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Public health and infectious disease experts offered their perspectives on the 2024 US bird flu outbreak and its potential of becoming a greater public health crisis.

H5N1 Bird Flu: A Slowly Looming Public Health Threat

On the most recent episode of Over the Counter, James Rider, PharmD, joined Drug Topics to discuss his career journey as a chain pharmacist. 

Chain Pharmacist Embracing Expanded Role in the Profession

Researchers explored the benefits of tai chi and prevalence of liver disease in patients with osteoarthritis.

Tai Chi Intervention, Liver Disease Prevalence for People with OA | ACR Convergence

Research presented at American Heart Association’s 2024 Scientific Sessions examined the SGLT inhibitor’s effect on systolic blood pressure.

Sotagliflozin’s Effect on BP Remains in T2D Regardless of Kidney Function | AHA 2024

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Spotlight

NCPA Annual Convention

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In the "B.S. vs. Pharm.D." exchanges that have been featured in these pages over recent months, one facet of the issue has been overlooked. A sine qua non of pharmacy is attention to detail, yet these exchanges have, as is so often the case, fallen into using the abbreviation "B.S." to refer incorrectly to the bachelor of science in pharmacy degree.

Viewpoint: A matter of degree: Let's get it right

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

Today, effective and executional pharmacy workflow relies on the common goal of shortening wait times and streamlining services. However, according to presenters at the National Community Pharmacists Association (NCPA) 2024 Annual Convention and Expo, the future state of pharmacy workflows will be designed around the quality of each patient’s care and their overall clinical experience.

In a session presented at the NCPA 2024 Annual Convention and Expo, Cascadia Pharmacy Group’s Tara Pfund, PharmD, and Crystal Bryan, PharmD, presided over the community pharmacist audience to discuss how basic, everyday pharmacy processes are expected to shift in the future.

“We want to work towards that freedom state, where instead of patients coming to us for a short wait time, they come to us for care. We are that point of access, and they trust us for our advice, and they go back and tell all of their friends, and [then you] have a whole other revenue stream coming into the pharmacy as well,” said Bryan.

The duo went into depth about the structure of a pharmacy’s workforce, from techs and clerks to students and residents. They mentioned how each employee within the pharmacy plays a key role and how pharmacy owners should be assisting their employees on a daily basis to ensure they are working at the top of their licenses. Pfund then shared her thoughts on one of the most important aspects of ensuring any team functions properly, not just in the pharmacy.

“If you think about a good communication plan that’s layered in the vision and where you're headed, that can make a huge difference,” she said.

Pfund went further into depth about how her pharmacy team executes their streamlined workflows and focuses on patient care. She discussed how pharmacists should be encouraged to offer more services than what patients had originally intended prior to visiting. If a clinical encounter at the pharmacy can solve more than one patient outcome, both the patient and the pharmacist will leave that encounter having gone above and beyond the normal processes.

“We ask, ‘Do you want to have a vaccine assessment?’ So, the pharmacist will let you know what additional vaccines you might need, and they say ‘Yes’ or ‘No,’ and we ask for their medical insurance card at that point in time. We then have a pharmacist intern actually remotely logging in…and she prepares clinical recommendations and actually pre-charts in our medical billing software a vaccine assessment for the clinical pharmacist,” continued Pfund.

They discussed clinical services in general and the common, and not-so-common, care patients can receive during any clinical encounter at a local pharmacy. According to Bryan and Pfund’s presentation, pharmacists can evaluate, screen, manage, and treat select conditions; conduct medication management; and establish health outcome or value-based care payment models. Furthermore, they gave specific examples of clinical services pharmacists can administer, like point-of-care testing for strep throat, lipid screenings, diabetes management, and so much more.

Ultimately, its pharmacists’ duty to meet and exceed patients’ expectations.

 At the very minimum, and especially in the community setting, pharmacists should dispense medication and communicate to their patients with the utmost quality. They should also be able to meet patients’ urgent needs and create basic clinical programming.

Bryan and Pfund concluded their presentation by explaining that a good pharmacy workflow is less about the actual tasks done as a business owner or pharmacist, but it’s about transforming the mindset. They stated that to run an operable independent pharmacy, owners should consider shifting the mindset of providers, payors, patients, and most importantly, the pharmacy.

Click here to follow along with our NCPA conference coverage

Coverage of the National Community Pharmacists Association 2024 Annual Convention and Expo was supported by Red Sail, with independent editorial content creation on-site by the Drug Topics team.

1. Pfund T, Bryan C. Workflow and mindset shifts: Enabling clinical program growth in community pharmacy. Presented at: National Community Pharmacists Association 2024 Annual Convention and Expo; October 26-29, 2024; Columbus, OH.

Presenters at the National Community Pharmacists Association 2024 Annual Convention and Expo discussed workflow and the future of pharmacy as a patient destination.

Practice Management

How to Turn Patient Visits into Clinical Encounters in the Pharmacy | NCPA 2024

TaQuina Warren, PharmD: Part 1

TaQuina Warren, PharmD: Part 2

TaQuina Warren, PharmD: Part 3

TaQuina Warren, PharmD, is an independent pharmacist and owner of Focus Pharmacy in Smyrna, Delaware. She has been a community pharmacy owner since 2019 and is touted in high regard amongst community members and peers within the state of Delaware. She prides herself on being a pillar of valued care in her community, and she sat down to discuss her experience in pharmacy.

