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Articles

Researchers address impacts of the Inflation Reduction Act on the access, cost, and coverage of glucagon-like peptide-1 medications for patients with diabetes.

OOP Costs, Prior Authorizations for GLP-1s Expected to Increase Dramatically by 2025

In the final part of our interview with Mark Garofoli, PharmD, BCGP, CPE, CTTS, he discusses what the future will hold regarding clinical decision-making following the reported acetaminophen-autism link.

Q&A: How Acetaminophen-Autism Link Creates Concerns in Clinical Decision-Making

Pharmacists are on the frontline for patients looking to self-manage their menstrual pain, making their role invaluable in women’s health.

Pharmacist’s Role in Education About Menstrual Pain Shows Value of Profession in Women’s Health

Pain medication expert Mark Garofoli, PharmD, BCGP, CPE, CTTS, joined Drug Topics to explore the referenced studies in the Trump Administration’s push to link acetaminophen use with autism.

Q&A: Acetaminophen-Autism Link Highlights Issues of Confounding Evidence

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

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Heidi Polek, RPh, EMBA, discusses how pharmacies must adopt strategic approaches to maintain financial health and continue providing patient care.

Turning Reconciliation into a Revenue Growth Engine

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.”

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

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

Pharmacists discuss state barriers and scope of practice challenges

Pharmacists Break Down State Barriers and Challenges in Scope of Practice

In the evolving landscape of health care, pharmacists are emerging as critical frontline providers, pushing the boundaries of their traditional roles and seeking recognition for their expanding clinical capabilities. The current health care system presents a complex patchwork of regulatory challenges that significantly limit pharmacists' potential to deliver comprehensive patient care. Across the United States, the scope of practice for pharmacists varies dramatically from state to state, creating a fragmented approach to health care delivery that ultimately impacts patient access and quality of care.

These variations manifest in critical areas such as prescribing authority, lab test ordering, and the extent of physician oversight required. Community pharmacies, in particular, face substantial obstacles in providing consistent, high-quality services, especially in sensitive areas like reproductive health. The inconsistency extends beyond clinical capabilities, encompassing fundamental operational aspects like technician staffing ratios and the ability to administer specific medications. Perhaps most significantly, pharmacists continue to face a fundamental challenge at the federal level: they are not recognized as reimbursable providers under Medicare. This systemic exclusion creates a substantial financial barrier that prevents pharmacists from fully leveraging their extensive medical training and potential to improve patient outcomes.

The conversation around pharmacists' scope of practice is not merely about professional expansion but about fundamentally reimagining health care delivery. Pharmacists represent a largely untapped resource in the health care ecosystem, with advanced training and daily patient interactions that position them uniquely to provide preventative care, disease management, and critical health interventions.

Emerging voices in the pharmacy profession are calling for a more collaborative, patient-centered approach. They argue that by breaking down institutional barriers, standardizing practice guidelines, and creating sustainable payment models, pharmacists can become integral partners in comprehensive health care delivery. The goal is not to replace traditional medical providers but to complement their work, filling critical gaps in patient care and improving overall health outcomes. As health care continues to evolve, the role of pharmacists stands at a critical juncture. The profession is poised to transform from a traditional dispensing model to a dynamic, clinically engaged approach that could revolutionize how we understand and deliver primary care.

Pharmacists advocate for standardized scope of practice, improved collaborative care models, and equitable reimbursement to enhance patient services across different states.

Total Pharmacy Interviews

Pharmacists Break Down State Barriers and Collaborative Care Challenges

Public trust in vaccination is at some of the lowest points in history.

Pharmacist Discusses Concerns Over Immunization Changes

Laura Knockel, PharmD, BCACP, a clinical associate professor at the University of Iowa College of Pharmacy, discusses the challenges health care providers face in communicating accurate vaccine information in an increasingly complex and fragmented information landscape. Knockel highlights growing concerns over how vaccine recommendations are being communicated, noting a shift away from traditional, transparent discussions to less formal channels such as social media posts.

To address this challenge, she recommends that health care professionals and patients rely on reputable sources such as the American Academy of Pediatrics and the Infectious Diseases Society of America. These organizations are increasingly developing robust vaccine resources that are accessible to the public, prioritizing the distribution of evidence-based recommendations.

Knockel also emphasizes the importance of vaccine safety and accessibility. She notes that vaccines undergo more rigorous testing than most medications due to their administration to healthy populations, and the US vaccine safety program is exceptionally robust. However, potential changes in the Advisory Committee on Immunization Practices recommendations could have significant implications for vaccine access and public health. Specifically, Knockel warns that narrowing vaccine recommendations could lead to patients paying out of pocket for vaccines, potentially discouraging vaccination and even impacting vaccine manufacturing.

Ultimately, she calls for continued education, staying informed about vaccine policy changes, and maintaining a focus on communicating the value of vaccines to patients. Despite the overwhelming nature of constant updates, health care providers must remain committed to keeping patients informed and healthy.

"What's happening with vaccine policy at the federal level is irresponsible at best and, I would say, extremely dangerous at worst and can be overwhelming, especially when pharmacists have so many other demands on their time to try to keep track of all these updates that keep coming out," Knockel said. "I really think we need to stay up to date, focus[ing] on educating the public and letting the patient, our patients, know the value of vaccines, and hopefully we can continue to keep our patients healthy."

Laura Knockel, PharmD, BCACP, expresses concerns about how vaccine recommendations are being communicated, noting a shift away from traditional, transparent discussions to less formal channels such as social media.

Pharmacist Discusses Concerns Over Immunization Changes, Public Trust

Pneumococcal and influenza vaccination rates were significantly inadequate among people living with HIV (PLWH) in Belgium, according to study findings published in 

With study data spanning from 2017 to 2022, and COVID-19 vaccine rates being high throughout, researchers believe targeted vaccine interventions and reminders can improve rates among this population.

Due to an increased risk of vaccine-preventable diseases, researchers explore pneumococcal, COVID-19, and influenza vaccine coverage among people living with HIV in Belgium.

Heidi Polek, RPh, EMBA

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