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Patients with type 2 diabetes and moderate cardiovascular risk had a higher rate of major heart-related events when treated with sulfonylureas.

Glipizide Increases Cardiovascular Risk Compared With DPP4 Inhibitors in T2D

Among rural community pharmacies in the US, researchers explored pneumococcal immunization services, the processes used to identify patient eligibility, and the barriers to vaccine administration.

Rural Community Pharmacies Play Crucial Role in Pneumococcal Vaccine Access

FDA approves Biktarvy for HIV treatment in patients not virologically suppressed, enhancing options for those restarting antiretroviral therapy.

FDA Approves Biktarvy for Patients With HIV Previously Treated With Antiretroviral Therapy

Researchers conducted a systematic review to determine the effectiveness of pharmacists in promoting vaccine uptake for protection against the most prominent infectious diseases.

Pharmacist-Led Interventions Boost Vaccine Uptake in Older Adults

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

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Despite challenges from a contracting economy, pharmacists are optimistic about 2009.

Pharmacists hope 2009 will be a good year for 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

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 

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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

Through the Bristol Myers Squibb-Pfizer Alliance, the pharmaceutical companies are bringing apixaban (Eliquis) directly to patients at over 40% less than the list price, according to a Bristol Myers Squibb press release.

“The BMS-Pfizer Alliance is committed to increasing patient access and affordability, which is why we are launching this direct-to-patient offering for [apixaban],” said Christopher Boerner, PhD, board chair and CEO of Bristol Myers Squibb. “[Apixaban] is the nation’s No. 1 prescribed oral anticoagulant that provides important benefits to patients and the health care system.”

Offered through the partnership’s Eliquis 360 Support program, the anticoagulant therapy is discounted for uninsured or underinsured individuals. Focused on simplicity and transparency in drug dispensing, this new offering was designed to increase access and decrease patients’ out-of-pocket (OOP) expenses.

How the Complexities, Trends in Drug Benefit Design Are Evolving in Real Time

Although the new program is centered around only 1 specific formula of an anticoagulant therapy, the medication class is a significant one. Every year in the US, around 900,000 patients experience blood clots that result in up to 100,000 deaths. The first line of defense for preventing blood clots, according to AARP, is either antiplatelet or anticoagulant therapies.

Apixaban was first approved in 2012 for patients with atrial fibrillation to reduce blood clots and risk of stroke.

 Since then, its use among US patients has increased significantly. From 2018 to 2022, for example, Medicare Part D spending on apixaban per beneficiary increased 43%, with patients’ average annual OOP cost increasing by 23%.

“Beginning September 8, eligible US patients with an [apixaban] prescription may purchase the medicine directly through Eliquis 360 Support and will pay a discounted rate of more than 40% less than the current list price,” wrote authors of the release.

 “The program will provide direct shipping to patients across all 50 states and Puerto Rico, offering an additional, simplified option for accessing [apixaban] and full transparency into the associated costs.”

Eliquis 360 Support is an around-the-clock resource for helping patients understand their atrial fibrillation and apixaban regimens. In addition to providing patients with actual OOP savings and transparency regarding the pricing of apixaban, the program is also available for any patient seeking general advice or guidance on their conditions.

“Eliquis 360 Support is here to help you understand your prescription insurance coverage and help those with an [apixaban] prescription learn about potential ways to save on out-of-pocket costs,” states the Eliquis 360 Support website.

Throughout apixaban's time on the prescription drug market, it has amassed an estimated $3 billion in health care savings for every 100,000 patients treated, as over 15 million Americans have received an apixaban prescription. Now, with the introduction of Eliquis 360 Support, patients will have a grasp of their prescription drug costs like never before.

However, some experts believe initiatives such as the Eliquis 360 Support program enable pharmaceutical companies to avoid the true cause of increasing drug costs.

“We call this ‘having your cake and eating it too,’” said Antonio Ciaccia, CEO of 46brooklyn Research and president of 3 Axis Advisors, in a 

. “[It's] another niche program that can provide good relief to those who need it but avoids the root cause of bloated drug list prices, which necessitate the existence of the program in the first place. Regardless of its potential usefulness, the fact that this is even a thing is the indicator that the architecture of our system is absurd, overly complex, and misaligned with the interests of patients—all so we can maintain our overarching addiction to bloated discounts off bloated prices.”

Regardless of the overarching implications this new program could have, it is providing future relief to a prominent patient population that needs drugs such as apixaban. 

