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Articles

Deucravacitinib demonstrated a statistically significant inhibition of radiographic progression compared to placebo.

Deucravacitinib Shows Joint, Skin Symptom Improvements in Psoriatic Arthritis

Pharmacists have shown the ability to stand out among other providers amid some of the most debilitating natural disasters in recent history.

Independent Pharmacists’ Unique Role During Disaster Management Efforts

Using the “Psoriasis and Beyond” survey design, researchers addressed patients’ awareness of psoriatic diseases and their associated comorbidities.

Significant Knowledge Gap Exists in Patient Awareness of Psoriatic Disease

Noel Brewer, PhD, states that the Advisory Committee of Immunization Practices will need to quickly work to regain trust.

RFK Jr's Decision to Replace Entire ACIP Panel "Completely Unexpected," Former Member Says

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

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Bert Drachtman is a retired pharmacist living in Great Neck, New York. You can e-mail him at ardiel@optonline.net.

Retired pharmacist offers valuable suggestions

Three tips for new pharmacy graduates

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 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?

Despite repeated promises, Congress has continued to delay pharmacy benefit manager (PBM) reform, leaving independent pharmacies in crisis. With a new administration in the White House that has signaled support for PBM reform, there is renewed hope for change. However, Douglas Hoey, RPh, MBA, CEO of the National Community Pharmacists Association (NCPA), warns that while there is optimism, patience is wearing thin—the time for meaningful reform is now.

® sat down with Hoey at the American Associated Pharmacies (AAP) Annual Conference, held April 10 to 12 in Austin, Texas, to discuss if he is hopeful that PBM reform will be passed under the new administration, what needs to be done to get PBM reform passed, and his take on Optum Rx’s announcement that it plans to introduce a cost-plus prescription reimbursement model.

Medicare Drug Price Negotiation Could Expose Pharmacies to Significant Financial Risk | AAP 2025

: Despite bipartisan support, PBM reform continues to be brushed aside. Are you at all hopeful that some type of PBM reform will be passed under the new administration? What do you think needs to be done to get PBM reform passed?

: I'm extremely optimistic, if for no other reason that it saves over $5 billion for taxpayers. As far as it being delayed and delayed and delayed, we've said to members of Congress, “Look, we've been the bridesmaid left at the altar three different times with continuing resolutions that were passed to fund the government and pharmacy not being included.” They continue to assure us that PBM reform will be included. The latest that we've been told by the leadership of Congress is that it will be done through the reconciliation process, so as the budgets are reconciled between the Senate and the House, PBM reform will be included in that. That does make some sense, because they're going to need some ways to save money. And again, PBM reform saves $5 billion, so it should be attractive for that. We are beyond impatient, though, and in fact, our fly in is coming up, and the message is, “When are you going to get this done?” I mean, we want to be polite to a certain extent, but we're almost beyond politeness because it hasn't been done. Pharmacies are closing. Patients are suffering. Prices are going up. And Congress continues to sit on its hands. Am I optimistic? Yes. Am I done waiting? Yes.

As far as things that need to be done, continued pressure on members of Congress. I mean, really make your representatives tell you why it can't be done. And if they say, “Well, leadership hasn't put it up for a vote,” ask them why. They have a vote. I don't want to hear, “I'm a helpless member of Congress.” No, you're a member of Congress. You have a vote. You can talk to leadership about why it hasn't come up for a vote. We personally talked to Speaker Johnson, and he has said it will go through. He is in favor of it, and he supports it. That's great. We appreciate that. Now do it. So, that continued pressure from pharmacists and when they can, engage their patients. I think it's good for the members of Congress to hear it not only from pharmacists, not only from small business owners, not only from their constituents, but also other constituents that can vote them in or out of office.

: What’s your take on Optum Rx’s recent announcement that it plans to introduce a cost-plus prescription reimbursement model?

: Optum Rx came out and said that they want to pay pharmacies.

 They understand that pharmacies are losing money on brand drugs, and they want to smooth that out so that pharmacies no longer lose money on all or most brand drugs. However, instead of increasing the size of the pie, they're just cutting it up differently. What they are proposing is that pharmacies would make less on generics and basically break even, or maybe not lose money, on brands. I guess two reactions. One, if you're just shuffling the chairs on the deck of the Titanic, that doesn't really help. Two, if I'm trying to look at this in the most optimistic fashion, it's at least trying to do something different. As we've talked to them, they are talking to PSAOs. And as we've talked to the PSAOs—NCPA does not negotiate any contracts—but the PSAOs do. The PSAOs are trying, or at least the PSAOs that Optum Rx is talking to, are trying to increase the size of the pie. If the pie actually gets bigger, if there is more dollars going to pharmacies, then I think the effort is actually good. They're at least trying to do something different, unlike their two competitors. So, largely skepticism. Actions will speak louder than words, is what we told Optum Rx when they told us about it. If it does change the pharmacy payment model, which is NCPAs mission, change the pharmacy payment model so that pharmacies are paid, not losing money on brands, and paid fairly on generics. If it became that which it's that's not what's being proposed, it could be a good thing. But for now, it's like I said, just shuffling the chairs on the Titanic, it's just moving money around. Same results for pharmacies.

