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Articles

A recent study showed that 45% of women treated with both therapies achieved at least 20% total body weight loss.

Tirzepatide, Hormone Therapy Combination Increases Weight Loss Among Postmenopausal Women

Jennifer Clements, PharmD, FCCP, FADCES, BCPS, CDCES, BCACP, BC-ADM, discusses how pharmacists can help patients manage insulin.

Q&A: Pharmacists Play Essential Role in Insulin Therapy Success

Researchers addressed the current trends in prescription drug use and spending among Medicare Advantage beneficiaries during the first year of clinician access to a real-time prescription benefit tool.

Real-Time Prescription Benefit Tools Need to be Improved for Patients, Payers

Investigators find that erenumab, a calcitonin gene-related peptide receptor (CGRP) monoclonal antibody, is not a preventative treatment for chronic cluster headache.

CGRP Medication Did Not Prevent Cluster Headache Attacks

Drug Topics connects pharmacists across retail, health system, and specialty practice with clinical updates, pharmacy trends, and regulatory news.

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Alexa A. Carlson, PharmD, BCPS, is an assistant clinical professor in the Department of Pharmacy and Health System Sciences at Northeastern University, School of Pharmacy, Boston, MA.

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

McKesson is committed to supporting independent pharmacies.

Independent Pharmacies are the Future of the Health Care Industry

Independent pharmacies are navigating a complex and challenging health care environment, with economic pressures and evolving regulatory requirements threatening their sustainability. In an interview at McKesson ideaShare in Nashville, Tennessee, from July 10 to 13, 2025, Crystal Lennartz, president of Health Mart & Health Mart Atlas at McKesson, discusses the company's Health Mart franchise, which supports over 4400 independent pharmacies nationwide. She states that these pharmacies are struggling with reimbursement issues, operational complexities, and the need to expand clinical services. Their approach focuses on providing multifaceted solutions that help pharmacies not just survive but potentially thrive in a rapidly changing health care ecosystem.

The future of independent pharmacies appears to be increasingly centered on expanded clinical services. These emerging opportunities include immunizations, medication therapy management, and point-of-care testing. By diversifying their service offerings, pharmacies can become more integral to patient care and create additional revenue streams. McKesson's strategy aims to enable pharmacies to focus on patient care by handling backend support, including business operations, marketing assistance, and advocacy. Independent pharmacies are crucial health care access points, particularly in communities where traditional medical infrastructure might be limited.

"One of the major significant things that is impacting [independent pharmacies] is the ability to be reimbursed adequately for the clinical services that they provide, and also they're faced with a lot of regulatory changes that are impacting pharmacy and their scope of practice," Lennartz said. "That's why we're focused on strengthening the health of pharmacies and also providing them with the operational and clinical tools that they need to succeed."

Crystal Lennartz, president of Health Mart & Health Mart Atlas at McKesson, discusses challenges that independent pharmacies are facing in today's health care landscape.

Total Pharmacy Interviews

Independent Pharmacies Face Mounting Challenges in Modern Health Care Landscape | McKesson ideaShare

McKesson Executive Discusses Amplify initiative.

Independent Pharmacies Are Important to the Health Care Ecosystem

Independent community pharmacies are finding critical support through innovative initiatives like McKesson's Amplify program. In an interview at McKesson ideaShare in Nashville, Tennessee, from July 10 to 13, 2025, Jeanine Singer, senior vice president of national and key accounts at McKesson, highlighted the company's strategic approach to empowering pharmacists and strengthening the community pharmacy ecosystem. The Amplify initiative, launched just 1 year ago, represents a significant commitment to independent pharmacies nationwide. By providing direct funding to state associations in all 50 states, McKesson has created a robust support network designed to champion pharmacists' critical role in patient care. The program is deliberately pharmacist-led and mission-driven, focusing on enhancing patient access and ensuring the long-term sustainability of local pharmacies.