“This program passes more savings directly to patients and demonstrates our continued focus on identifying innovative solutions that foster the best outcomes for each individual while prioritizing access to care,” concluded Boerner.

The Current Drivers in Medication Use, Spending

Are you ready to elevate your pharmacy practice? Sign up today for our 

 and get the latest drug information, industry trends, and patient care tips straight to your inbox.

1. Bristol Myers Squibb and Pfizer announce direct-to-patient Eliquis (apixaban) option. News release. Bristol Myers Squibb. July 17, 2025. Accessed July 17, 2025. 

https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-and-Pfizer-Announce-Direct-to-Patient-Eliquis-apixaban-Option/default.aspx

2. Szabo L. What you need to know about blood thinners. AARP. November 15, 2024. Accessed July 17, 2025. 

https://www.aarp.org/health/drugs-supplements/blood-thinners/

3. Agrawal A, Manna B. Apixaban. StatPearls Publishing; 2025-. Updated February 22, 2024. Accessed July 17, 2025. 

https://www.ncbi.nlm.nih.gov/books/NBK507910/

4. Eliquis: Medicare enrollee use and spending. Assistant Secretary for Planning and Evaluation. October 30, 2023. Accessed July 17, 2025. 

https://aspe.hhs.gov/sites/default/files/documents/d1e51e1f27136349e9a48677d14c5198/Eliquis.pdf

5. Eliquis 360 support. Bristol Myers Squibb Company. Accessed July 17, 2024. 

https://www.eliquis.bmscustomerconnect.com/support

The 2 corporations formed the Bristol Myers Squibb-Pfizer Alliance and will be offering discounted Eliquis to eligible patients starting September 8, 2025.

Bristol Myers Squibb, Pfizer to Sell Eliquis Directly to Patients

Over 100 years after the first successful insulin injection, advancements in diabetes care have saved lives and made the disease increasingly more manageable as the years go by. However, challenges, barriers to access, and many more factors continue to lead to poor diabetes outcomes such as hyperglycemia and hypoglycemia.

All these ongoing developments underscore the importance of insulin management in diabetes care.

“Insulin is a very narrow therapeutic window. It's not an easy drug to give and to take,” Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, director of education and training in diabetes technology at the Cleveland Clinic, told 

. “In terms of challenges, what we're trying to do with insulin is to mimic the body's physiologic response. But it turns out it's very challenging to do that, even with all the different types of insulins that we have.”

to discuss the importance of insulin delivery, the pharmacist’s role, advancements in this space, and so much more. From her extensive background in diabetes to her work in the community as a pharmacist, Isaacs offered insights into the most notable developments in patients’ diabetes journeys, with a specific focus on the power of insulin.

But despite all the ongoing developments, Isaacs believes more can be done to maximize improved diabetes outcomes.

“We have certainly made a lot of advances,” she said. “What I would almost ultimately love to see is a truly glucose-targeted insulin that just works when the glucose is high and is truly physiologic, so that someone doesn't have hypoglycemia or is not at risk of hypoglycemia.”

Stay tuned for weekly podcast episodes on 

 every Thursday afternoon. Check out our previous episode with 

, state representative in Iowa’s 51st District. Joining to discuss Iowa’s recent passing of Senate File 383, Barker discussed the impacts state-level PBM reform can have on federal policy.

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our 

The history of a wonderful thing we call insulin. American Diabetes Association. July 1, 2019. Accessed July 17, 2025. 

https://diabetes.org/blog/history-wonderful-thing-we-call-insulin

Amid increased advancements in diabetes management, Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, discussed how these developments are currently impacting the delivery of insulin.

The Evolving Landscape of Insulin Delivery in Diabetes Management

Influenza vaccination showed benefits in reducing infections to both vaccinated and unvaccinated individuals, even when effectiveness and uptake were low, according to results of an analytical model study published in 

 However, the authors noted that when transmission was high, even highly effective vaccines did not protect those who were unvaccinated.

“In our results, a substantial proportion of infections was prevented when transmissibility was similar to that encountered in typical influenza seasons, vaccine effectiveness was within the ranges estimated for those seasons, and vaccine uptake was similar to what is typically found in the US,” the study authors said.

Flu vaccination significantly reduces illness in vaccinated and unvaccinated individuals, highlighting its importance in public health strategies.

David Bennett, Senior Editor

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