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Articles

Andrea Sikora, PharmD, MSCR, FCCM, FCCP, BCCCP, chair of the committee presenting new guidelines, discussed her role in bolstering pharmacists’ support in the ICU.

Q&A: New ICU Guidelines Highlight, Confirm Role of Critical Care Pharmacists

Among individuals with both diabetes and HIV, researchers determine patients’ adherence to comprehensive diabetes care interventions.

Diabetes Care Significantly Lacking For People With HIV

The Medicare Drug Price Negotiation Program is anticipated to cause multiple issues for pharmacy owners and their cashflow sustainability.

Pharmacy Owners Say They Are Unable to Participate in MDPNP

Olezarsen significantly reduces triglycerides and acute pancreatitis events, offering new hope for patients with severe hypertriglyceridemia.

Olezarsen Demonstrates Favorable Reductions in Triglycerides for Hypertriglyceridemia

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

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CVS and Walgreens will limit their offerings for the COVID-19 vaccine, even for those who meet the new criteria from the FDA, according to 

 The new criteria limit who can receive a COVID-19 vaccine, with 4 different vaccines having different indications on who can receive the immunization.

CVS will now offer COVID-19 vaccines in 13 of 16 states and the District of Columbia to those who have a prescription from their physician or other medical provider. The states include Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, North Carolina, New York, Pennsylvania, Utah, Virginia, and West Virginia. CVS will not offer COVID-19 vaccines in Massachusetts, Nevada, and New Mexico. According to 

, CVS will offer updated COVID-19 vaccines in the remaining states pending Advisory Committee on Immunization Practice (ACIP) guidelines. For Walgreens, patients need prescriptions for 16 states but not all of them overlap with CVS, and it is unclear which states include these 16, according to 

The FDA recently approved 4 updated COVID-19 vaccines: Pfizer and BioNTech’s Comirnaty, Novavax’s Nuvaxovid, and Moderna’s Spikevax and mNexspike. All have been approved for adults 65 years and older to prevent COVID-19. Other indications include

Nuvaxovid: for patients aged 12 years through 64 with at high risk of severe disease with least 1 underlying condition

Spikevax: for patients 6 months through 64 years at high risk of severe disease with at least 1 underlying condition

mNexspike: for patients aged 12 through 64 years at high risk of severe disease with at least 1 underlying condition

Comirnaty: for patients aged 5 through 64 years at high risk for severe disease with at least 1 underlying condition

Guidance and information on the upcoming 2025-2026 respiratory season have been met with confusion. Recommendations, which were once aligned across organizations, are now conflicting, which included government organizations, such as the CDC, as well as the health care organizations, such as the American Academy of Pediatrics (AAP). Pregnancy has been removed from the adult schedule, even though some health care providers consider it an underlying condition leading to severe disease.

“We need to take the politics out of immunizations and rely on medical experts with years of education, the experience, and the knowledge to interpret that data to provide evidence-based recommendations," Laura Knockel, PharmD, BCACP, clinical associate professor at the University of Iowa College of Pharmacy, said.

AAP published its annual immunization schedule, which covers guidance for influenza, respiratory syncytial virus, and COVID-19. Although recommendations from the organization typically follow ACIP guidelines, this year the schedule differs from the recent recommendations from the committee.

“[Patients are] understandably confused. The space around vaccines is changing so rapidly,” Knockel said.

 “There's so much misinformation and disinformation out there, so I really think the first step is to acknowledge that concern, and again, coming from the point of they want to do what's best for their child.”

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1. Astor M, Blum D. CDC uncertainty upends COVID vaccine access at CVS and Walgreens. 

. August 28, 2025. Accessed September 2, 2025. https://www.nytimes.com/2025/08/28/well/cvs-pharmacy-covid-vaccine-16-states.html

2. Levy S. CVS, Walgreens limiting offerings of new COVID-19 vaccines. 

. September 2, 2025. Accessed September 2, 2025. https://drugstorenews.com/cvs-walgreens-limiting-offerings-new-covid-19-vaccines

3. Gallagher A. FDA approves COVID-19 vaccines for patients 65 years and older. 

. August 23, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/fda-approves-covid-19-vaccines-for-patients-65-years-and-older