Singer encourages pharmacists to engage actively in policy-making by connecting with state and national associations like the National Community Pharmacists Association and American Pharmacists Association and by building relationships with local representatives. This approach aims to educate policymakers about the essential services pharmacists provide, particularly in areas like COVID-19 vaccinations and test-and-treat programs. As health care continues to evolve, initiatives like Amplify demonstrate a forward-thinking approach to supporting independent pharmacies, ensuring they remain vital, responsive, and integral to local health care ecosystems.

"I've been in this industry a long time. I think our industry is at a pivot point, but I know locally, as we stand at ideaShare, this event was actually built to share best practices, to share ideas, to cross peers, and I'm actually seeing that happen in real life at this event," Singer said. "It's incredibly exciting, and I'm more than confident that the future is going to be bright for our industry."

Jeanine Singer, senior vice president of national and key accounts at McKesson, discusses the company's approach to empowering pharmacists and strengthening the community pharmacy ecosystem.

McKesson's Commitment to Independent Community Pharmacies Takes Center Stage | McKesson ideaShare

An expert from McKesson discusses their approach to supporting community pharmacy

Expert Discusses McKesson Supporting Community Pharmacy

The community pharmacy sector is facing unprecedented challenges, with shrinking margins and evolving health care dynamics putting increasing pressure on independent pharmacies. In an interview at McKesson ideaShare, taking place in Nashville, Tennessee, from July 10 to 13, 2025, Emily Flaugher, vice president and general manager of  payer solutions at McKesson, shed light on the critical strategies being developed to support these pharmacists through a period of significant transformation.

Reimbursement pressures have become a central concern for community pharmacies, with script revenue no longer providing the financial stability it once did. McKesson emphasizes the importance of diversification, helping pharmacies explore new service offerings and operational efficiencies that can bolster their financial health. Through platforms like Health Mart Atlas, the company is providing pharmacists with tools to better understand their financial landscape, contract structures, and potential growth opportunities. Additionally, the Medicare space is receiving particular attention, especially in light of recent legislative changes like the Inflation Reduction Act, according to Flaugher.

By creating a continuous feedback loop and commitment to evolving solutions, McKesson is demonstrating its dedication to the long-term success of community pharmacies.

"I think the community pharmacy segment continues to be challenged in reimbursement. There's going to be reimbursement pressures that pharmacies are faced with when it comes to script revenue," Flaugher said. "I think it's really important, as we move to 2026 and beyond, we figure out ways to help pharmacies ease that burden and diversify their business."

Through platforms like Health Mart Atlas, the company is providing pharmacies with tools to better understand their financial landscape.

Expert Discusses McKesson's Approach to Supporting Community Pharmacies | McKesson ideaShare

Thomas Sherrer, PharmD, emphasizes the importance of a team-based approach to inventory control.

A Team Effort Is Needed for Inventory Management

Effective pharmacy inventory management requires a collaborative and proactive approach. In an interview at McKesson ideaShare 2025, Thomas Sherrer, PharmD, co-owner of Poole's Pharmacy, highlighted that managing inventory is fundamentally a "team sport" that requires comprehensive involvement from all pharmacy staff. By getting team members to understand the broader goals and objectives, pharmacies can create a sense of shared ownership not just of inventory, but of patient care and satisfaction.

One key strategy he discussed is maintaining close relationships with trusted wholesalers while avoiding overreliance on automated systems. Sherrer advocated for a hands-on approach where team members actively monitor inventory, pricing, and potential changes, which would involve regularly checking prices, understanding reimbursement shifts, and being vigilant about potential discrepancies.

Sherrer also shared a personal journey where he used manual, handwritten tracking before eventually expanding to sophisticated software solutions. Currently, the pharmacy uses perpetual inventory systems that provide real-time insights into stock levels and leverage advanced reporting tools. By creating a culture of shared responsibility and using advanced tools strategically, pharmacies can optimize their inventory management, ultimately enhancing patient care and operational efficiency.

"It's a team sport. It's a team effort. So in doing so, getting everybody involved, getting everybody to understand, not just one person, because I find, and we know in pharmacy, you come and if you have all these ideas and you're trying to push them, and everything else is going every which way, then you don't get to accomplish everything," Sherrer said.

Alexa A. Carlson, PharmD, BCPS

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