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Articles

Heather Johnson, PharmD, BCACP, CTTS, and Heather Roth, BSPharm, RPh, compare patients’ diabetes outcomes in clinical and community pharmacy settings.

Diabetes Care in Clinical, Community Pharmacy Practices | APhA 2025

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Elizabeth Pogge, PharmD, professor in the College of Pharmacy at Midwestern University, discusses the safety and efficacy of anticoagulation for this population.

Pharmacists Play Critical Role in Optimizing Anticoagulation Therapy for Older Adults | APhA 2025

Dan Krinsky, BS, MS, RPh, FAPhA, and Stefanie Ferreri, PharmD, BCACP, FAPhA, discuss new OTC product releases, recalls, and other updates pharmacists should be aware of.

The Importance of Staying Informed on New OTC Product Releases, Recalls | APhA 2025

Ravi Patel, PharmD, MBA, MS, lead innovation advisor in the School of Pharmacy at the University of Pittsburgh, explains how artificial intelligence can be used in pharmacy.

Artificial Intelligence in Pharmacy Has Potential to Change Landscape | APhA 2025

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Sally Arif, PharmD, professor in the College of Pharmacy at Midwestern University, discusses how pharmacists can effectively communicate with diverse patients.

Effective Communication Can Bridge Gaps in Care | APhA 2025

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.

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.

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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

Pharmacists reflect on their experiences since the pandemic.

5 Years of COVID-19

Jeffery Goad, PharmD, MPH, president of the National Foundation for Infectious Diseases, explores the challenges pharmacies faced during the COVID-19 pandemic, highlighting the significant adaptations and crucial role pharmacists played in community healthcare. Jade Ranger, PharmD, co-owner and pharmacist at the Prescription Shoppe, and Tom DePietro, PharmD, owner of DePietro's Pharmacy, described their experience of shutting down physical operations, transitioning to curbside services, and leveraging creative solutions like enlisting local high school football players to help manage orders. They focused on the complex process of vaccine distribution. Pharmacies were among the first to receive COVID-19 vaccines, which created immense logistical challenges. They had to develop systematic approaches to vaccine allocation, manage overwhelming demand, and combat misinformation.

Pharmacists emerged as essential health care providers during the pandemic, doing much more than simply dispensing medications. They advocated for vaccine access, provided critical health guidance, built strong patient relationships, and demonstrated remarkable adaptability. Pharmacists' specialized training and direct patient interactions allowed them to make significant contributions to public health, from managing complex medication interactions to providing immediate healthcare advice. Pharmacists are resilient, community-focused professionals who played a pivotal role in navigating the unprecedented challenges of the COVID-19 pandemic.

Pharmacists are resilient, community-focused professionals who played a pivotal role in navigating the unprecedented challenges of the COVID-19 pandemic.

5 Years of COVID-19: How Pharmacists Became Community Heroes During the Pandemic

During the COVID-19 pandemic, pharmacies underwent a transformation, rapidly expanding their services to meet unprecedented demand for vaccination and testing while facing significant challenges like staffing shortages and misinformation. Pharmacists emerged as trusted health care providers, leveraging their entire workforce—including technicians and student pharmacists—to administer vaccines, provide critical education, and maintain accessible health care services. The pandemic highlighted pharmacies' adaptability, with many implementing hybrid appointment models and playing a crucial role in community health education. Looking forward, the experience has opened opportunities for expanded clinical services, increased recognition as essential healthcare providers, and the potential for more comprehensive patient care models.

Jeffery Goad, PharmD, MPH, president of the National Foundation for Infectious Diseases, reflects on the COVID-19 pandemic 5 years later.

Looking back over the past 5 years, what would you say was the single biggest challenge the pandemic posed to pharmacies?

Well, I think the most significant challenge really was the unprecedented surge in demand for vaccination and COVID testing, which all the while facing staffing and [personal protective equipment] shortages. Pharmacies were not getting many types of vaccines or doing any point-of-care testing at the time had to really rapidly expand their role while managing burnout, evolving testing and COVID guidance, and patient misinformation. Many pharmacies also had to quickly train and deploy pharmacy technicians to help manage workflow, particularly for vaccine administration and COVID testing. In fact, the US PREP Act provided a federal framework for the expansion of vaccination testing and prescriptive authority, but when it went away, it was up to the states to make those changes permanent. Many did not. Student pharmacists were also important workforce players early on in the pandemic as hospitals kept students out and [ambulatory] care largely shut down. The community pharmacy, however, did not exclude student pharmacists, nor did they shut down.