A cynical view could also say that pharmacy abandonment, which is when the pharmacy says, “I can't fill this brand drug because I'm losing too much money on it,” which we're hearing about increasingly. A cynical view would say maybe that's motivating OptumRx, because maybe they're making less money in rebates and fees from brands because the brands aren't getting filled, Maybe they're hearing from brand manufacturers that they're not going to pay the fees that Optum Rx is extorting from them. Maybe they have a less benevolent motivation. As long as they pay the pharmacies fairly and increase the size of the pie, their motivation doesn't matter as much to me. The bottom line is, what they've proposed, unless it increases the reimbursement pie for pharmacy, same old, same old.

I think, like the CVS thing was, to me, clearly, in response to the Mark Cuban Cost Plus model. Cost plus is something that NCPA has advocated for for years. Cuban’s large megaphone, he's got, I don't know, several million followers on X. I think that catalyzed some of CVS’ move to a cost plus model. I think some of it's the pressure. All three of the PBMs, especially Express Scripts, are trying to do a lot of smoke and mirrors to convince Congress that there's nothing to see—everything's okay with independent pharmacies. We've solved it through the Marketplace, which is the way everyone would like to solve the problems between PBMs and pharmacies. We need legislation, because the marketplace is so tilted, it's so one sided in the PBMs favor that, unfortunately, the marketplace doesn't work anymore. I think the cost plus from CVS, Express Scripts is also trying to do cost plus, and this from Optum Rx, some of that, and maybe a lot of it, is to try to dissuade Congress and the FTC from continuing to look at things. NCPA’s message has been very clear. Actions speak louder than words and actions have not happened yet that change anything. We still need PBM reform legislation passed.

Be sure to keep up with all of our coverage from AAP 2025 here.

1. Optum Rx to Modernize Pharmacy Payment Models. News Release. Optum Rx. March 20, 2025. Accessed April 14, 2025. 

https://www.unitedhealthgroup.com/newsroom/2025/2025-03-20-orx-modernize-payment-models.html

At AAP 2025, Douglas Hoey, CEO of NCPA, discussed the possibility of PBM reform under the new administration and his take on Optum Rx’s plans to introduce a cost-plus reimbursement model.

Practice Management

Q&A: Douglas Hoey on PBM Reform, Optum Rx Cost-Plus Announcement | AAP 2025

Microvascular complications due to type 2 diabetes (T2D) contribute to cognitive impairment and depression, according to results of a study published in 

 Investigators found that nephropathy in particular is strongly linked to cognitive decline.

“Our systematic review and meta-analysis assessed microvascular complications in individuals with T2DM [type 2 diabetes] were found to be linked with a high prevalence of cognitive impairment and depression, although the strength of these associations varied by complication type,” the study authors said. “Diabetic nephropathy demonstrated a statistically significant relationship with cognitive impairment, whereas associations for neuropathy and retinopathy with cognitive impairment or depression were generally weaker and not statistically significant.”

T2D is associated with various complications and is linked to cardiovascular disease and other metabolic disorders. Additionally, T2D has many impacts on mental health outcomes. According to the CDC, people with diabetes are 2 to 3 times more likely to have depression than patients without diabetes, and there is a low rate of diagnosis and treatment at only 25% to 50% for patients with diabetes and depression. Further, patients with diabetes are 20% more likely to have anxiety than those without.

Diabetes has also been identified as a major risk factor for cognitive dysfunction. In a review published in 

, since diabetes is largely self-managed, cognitive decline can further worsen as a result of diabetes’ effects on neuronal function and mental capacity, such as local hyper- and hypometabolism of brain areas from insulin resistance and recurrent hypoglycemic episodes resulting in neuronal damage.

In the systematic review and meta-analysis, investigators aimed to determine the impact of diabetic neuropathy, retinopathy, and nephropathy on both cognitive impairment and depression. They included observational studies that included the prevalence and association of cognitive impairment and depression for patients with diabetic complications. There were 5640 studies identified, with 4713 being screened. Investigators included a total of 7 after excluding the rest due to being editorials or opinions, not containing outcomes of interest, or not being full-text articles. There were 6 cross-sectional studies and 1 cohort study, with 2 studies from China, 2 from Poland, 1 from Brazil, 1 from Greece, and 1 from Japan.

The associations and strengths of these links varied by the complication type, including diabetic nephropathy, neuropathy, and retinopathy. 

Bert Drachtman, BS, RPh

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