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Antonio Ciaccia, President of 3 Axis Advisors, led a discussion on pharmacy benefit manager reform and how the inability to pass legislation has led to increased financial hardships in community pharmacy.

How PBMs Impede Pharmacists’ Ability to Perform Clinical Services | APhA 2025

Slideshows

Jean-Venable Goode, BSPharm, PharmD, and Jeff Goad, PharmD, MPH, presented on the most notable vaccine updates from the past year and how they impact pharmacy practice.

Respiratory Vaccine Recommendation Updates from the Past Year | APhA 2025

Lydia Newsom, PharmD, discusses injection techniques, managing side effects, and the importance of collaboration between the healthcare team.

Q&A: Pharmacist Strategies for Optimizing GLP-1 Therapy Outcomes

As information changed rapidly, pharmacists quickly adapted their strategies by leveraging social media for updates to patients.

Q&A: The COVID-19 Pandemic Changed the Landscape of Health Care

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3 Ways to Use Your Pharmacy Software to Market & Grow Your Business

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.

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

With pressure from the media, anti-vaccination lobbies, politics, and more, misinformation among the general public has significantly contributed to declining immunization rates in the US, according to a presentation at the American Pharmacists Association 2025 Annual Meeting and Exposition.

In a presentation titled Fixin' to Address Vaccine Misinformation, Lauren Angelo, PharmD, MBA, began by addressing the declining immunization rates among US adults. She set the stage by introducing trends in patient intent to receive various vaccines, including COVID-19, influenza, and respiratory syncytial virus (RSV). The most notable data points Angelo discussed were how at least 20% of all adults were probably or definitely not interested in receiving any of the 3 vaccines.

“As we explore vaccine hesitancy, you’ve seen this definition before: The delay in the acceptance or refusal of getting [a] vaccine even though it’s available,” said Angelo.

 Discussing data from over 300 local health departments, she also mentioned how survey responses from providers across the country show that hesitancy and a lack of confidence in their effects are the main barriers to vaccine uptake in the US.

Pharmacists’ Role in Addressing Vaccine Barriers Among Underserved Communities | APhA 2025

With vaccine hesitancy leading to declining immunization rates, Angelo’s goal was to help the audience understand why a lack of confidence in vaccines is so prominent in the US. By grouping the factors leading to hesitancy into specific influences, experts are able to better understand why patients are impartial toward specific vaccines. These factors include contextual, individual group, and vaccine-specific influences.

“We talk about media. We talk about anti-vaccination lobbies, some of the policies around this, perceptions of industry,” she continued.

 “We look at some of the individual group influences just putting on their communities regarding beliefs and attitudes. We’re seeing that with some of those measles outbreaks right now, [which are] very community-focused.”

She then discussed the vaccine-specific issues, which were notably heightened at the inception of the first COVID-19 vaccine.

“Whenever there’s new information, new policies, we do see an uptick in hesitancy and those concerns that have come to light. Some examples would be the MMR vaccine and autism, HPV and fainting, and then the COVID-19 infodemic,” she said.

These examples of vaccine hesitancy and misinformation have circulated throughout the media for years, leading to the mass acceptance of misinformation. While the efficacy and safety of all of these vaccines have been clinically proven, the dissemination of information becomes key in ensuring the population is able to reap the benefits of immunization.

“The data also reveals that perceived information overload led to an increase in vaccine acceptance and uptake, whereas belief in vaccine misinformation may cause a decrease,” according to a study published in 

This study showed that understanding the correct information regarding vaccines led to higher uptake and vice versa, a finding that highlights the amplification of misinformation on social media and within specific communities.

“We know that false information tends to spread more quickly. Again, it gets back to that emotional response or that need to latch on to something,” continued Angelo.

 “It's interesting with social media and fact checking, most of them are post-posting [or] post-policing, so the post is made and then it might get pulled if it's deemed to be incorrect, as opposed to fact checking in advance before something gets posted. And algorithms just love the spread of things that trigger negative emotions.”

As she detailed throughout her presentation, addressing vaccine hesitancy is not a simple task. With internet and community infrastructures built on misinformation, pharmacists and other health care providers face a growing issue that can only be combated with further education and clinical evidence.

Angelo concluded her presentation by addressing the key factors that lead to hesitancy and what providers need to understand in order to correct declining immunization rates.

“Misinformation, disinformation, [and the] infodemic have definitely contributed to a lot of the vaccine hesitancy and lower rates that we're seeing or continuing to see,” she concluded.

 “I think access and affordability are 2 of the biggest challenges [in] a lot of communities that we need to work with, and making sure we have community leaders involved.”

Read more from our coverage of the American Pharmacists Association 2025 Annual Meeting and Exposition

1. Momah CI, Angelo L. Fixin' to address vaccine misinformation. Presented at: American Pharmacists Association 2025 Annual Meeting and Exposition; March 21-24, 2024; Nashville, TN.

2. Lin F, Chen X, Cheng EW. Contextualized impacts of an infodemic on vaccine hesitancy: The moderating role of socioeconomic and cultural factors. 

. 2022 Sep;59(5):103013. doi: 10.1016/j.ipm.2022.103013.

Lauren Angelo, PharmD, MBA, discussed current vaccination sentiments across the country and how misinformation has contributed to declining rates among US patients.