What lessons from the pandemic do you think will be most valuable for pharmacies moving forward, especially for independent community pharmacies?

I think one key lesson is the importance of adaptability and workforce optimization. Pharmacies that leverage their entire staff, including technicians and student pharmacists, for immunization and testing services, were able to scale operations more efficiently. The pandemic also underscored the value of diversifying services such as telehealth consultations and point-of-care testing, which many pharmacies successfully implemented.

How did pharmacies successfully address the increased demand for vaccinations and testing, and what were some of the logistical hurdles they faced?

Pharmacies adapted by scaling operations. So what that means is they were implementing appointment scheduling systems, mobilizing technicians and student pharmacists to administer vaccines and perform COVID-19 tests. Many pharmacies initially relied on scheduled appointments to manage vaccine distribution efficiently, control patient flow, and prevent overcrowding. However, as demand fluctuated, many transition[ed] to allow walk-ins, which increased accessibility, but also introduced challenges in inventory management, staffing, and workflow efficiency. While appointment-based systems help pharmacists prepare to staff and allocate doses appropriately, they sometimes limited the vaccine uptake among individuals who preferred convenience. Some pharmacies implemented and now maintain a hybrid model, offering both scheduled slots and walk-in availability to balance efficiency and accessibility.

How did patient counseling and education strategies adapt during the pandemic, especially with the influx of information and misinformation?

I think it's important to point out that has been for many years, but the Gallup Poll consistently ranks pharmacists as one of the most trusted professions. During the pandemic, pharmacists took on a crucial role as a frontline educator, countering misinformation with evidence-based guidance from the CDC and non-governmental organizations such as the National Foundation for Infectious Diseases. Many used social media, community outreach, and 1-on-1 counseling to dispel myths about COVID-19, vaccines, testing, and treatment. Additionally, all pharmacy staff played an important role in consistent messaging, managing vaccine appointment scheduling, and distributing educational materials, allowing pharmacists to focus on more complex consultations.

What are the biggest opportunities and challenges you see for independent pharmacies in the post-pandemic landscape?

Well, I think it's been said before: never let a good pandemic go to waste. So it sounds horrible, but a silver lining here is that pharmacists really develop new skills, new ways of operating, but really what we look for now are, what are the opportunities for the future. Opportunities to expand clinical services, to include travel health clinics, test-to-treat, programs, chronic disease management, and medication therapy management. Challenges remain though in reimbursement for clinical services; there's workforce burnout, and of course, retention. Pharmacy must also consider how to effectively utilize pharmacy technicians, particularly, in immunization and testing services, as these roles proved essential during the pandemic and could be valuable moving forward.

How do you think independent pharmacies can continue to play a vital role in community health and patient care in the future?

Pharmacies thrive on focusing on personalized patient care and filling gaps in health care access, particularly in rural and underserved areas. Expanding services such as point-of-care testing, long-term care partnerships, and medication synchronization programs will be key. Additionally, training and retaining skilled staff, including pharmacy technicians, will help improve efficiency and allow pharmacists to focus on more clinical services.

Do you have any recommendations for policy changes or support systems that would help independent pharmacies better serve their communities?

Policy should address equitable reimbursement for clinical services and expanding the standard of care model as physicians have. The standard of care model allows pharmacists to provide patient care based on their training, credentials, and professional judgment, using their skills and knowledge to make decisions that are best for the patients rather than being limited by rigid state rules. It's essential to ensure that pharmacists are recognized as health care providers under federal and state laws that allow for Medicare and Medicaid reimbursement of pharmacists clinical services.

Is there anything else you would like to add?

I think, really to summarize, the pandemic underscored that pharmacists are essential health care providers, not just medication dispensers. Moving forward, we must continue advocating for legislative changes, strengthening public trust, and ensuring pharmacists receive the support they need to sustain and expand their vital services. Pharmacy teams, including technicians, played a key role during the pandemic, and continued investment in workforce, training, retention, and development will be essential for the future.

Q&A: How the COVID-19 Pandemic Changed the Landscape of Pharmacy

With the recent closure of thousands of chain and independent pharmacies, experts from several industries are coming together to address the issue of pharmacy deserts. One of the most prominent entities working to alleviate the issue includes pharmacy advocacy and solutions groups like Cencora and Good Neighbor Pharmacy.