4. Gallagher A. New COVID-19 vaccine recommendations cause confusion among public, health care providers. 

. June 10, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/new-covid-19-vaccine-recommendations-cause-confusion-among-public-health-care-providers

5. Gallagher A, Knockel L. Q&A: pharmacist advocates for evidence-based immunization guidelines for COVID-19 vaccines. 

. September 1, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/q-a-pharmacist-advocates-for-evidence-based-immunization-guidelines-for-covid-19-vaccines

6. Gallagher A. FDA approves updated 2025-2026 COVID-19 vaccine for patients 65 years and older. 

. August 27, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/fda-approves-updated-2025-2026-covid-19-vaccine-for-patients-65-years-and-older

CVS will not offer COVID-19 vaccines in Massachusetts, Nevada, and New Mexico.

Clinical

CVS, Walgreens Will Limit COVID-19 Vaccine Offerings in 16 States

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.

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

Childhood immunizations have long been a cornerstone of public health, but in recent years, the landscape has grown increasingly complex. Although there has been misinformation and disinformation in the immunization landscape, particularly with COVID-19, health care providers must navigate a maze of evolving guidelines, state regulations, and insurance requirements. The American Academy of Pediatrics (AAP) vaccine schedule remains a trusted benchmark, yet the practicalities of delivering these vaccines—especially in pharmacies—are often decided by policies on vaccine schedules.

In this interview, Laura Knockel, PharmD, BCACP, clinical associate professor at the University of Iowa College of Pharmacy, discusses challenges facing families and frontline health care workers. She highlights the importance of acknowledging parental concerns, directing families to reputable sources, and explaining the limitations of pharmacies imposed by state and federal regulations. She also discusses the behind-the-scenes advocacy efforts by national pharmacy organizations to maintain vaccine access and streamline administration.

How can pharmacists anticipate handling conversations with parents who may be confused or concerned about which schedule to follow

 They're understandably confused. The space around vaccines is changing so rapidly. There's so much misinformation and disinformation out there, so I really think the first step is to acknowledge that concern, and again, coming from the point of they want to do what's best for their child. So [I suggest] explaining that the American Academy of Pediatrics, if those are the recommendations you're using, [has] a long history of developing immunization recommendations using evidence reviewed by a group of knowledgeable, experienced health care providers. I would also avoid repeating recommendations that don't have basis in evidence, as words tend to stick in our heads whether they're true or not. If they would like to do their own research, it's good to provide reputable sites like AAP's website, healthychildren.org, or immunize.org's public website, vaccineinformation.org, to make sure they're getting that accurate information If they do want to do their own research.

From a professional standpoint, how can pharmacists manage the legal and liability aspects of this situation, given that some state laws and insurance coverage policies are often tied to CDC/ACIP recommendations?

 Pharmacists, technicians, and students...all need to ensure they have appropriate liability coverage, commensurate with their responsibilities, and that's just best practice, regardless of the situation. I do think staying aware of what your state's rules are is important, as well as your individual pharmacy workplace's policies on immunizations, checking to see if your ability to provide immunizations is tied with the CDC and ACIP [Advisory Committee on Immunization Practices] recommendations. I strongly encourage everyone to join their state pharmacy association, as well as national organizations, as they are a great resource when it comes to dealing with this sort of issue. Multiple national pharmacy organizations have come together, in fact, to create a pharmacy-based vaccine access work group. They're working on an executive order template for state governors to use that will allow pharmacists to administer immunizations based on guidance other than ACIP. It's only a stopgap while they're working on longer-term solutions for that legislative, regulatory policy. This group also sent a letter to insurance companies requesting that coverage and access to vaccines is maintained, and so those are great examples of why belonging to these organizations is important. They need our support in order to do the work on [our] behalf.

What message would you like to convey to other pharmacists, health care professionals, and the public about this situation and pharmacists' role in the upcoming vaccination season?