How Misinformation Has Contributed to Declining Vaccination Rates | APhA 2025

Click the link below to register for the Total Pharmacy® Solutions Summit September Summit:

https://registration.pharmacytimes.org/total-pharmacy-solutions-summit-patient-access-and-education

Total Pharmacy® Solutions Summit: September 13th 2025

Click the link below to register for the Total Pharmacy® Solutions Summit June Summit:

https://registration.pharmacytimes.org/total-pharmacy-solutions-summit-revenue-stream-diversification 

Total Pharmacy® Solutions Summit: June 14th 2025

Independent pharmacies are crucial to the communities they serve nationwide, according to a session presented at the American Pharmacists Association 2025 Annual Meeting and Exposition.

 With their unique positioning across the country, independent pharmacy closures are negatively affecting underserved communities and must be addressed for the benefit of public health in the US.

“What happens when pharmacies close? What are our patients losing? What are our communities losing?” asked Lucas Berenbrok, PharmD, MS, in a presentation titled Blank Space: Discussing Pharmacy Deserts. “Well, they're losing access to convenient care. They're also losing those touch points to discuss health. We know just how frequently or often patients are coming to see pharmacists in both Medicare populations and commercial payers; it's about twice as often as patients are seeing their primary care providers.”

In his presentation, Berenbrok provided the audience with an in-depth look at pharmacy closures, how they impact communities, and the dire need to address pharmacy deserts, which have spurred minimal access to care and medications in many urban and rural locales.

What is Being Done to Address Pharmacy Deserts in the US?

“You can put probably a list of 50-100 different reasons why we need good access to community pharmacies in the country,” he continued. “Usually, whenever I try to think about this myself, I think about the types of needs that I have, not as a pharmacist, but what I have as a patient, what I look to at my community pharmacy, what things I buy there, what things I expect my pharmacist to be able to help serve me.”

By putting himself in his patients’ shoes, and understanding how pharmacy access impacts them each individually, Berenbrok is able to easily shine a light on the importance of pharmacy services in various communities. And it’s not just the opinions and perspectives of pharmacists that prove how crucial pharmacies are to public health.

Journal of the American Pharmacists Association

 study found that community pharmacies are highly accessible health care destinations, specifically based on drive time, in both urban and suburban areas.

 Berenbrok also noted data explaining that 88.9% of the US lives within 5 miles of a community pharmacy while 91.1% live within 20 minutes of one.

“There's a lot of different ways in which we can define a pharmacy desert. It's based upon food desert definitions from the US Department of Agriculture and pharmacy deserts have been defined in 2 different ways in the literature,” said Berenbrok. Indeed, as previously mentioned, pharmacy deserts are either defined by drive time or distance. And with the term “pharmacy desert” only being coined in 2014,

 it may make sense why experts continue to deliberate on the definition of this lack in health care services.

While notably more challenging than calculating distance, drive time takes into account many more factors that translate to pharmacy access, including public transportation access, speed limits, traffic lights, time of day, and so much more. Berenbrok also touched on the fact that not all patients visit the pharmacy closest to their home and that pharmacy access to these people could be what’s closest to their work, children’s school, etc.

But despite continued debates on the best way to identify pharmacy deserts, the need to address them is significantly more important. “We have a problem with pharmacy closures for our country, but we also have a problem with pharmacy closures with specific populations, in which there already exists health disparities; we don't want those to widen,” he continued.

After defining the issue and highlighting the need to address pharmacy deserts, Berenbrok discussed the overarching policy reforms that may begin to alleviate these growing challenges within pharmacy. There are several ways for pharmacists to combat the loss of pharmacy services, including increased patient education, community outreach, patient surveys, and so much more. However, according to Berenbrok and several other experts within the industry, significant change that positively impacts the population may come from federal policy reforms.

Among many reforms that can have a beneficial impact on the pharmacy industry, Berenbrok focused on the need for increasing pharmacist reimbursement, further recognition of pharmacists as providers, and an increase in the services pharmacists are able to bill for.

Alleviating pharmacy deserts within the US will almost certainly be a gradual effort. But through education, advocacy, and community-based services, independent pharmacies have the ability to correct the path of public health in the US and offer valued care to all populations. These pharmacies, however, simply may not be able to do it alone.

As the issue of pharmacy closures and deserts is ongoing, Berenbrok concluded his presentation with a hopeful yet skeptical look to the future.

“So how do we make sure that we're protecting these pharmacies, that they're not closing, that they can continue to serve the people that they do?” he concluded.

 “Are there ways to increase reimbursement for those areas in need? Can there be government subsidiaries for pharmacies? These are all things that people are thinking about, writing about, and advocating for.”

1. Berenbrok L. Blank space: discussing pharmacy deserts. Presented at: American Pharmacists Association 2025 Annual Meeting and Exposition; March 21-24, 2024; Nashville, TN.

2. Sharareh N, Zheutlin AR, Qato DM. Access to community pharmacies based on drive time and by rurality across the contiguous United States. 

 (2003). 2024;64(2):476-482. doi:10.1016/j.japh.2024.01.004

3. Wittenauer R, Shah PD, Bacci JL. Locations and characteristics of pharmacy deserts in the United States: a geospatial study. 

Lucas Berenbrok, PharmD, MS, discussed pharmacy deserts and how closures around the US have the potential to impact public health.

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