Warren has always wanted to serve her communities and take care of the people who make those communities thrive. She first wanted to pursue a career as an OBGYN but was later encouraged to consider a profession in pharmacy, and she hasn’t looked back since.

Known as “Dr. Tee” to her patients, Warren has become somewhat of a celebrity in her community. Appearing on programs like “Good Morning America” and being recognized by pharmacy customers on a daily basis, she has garnered a reputation for providing care and always being a resource for the patients within her community.

, Warren discussed her experience as a pharmacist and their expanding role within health care, and she touched on some of the inner workings of her pharmacy practice.

Our coverage of American Pharmacists Month continues all October. To view all of our interviews, 

visit our American Pharmacists Month landing resource center

In an interview with Drug Topics, TaQuina Warren, PharmD, discussed what it means to serve her community and how she has garnered a reputation within her profession.

The Celebrity Pharmacist Bridging Gaps in Community Care

Benjamin Jolley, PharmD: Part 1

Benjamin Jolley, PharmD: Part 2

Benjamin Jolley, PharmD: Part 3

Benjamin Jolley, PharmD, is an independent pharmacist at Jolley’s Compounding Pharmacy in Salt Lake City, Utah. With nearly 20 years in the profession, Jolley shared his insights on the industry as a whole and what his pharmacy experience has been like.

Jolley grew up around the pharmacy profession: His grandfather was a pharmacist, which encouraged Jolley to follow that same career. His entire career has been in independent community pharmacies and he has since evolved into consulting within the independent space.

analysis of pharmacy locations across the country

, detailing the 2000-plus stores that have closed in 2024 alone. And amidst ongoing pressure toward pharmacy benefit manager (PBM) reform, Jolley has teamed up with independents across the country to fight back as an advocate for community pharmacies.

, Jolley discussed his experience as a pharmacist and their expanding role within health care, and he touched on some of the inner workings of his pharmacy practice.

Our coverage of American Pharmacists Month continues all October. To view all of our interviews, 

Drug Topics sat down with Benjamin Jolley, PharmD, of Jolley’s Compounding Pharmacy, to discuss the pharmacy industry and his experience in a myriad of roles within the profession.

An Independent Pharmacist’s Journey to Championing Community Care

Walmart has filed suit against the United States Department of Justice (DOJ) and the Drug Enforcement Administration (DEA), asking a US District Court judge to clarify the roles and responsibilities of pharmacists and pharmacies under the Controlled Substances Act (CSA), the retailer said in a news release.

Although Walmart’s pharmacies have blocked “thousands” of questionable physicians from having their opioids scripts filled by its pharmacists, “certain DOJ officials have long seemed more focused on chasing headlines than fixing the crisis,” the retailer said. “They are now threatening a completely unjustified lawsuit against Walmart, claiming in hindsight pharmacists should have refused to fill otherwise valid opioid prescriptions that were written by the very doctors that the federal government still approves to write prescriptions.”

Walmart is the third-largest pharmacy retailer in the US, with more than 5000 pharmacies nationwide. The supermarket chain has expressed its commitment to fighting the opioid epidemic, which has worsened over the years; overdose deaths from opioids were 4 times higher in 2018 than in 1999.

However, there is no federal law requiring pharmacists to interfere in the phyisician-patient relationship to the degree that DOJ is demanding, according to Walmart. “In fact, expert federal and state health agencies routinely say it is not allowed and potentially harmful to patients with legitimate medical needs,” Walmart said.

On one hand, DOJ is criticizing Walmart for not taking further actions to second-guess opioid presciptions; on the other, state health regulators argue that Walmart is unnecessarily meddling with physician-patient relationships, according to the news release.

“DOJ is forcing Walmart and our pharmacists between a rock and a hard place,” Walmart asserted in its statement.

The confusing dichotomy requires a federal court to clarify the roles and responsibilities of pharmacists and pharmacies, according to Walmart.

“Walmart and our pharmacists are committed to helping address the opioid crisis that has affected so many. We are proud of our pharmacists, who help patients understand the risks about opioid prescriptions, and who have refused to fill hundreds of thousands of opioid prescriptions they thought could be problematic,” Walmart added.

 was filed on October 22 in the US District Court for the Eastern District of Texas.

Walmart sues DOJ and DEA seeking clarity for pharmacists in dispensing prescription opioids. News release. Walmart; October 22, 2020. Accessed October 26, 2020. 

https://corporate.walmart.com/newsroom/2020/10/22/walmart-sues-doj-and-dea-seeking-clarity-for-pharmacists-in-dispensing-prescription-opioids

Redman R. Walmart sues DOJ over pharmacists’ role in dispensing opioid prescriptions. Supermarket News. October 23, 2020. Accessed October 26, 2020. 

https://www.supermarketnews.com/health-wellness/walmart-sues-doj-over-pharmacists-role-dispensing-opioid-prescriptions

Walmart filed a pre-emptive suit against 2 government agencies that are threatening to sue Walmart over its pharmacists filling opioid prescriptions.

Joseph L. Fink III, BS Pharm, JD

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