 It would be helpful for the public and other health care professionals to know that there may be extra steps before you can receive your immunizations at a pharmacy, and [in] many states, pharmacists' and technicians'...authority to administer those immunizations is contingent on ACIP recommendations. So in those cases, if an immunization is not on the ACIP schedule, we can't administer it. So just like any other FDA-approved product, these vaccines can be prescribed for off-label use or using a medication for something other than its original FDA approval, and if that's the case, we need to rely on health care providers that have a much [broader] prescriptive authority, such as primary care providers and pediatricians. So a lot of it depends on your state, but the pharmacy may be able to contact that provider for a prescription in order to bill and administer that vaccine. The big thing is this takes time. It adds to the workload of both pharmacies and provider offices, and then, as pharmacists, I think we need to ensure we're explaining why we're unable to provide a vaccine in the same way that we were last year and making sure we give the patient other suggestions on how to receive that vaccine. We want to make sure that they understand that we're not the ones refusing it. It's just [that] our hands are tied, we're unable to provide it, and then give them those suggestions on where to go and what to do next.

Is there anything else you would like to add?

When I step back and I look at this...from the bigger picture, I think there needs to be a discussion, really, of [whether] this should be the way immunizations are handled, with the government making recommendations that health care professionals are required to follow. It's worked in the past, but in the current climate, we've lost focus on what's important from both the patient [at the] individual level as well as [at the] public health level. When I think of how recommendations for other health care topics are dealt with, although these aren't considered public health categories, but for example, most common guidelines for blood pressure and cholesterol developed by organizations like the American Heart Association, American College of Cardiology, [and] the American Diabetes Association create clinical practice recommendations regarding diabetes, we don't have government officials or nonexperts deciding how we treat patients. We need to take the politics out of immunizations and rely on medical experts with years of education, the experience, and the knowledge to interpret that data to provide evidence-based recommendations.

Pharmacists navigate complex immunization challenges and address parental concerns and misinformation while advocating for streamlined vaccine access and adherence to evolving guidelines.

Q&A: Pharmacist Advocates for Evidence-Based Immunization Guidelines For COVID-19 Vaccines

Amid constant calls for reform among the prescription drug market’s middlemen, or pharmacy benefit managers (PBMs), many experts have begun to uncover practices that directly impact access to medications and patient outcomes. Bil Schmidtknecht, whose son tragically passed away after experiencing a medication drop from his PBM’s formulary, joined 

to discuss the most detrimental PBM practices uncovered across the country.

“The biggest problem is that whole step process, prior authorization, stuff like that,” Schmidtknecht, founder of Patient Protector and director of patient experience at AffirmedRx, told 

. “It all leads back to money [and] rebates. $500 billion is a lot of money, and the top 3 [PBMs] like that kind of money.”

Now working to fight for patient access and improved outcomes among various stakeholders in pharmacy, Schmidtknecht sat down to discuss the PBM practices that led to tragedy in his life and how other families, patients, and pharmacists have been negatively impacted.

“Who gets first placement on my drug formulary, on my prescription list?” he continued. “Who gets to go first? The person who pays the biggest rebate gets to go first. That's what causes these problems.”

Before learning more about Bil’s perspective on common PBM practices, be sure to check out 

 with him. In it, he shared his son Cole’s story and the reasons that made him join the calls for PBM reform.

: Whether through your experience or other patient instances that you’ve observed, is there one PBM practice that you believe is the most detrimental to patient care?

The step process. What goes into the step process? Simply, you're at your doctor. They say, ‘You need this medicine today.’ You show up to a pharmacy and they say, ‘Well, that's not covered, but you have to try this one first before you can get to the medicine your doctor says you have to have.’ It doesn't sound too bad. Maybe they're trying to save you money, and that's what they claim to do. The reality of what it is, and in Cole's situation, my situation, and many other situations, [is that] the replacement medicine might have the same co-pay as me, but it isn’t cheaper. It's not the generic alternative, because there [are] rebates paid on prescription drugs from the manufacturers. It's a legislatively approved kickback, is what it is. Ever since it started back in 2008, 2009, it has been detrimental to the patients because it's a pay-to-play. Who gets first placement on my drug formulary, on my prescription list? Who gets to go first? The person who pays the biggest rebate gets to go first. That's what causes these problems, because they made a change to the formulary. They didn't notify Cole; that's a fact, and that's required under state law. They didn't notify me of the change; that's required under state law. But that step process, essentially, is what set the ball in motion for Cole not getting his drug, and the price being met at what it was.

From the perspective of someone directly impacted by PBM practices, Bil Schmidtknecht shares his insights into the ways PBMs affect patients’ access to medications.

Andrea Sikora, PharmD, MSCR, FCCM, FCCP, BCCCP

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