“I believe it's all of us,” said Jennifer Zilka, Senior Vice President of Community and Specialty Pharmacy at Cencora and President of Good Neighbor Pharmacy. “It's crucial that pharmacies, trade organizations, advocates, peers, and even patients relentlessly push for the changes that are needed to support the longevity of these pharmacies and the care that they provide to their patients.”

was also joined by Kyle Pudenz, DBA, Senior Vice President of Data & Analytics at Cencora. His team is filled with data experts trained to identify areas vulnerable to pharmacy deserts, the resources needed for pharmacy businesses, the characteristics of an area’s pharmacy services, and so much more.

The duo suggested that it takes the efforts of multiple players within the pharmacy industry to truly enact change. However, they were sure to highlight the utmost importance of community pharmacies and how they are uniquely positioned to address pharmacy deserts.

“Community pharmacies are a huge part of the solution to combat these health care deserts, whether it's a pharmacy desert or an overarching, larger-scale health care desert,” continued Zilka. In this part of our interview, Zilka and Pudenz discussed what’s being done to address pharmacy deserts and how their team is assisting pharmacies and communities across the country.

Stay tuned for more from our conversation with Zilka and Pudenz as they provide even more valuable insights into pharmacy deserts and what is being done to address them.

How Pharmacy Deserts are Being Defined, Identified

: Who do you believe holds the responsibility of addressing pharmacy deserts across areas of the US?

 I'll start because I feel really strongly about it, but I believe it's all of us. It's crucial that pharmacies, trade organizations, advocates, peers, and even patients relentlessly push for the changes that are needed to support the longevity of these pharmacies and the care that they provide to their patients. Community pharmacies are a huge part of the solution to combat these health care deserts, whether it's a pharmacy desert or an overarching, larger-scale health care desert. Just given who they are, they're already taking care of these underserved and socially vulnerable communities.

 members work tirelessly to look for gaps in care where they're able to maybe provide different services, different products. We have outreached into different communities to make sure that they're caring for their entire community. And then, the teams within Good Neighbor Pharmacy, and Kyle's team within Cencora, we're very passionate about supporting their efforts. In addition to all of us doing all the things we're doing that are really important, one thing we've done internally is worked with Kyle’s team to help our members with detailed snapshots of their communities, and again, look for those gaps where they might be able to provide tailored services or products to those patients.

As part of this effort, we worked with NCPDP (the National Council for Prescription Drug Programs), the CDC’s social vulnerability index, the US Census and American Community Survey. We pulled all of that information together, and this is Kyle’s team that did that, so Kyle, we are eternally grateful for it. We always knew where our Good Neighbor Pharmacies (GNP) were positioned, and we always had a good feel for who their patients were. But through Kyle's team's efforts, we were able to identify that 20% of GNP stores either directly serve or are adjacent to pharmacy deserts, 93.5 million US households are within reach of a GNP store, and 20 million of those reside in a low-pharmacy-access area. We also know that GNP pharmacies can serve more than 47.7 million low-income individuals.

Kyle and his team also did some research around disabled individuals, and there's 26 million disabled individuals, including 5.5 million who face limited access, that are within reach of a Good Neighbor Pharmacy store. Through that data, we've been able to really validate which patient populations our pharmacies are caring for. And we're really passionate about ensuring that our pharmacies have access to that information and are able to tailor their services accordingly. So Kyle, please feel free to expound on that.

No, I love all the facts and figures. You could join our team anytime, Jenni. But as Jenni said, we really developed this solution, understanding our place in Cencora. How can we help enable our pharmacies [to] serve their communities? The idea is that we can access this data. We can integrate a lot of this together in such a way to give them better visibility and insights into, not just the customers and patients that are coming through their doors already, but what does that greater community actually look like? [We] give some visibility into the broader surroundings and help them better plan some accessible services that they may be able to provide these communities. For many [pharmacies], they can now leverage the data to really prioritize resources. Now they have this understanding of what that larger population looks like and [can] provide some support and interventions in areas where there [is] a greater need for medicine, health care services, and vaccines. All of those things, I think, are super important.

