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While experts agree there is no one-size-fits-all approach, addressing medication nonadherence among patients presents opportunities for pharmacists to set themselves apart as medication counselors.

The Complex Issues, Opportunities for Pharmacists in Addressing Medication Adherence

Articles

Hyperkalemia, chronic kidney disease, and hypertension often don’t manifest until the diseases become chronically uncontrolled, according to Ralph J. Riello III, PharmD, BCPS.

Pharmacists Can Help Manage Therapies for Hyperkalemia

In an exploration of cardiovascular outcomes, health care utilization, and patient costs, researchers compare glucagon-like peptide-1s with alternative noninsulin glucose-lowering therapies.

Weekly GLP-1s Significantly Reduce Cardiovascular Risks

This episode explores how recent trends in the retail community pharmacy industry are informing the actions of pharmacy leadership and their teams across the country.

Dispensing Leadership: The Dominoes Are Falling in Community Pharmacy

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

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GPS-based dietary prompts, continuous glucose monitors among the devices poised to revolutionize diabetes treatment and patient management. 

The Smart Technology That Will Change Diabetes Care

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

Transitions of Care and Unmet Needs in Hyperkalemia Management

This content is a production of Drug Topics; this Pharmacist View Video is supported by funding from AstraZeneca. AstraZeneca was not involved in the creation of the content for this Video.

Transitions of care represent a critical and vulnerable period for patients, especially those hospitalized or moving between care settings. These transitions create opportunities for medication errors, poor communication, and gaps in follow-up, all of which can negatively impact patient safety. For patients with hyperkalemia, these risks are even more pronounced since a history of elevated potassium significantly increases the chance of recurrence. Pharmacists play a key role in anticipating potential problems, ensuring clear communication, completing prior authorizations before discharge, and educating patients to avoid issues such as unexpected medication costs that might prevent adherence.

Ongoing monitoring after discharge is essential, as patients leave the protective hospital environment and enter outpatient or rehabilitation settings. Utilizing electronic health records and predictive tools can help track patients with a history of hyperkalemia and heart failure, ensuring that they receive appropriate medications and follow-up care. Programs designed to identify at-risk patients post discharge create a safety net to catch those who might otherwise fall through the cracks. Pharmacists are uniquely positioned at multiple points along the continuum—from hospital discharge to community pharmacy—to support medication reconciliation, counseling, and continuity of care, making transitions safer and more effective.

Looking ahead, unmet needs in hyperkalemia management include earlier detection and proactive intervention before potassium levels become dangerously high. Advances in artificial intelligence and predictive analytics can help identify patients at risk, enabling timely pharmacist-led interventions. Despite the availability of novel potassium binders, many patients remain undertreated due to fears around hyperkalemia. Addressing this treatment gap, particularly in patients with comorbid heart failure and chronic kidney disease, is crucial. Implementing evidence-based strategies and increasing the use of these newer agents will allow more patients to safely reach guideline-directed therapies, ultimately improving outcomes across the spectrum of care.

An expert discusses the critical risks of care transitions for hyperkalemia patients, emphasizing the pharmacist’s essential role in ensuring medication safety, effective communication, and continuity of care, while highlighting the potential of predictive tools and novel therapies to improve early detection and long-term management.

Videos

Examining the Interplay Between Guideline-Directed Medical Therapy and Hyperkalemia

Guideline-directed medical therapy (GDMT) for heart failure is incredibly important—it’s often compared to chemotherapy in major cancers because of its significant impact on patient outcomes. The main challenge is that these lifesaving therapies, which include angiotensin receptor/neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors, can increase the risk of hyperkalemia due to their effects on the renin-angiotensin-aldosterone system. However, stopping or avoiding these medications because of hyperkalemia is not ideal, as their benefits in improving symptoms and survival start within weeks and are substantial. Managing hyperkalemia effectively is therefore crucial to ensuring patients continue to receive these therapies.

Within the GDMT options, some substitutions may help reduce the risk of hyperkalemia without sacrificing benefit. For example, ARNIs have a lower incidence of severe hyperkalemia compared with older ACE inhibitors like enalapril. Additionally, newer nonsteroidal MRAs may provide heart failure benefits with a more favorable potassium profile than traditional steroidal MRAs such as spironolactone. The early use of SGLT2 inhibitors also appears to lower hyperkalemia risk and enables patients to reach target doses of renin-angiotensin-aldosterone system inhibitors more safely. These nuanced choices can optimize both efficacy and safety, especially in patients with overlapping chronic kidney disease and heart failure.

Recent randomized controlled trials have demonstrated that novel potassium binders like patiromer and sodium zirconium cyclosilicate are effective tools to manage hyperkalemia, allowing patients to maintain or even escalate GDMT doses safely. These agents help bridge the gap for patients who might otherwise have to reduce or discontinue essential heart failure therapies due to potassium concerns. By incorporating potassium binders alongside GDMT, clinicians can better support long-term guideline adherence, improving outcomes and quality of life for patients with heart failure.

An expert discusses the critical balance in heart failure GDMT between maximizing lifesaving treatments and managing hyperkalemia risk, highlighting how novel potassium binders and strategic medication choices enable safer continuation and optimization of therapy to improve patient outcomes.

Discussing the Chronic Treatment Options for Hyperkalemia

The treatment landscape for chronic hyperkalemia has evolved significantly with the introduction of novel potassium binders such as patiromer and sodium zirconium cyclosilicate (SZC). These therapies represent a major improvement over older agents like sodium polystyrene sulfonate (SPS), which was historically approved with limited clinical evidence and has since raised serious safety concerns. SPS is associated with gastrointestinal complications, including erosions and even perforation, especially in sorbitol-containing formulations. Its variable efficacy and unpredictable patient response further limit its reliability. In contrast, patiromer and SZC were developed with modern clinical standards in mind, offering more consistent potassium reduction and an improved safety profile.

Each of the new agents offers distinct characteristics that help guide therapy selection. Patiromer is a calcium-based exchange resin that gradually reduces potassium over several hours, typically peaking in effect within 24 to 48 hours. It can interfere with the absorption of other oral medications, requiring careful dosing separation. SZC, on the other hand, is a sodium-based binder that acts more quickly, often lowering potassium within 1 to 2 hours, making it preferable in situations requiring rapid correction. However, the sodium content in SZC can pose a risk for fluid retention, particularly in patients with heart failure or volume overload, and should be used cautiously in those populations.

Choosing the most appropriate binder often depends on clinical context, urgency of treatment, comorbid conditions, and logistical factors like formulary access or insurance coverage. While both agents have demonstrated effectiveness in managing chronic hyperkalemia and allowing continuation of essential therapies such as renin-angiotensin-aldosterone system inhibitors, pharmacists play a crucial role in individualizing treatment plans. By understanding the pharmacologic nuances and patient-specific risks, clinicians can better balance hyperkalemia management with optimal use of cardioprotective medications, improving long-term outcomes in high-risk populations.

An expert discusses the evolving treatment landscape of chronic hyperkalemia, highlighting the clinical advantages of newer potassium binders like patiromer and sodium zirconium cyclosilicate over older agents, and emphasizing the pharmacist’s critical role in selecting and managing these therapies to support continued use of lifesaving medications in high-risk patients.

Chuck Green

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