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Throughout her research, Jenny Markell, BA, has uncovered some alarming trends within prescription drug advertising in the US.

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It’s never too far into flu season to educate patients.

Debunking 4 Common Myths About the Flu

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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See what’s trending in pharmacy with a preview of the Total Pharmacy August issue.

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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.

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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

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.

Q&A: NCPA Announces Independent Community Pharmacy Consortium for Government Engagement

It is projected between 20% to 30% of all community pharmacies will close in the United States within the next year.

While there are many reasons for this, community pharmacies across the country have been particularly impacted by opaque and anticompetitive pricing practices of pharmacy benefit managers (PBMs), declining reimbursement for prescription medications, and limited reimbursement for clinical services.

In a recent commentary published in the 

Journal of the American Pharmacists Association, 

Jennifer Bacci, PharmD, MPH, and her colleagues said that embracing the role community pharmacy teams play in patient care and advocating for payment transparency is critical for community pharmacy’s survival.

Bacci, who is the endowed associate professor of Innovative Pharmacy Practice at the University of Washington School of Pharmacy, sat down with 

to discuss what can be done to shift public perception of community pharmacists, how to address misconceptions about community pharmacy among other healthcare professionals, and how pharmacists can advocate for fair reimbursement and payment transparency.

Sustaining Positivity Among Students, Professionals Critical for Pharmacy’s Future

 What steps can be taken to shift public perception of community pharmacists from being seen primarily as medication dispensers to trusted healthcare providers?

 I think seeing is believing, and the image that the public has had of community pharmacy and community pharmacists for a long time has been pharmacy professionals behind a glass wall, separated, busy at work, filling prescriptions. I think to change the perception of that, we need to help the public see all the other things that we do beyond filling prescriptions and making sure that medications are appropriate for individuals. I think that's providing the services that are needed in a community and promoting what we do, not only to the public, but also to other providers. I think a great example of that is vaccines. In many states, pharmacists 10 years ago were not seen as the go to vaccine provider. We're now in a very different place. I think we want the transition of public perception to go much faster, and we can use what we learn from vaccines. I think that visibility and promotion of what we do is really important in changing public perception.

Do you think the general public is aware of the challenges facing community pharmacies?

 I think the public is more aware of community pharmacy now than they've probably ever been. Whether someone's had to wait in line themselves, wait on hold to get a hold of a team member, whether they've experienced their own pharmacy closing or been told they have to find a new pharmacy because their insurance is no longer accepted, or even if they've heard or read one of the many news stories from traditional media or social media. I don't know that it's really about not knowing. I think it's helping people know what action that they can take. It’s about helping our patients and our communities know that they can reach out to local government, policy makers, and legislators or even that they can report things that they might be unhappy with about their insurance to local government.

 What can be done to address the misconceptions about community pharmacy practice among other healthcare professionals?

 I think influencing other healthcare professionals starts within our own profession. I think it starts with how we as a pharmacy profession think about community pharmacy, how we talk about community pharmacy and how we value what community pharmacy contributes. There's so much important care that happens in a community pharmacy. I think about working with community pharmacy partners. A lot of our great success stories in recent history have come from pharmacists in other areas of the healthcare system understanding what a community pharmacist team can contribute, and being a champion. We've seen that happen many in instances. Pharmacists within payers help champion some of our community pharmacy enhanced services network, and as a result, those pharmacies are contracted to provide important care to their communities and be paid for providing that care.

 How can pharmacists effectively advocate for fair reimbursement and payment transparency?

 I think that it's important to show up and to use your voice. If we don't speak up and create our own future, someone else or some other entity will step in and do that. I think it's not only just important to community pharmacy, but it's important to our entire profession and to the healthcare system. I think that that's really important for all pharmacists. I think the challenges that we're seeing in community pharmacy are unique and acute compared to some of the other challenges. But at the end of the day, payment is a challenge across all of healthcare. It's about advocating, speaking up for community pharmacy, because of the urgency in maintaining that access, but also for all healthcare professionals to be fairly and transparently compensated for the care that they provide.

 If current trends continue, what do you foresee as the long-term impact on public health and the broader healthcare system if community pharmacies continue to close at this rate?

 This is a hard question to think about. I think that the ultimate impact is a negative impact on public health. I think about everything that community pharmacies did during the pandemic with testing, with vaccination, with treatment. It's widely accepted at this point that there will be a future pandemic, a future public health emergency, and what would happen if we don't have the community pharmacy infrastructure to rely on it? The states that strongly integrated community pharmacies into their vaccination plan had the most effective rollout, states like West Virginia, among many others. I think that we will see that our ability to get public health interventions to communities will suffer. But I think beyond that, it will take a toll on the health care system overall and other providers. I think about how often a phone rings and in one community pharmacy in a day because it's where someone can get a hold of a trained healthcare professional the most quickly. What's going to happen if those individuals can't get those questions answered? Where else will they be able to turn to get those questions answered? What will the consequences be to their own health and to their own medication use? I think that will have a strain on the healthcare system and healthcare providers across the system.

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1. Bacci JL, Carroll JC, Coley KC, et al. Act for the Future of Community Pharmacy. 

 (2003). 2024 Sep 25:102256. doi: 10.1016/j.japh.2024.102256. Epub ahead of print. PMID: 39332524.

Jennifer Bacci, PharmD, MPH, discusses ways to improve current issues impacting community pharmacy.

Q&A: Building a Better Future for Community Pharmacy

Two more US patients have been hospitalized with bird flu complications as cases continue to rise slowly among humans but much more quickly among animals, according to 

When H5N1 (bird flu) cases first took off in the US in 2024, all patients who tested positive made a full recovery. However, at the start of 2025, the first severe case of bird flu led to the hospitalization and subsequent death for a patient in Louisiana.

 Although the CDC has reported no human-to-human contact at this time,

recent cases are causing officials to raise alarms.

“This shows that H5N1 can be very severe, and we should not assume that it will always be mild,” Angela Rasmussen, PhD, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, said in an interview with 

 “I am very worried about H5N1 in patients [who] are being treated in hospitals where there are also many [patients with] seasonal flu because this creates opportunities for reassortment, which could produce a pandemic-capable H5N1.”

Of the 2 recent patients who tested positive, one was reported in Ohio and the other in Wyoming, marking the first human case of bird flu in either state. Since reporting symptoms, the Ohio patient recovered, but the Wyoming patient remains hospitalized.

The Ohio patient was a male facility worker responsible for killing poultry infected with bird flu. The Wyoming patient was an older woman with multiple underlying health conditions that heightened her complications from the disease, according to a Wyoming Department of Health news release.

Bird flu cases total 70 US patients as more animals are infected.

Ronald Richmond, RPh, MPH, Senior Vice President of Provider Relations, Paramount Rx

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