We really went out and found some publicly available data. This is available through US Census information to give us a lot of demographics, but we coupled that with some geospatial analytics to really give us that overlay of the demographics and other factors that really impact social vulnerability. In addition to some of the things Jenni highlighted, [something] like access to transportation [is] a real big one. I think sometimes people wonder ‘Why is the limit within an urban area just 1 mile?’ Well, you have different access to transportation in different areas. The likelihood that someone who's ill or elderly would have to go that far in that scenario without transportation really starts to limit whether or not they are going to be able to access that. By giving our pharmacies information and insights, they can actually develop services to help them reach and connect with these patients to provide those services that they're looking for.

So far, the data has really challenged what our prior assumptions and biases would have led us to previously believe. Pharmacy owners often find that the pharmacy deserts aren't necessarily where they expected them to be previously. In fact, the data and insights shared helps some of those pharmacies recognize that they're actually situated, as Jenni mentioned, either in or directly adjacent to a desert themselves. I think that's been pretty eye-opening. By doing that, where they suddenly have this visibility, now it can help those pharmacists identify new clinical and marketing opportunities that really help them serve their communities even better than they were before.

: What is being done on both state and federal levels to address the growing issue of pharmacy deserts in the US?

There is a lot of activity. In fact, we've had some wins that we're very excited about at both the national and the state levels. But there's still so much more work to be done that we together can achieve what's needed for pharmacies to remain financially viable. It includes improving reimbursement frameworks, but it also includes helping to expand the clinical care services that pharmacies are able to provide. There is a lot of activity. Unfortunately, we were hoping that some of it would make it across the finish line at the end of the year, and it didn't. And I think, as we all know, we're in the midst of a new administration, which is highly unpredictable, but there does continue to be a lot of activity, visibility, and even legislative bills that are on the table. We are very hopeful, or watching very, very closely, that they will cross the finish line and be included in an upcoming package.

One of them is around stabilization of reimbursement rates. Again, we're watching that one very, very closely. The other one is the Equitable Community Access to Pharmacists Services Act. We call it ECAPS because it's a mouthful. That was introduced last Congress. It had robust bipartisan support. The goal was aiming to ensure, as I mentioned before, that Medicare beneficiaries have access to the essential services, including test and treatment of common infectious diseases, by establishing a Part B reimbursement pathway for pharmacies to deliver those services. Those are a couple examples. There's a lot happening.

Positive change is not guaranteed. But I truly believe—this is an area I'm really passionate about and I spend a lot of time on—if we continue to advocate and ensure that legislators are aware of the danger of losing these pharmacies, and really the danger to their patients and their constituents, I'm very hopeful. That advocacy is essential to ensure accessible health care for our patients and will serve as really our industry's primary defense against the spread of these pharmacy deserts. A lot [is] happening on that front. We're keeping a very, very close eye on it, and we're hopeful that we will see some federal activity. And there's just a ton happening in the states as well. [There’s] a lot of activity and a lot of hope.

Rochester Pharmacy Access Coalition Uniting to Fill Gaps from Pharmacy Closures

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Insight into US pharmacy deserts. Cencora. August 7, 2024. Accessed March 10, 2025. 

https://view.ceros.com/amerisourcebergen/cencora-pharmacy-desert-map/p/1

Representatives from Cencora’s Good Neighbor Pharmacy Network discussed legislation created to improve declining pharmacy rates and who is accountable for addressing pharmacy deserts.

Q&A: Who is Responsible for Addressing the Growing Issue of Pharmacy Deserts?

The American Pharmacists Association’s (APhA) 2025 Annual Meeting and Exposition is set to kick off in Nashville, Tennessee on Friday, March 21 and run through Monday, March 24. The event is taking place at the Music City Center convention center and is sure to be a meeting that pharmacists from across the country won’t want to miss.

"The focus of the meeting this year is inspiration,” said Lauren Angelo, PharmD, MBA, associate dean of academic affairs and associate professor of pharmacy practice at the Rosalind Franklin University of Medicine and Sciences. “With so many changes in healthcare and pharmacy lately, we could all use a little inspiration. Many of the education sessions will help take our profession to the next level. These range from digital health, new technologies, and clinical updates to leadership and advocacy. The awards and recognition of our pharmacy superstars will also inspire us to continue to advance patient care. I look forward to being inspired."

This year’s meeting includes tons of education and business sessions for pharmacists, staff and students alike. The meeting will also feature opportunities for continuing professional education credits and other types of APhA education and training activities. Keynote speakers at this year’s meeting include Ben Nemtin, author of 

This year’s meeting will take place from March 21 to 24 in Nashville, Tennessee.

Sally Arif, PharmD

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