree. It was that visualization from the rose garden that said, along with the others who were represented there from the big-box chains, we need to make sure that we have a way for government entities to engage independents more easily in mass.

The entities that were involved in the Federal Retail Pharmacy Partnership Program cooperated with each other quite a bit in terms of sharing things and talking about “How are you handling this? How are you doing that”—all for the good of the country and the good of the patients that we're serving. I think it demonstrated that there were times and there were topics where it made sense to work together and it made sense to put a common, singular face on independents. We also learned that it's tough to get folks who don't deal with pharmacies all the time to understand independents and understand how they're aggregated. There's such a big learning curve. Folks that had just incredibly large sets of responsibility, we would explain the same thing to them multiple, multiple times. You can't necessarily expect them to remember it all. So, [we’re] putting ourselves out there as the experts about how community pharmacies are organized, who they're affiliated with, how they're aggregated, so that the government doesn't have to try to understand that, because they never will, frankly. [It’s] just [letting] them know that here we are as the easy button again for independents.

: With its focus on bolstering public health, who would you say will benefit most from the consortium’s efforts? Would you say it’s patients, community pharmacies, NCPA partners, or just public health initiatives in general?

Well, we're not trying to replace anything that exists and that functions well today, in terms of the relationship between pharmacies, the business partners they have, and the folks who you can think of them being aggregated by. It's 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. At this point, we don't have specific initiatives of our own to undertake other than readiness and making sure that, if the call comes, that we are able to respond to it, that we're able to engage the right people. Depending on what the need is—whether it's contracting, distribution, or dissemination of education and information—all of those things we can facilitate quite easily with a solid understanding of who the players are and how this marketplace works.

McKesson Amplify Initiative Secures Funding for State Pharmacy Associations

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Independent pharmacy partners form new consortium to bolster public health emergency preparedness and response. News Release. NCPA. January 16, 2025. Accessed January 21, 2025. 

https://ncpa.org/newsroom/news-releases/2025/01/16/ncpa-independent-pharmacy-partners-form-new-consortium-bolster

Kurt Proctor, PhD, RPh, President of the NCPA Innovation Center, discussed his organization’s efforts in launching the Independent Community Pharmacy Consortium for Government Engagement.

Jason Mehta

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