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The approval covers Pfizer and BioNTech’s LP.8.1-adapted monovalent COVID-19 vaccine, which is also indicated for patients aged 5 to 64 with at least 1 underlying condition.

FDA Approves Updated 2025-2026 COVID-19 Vaccine for Patients 65 Years and Older

Through considerations regarding cost, scalability, safety, and regulations, researchers provided an end-to-end perspective on microneedle-based vaccine strategies.

Microneedle-Based Vaccine Systems Emerging as Viable Future Option

Pharmacies face time, workload, and sustainability challenges when integrating social care, but support and reimbursement can make these efforts viable.

Q&A: Addressing Barriers to Social Care in Pharmacies

However, caution with empagliflozin use should be taken for patients who were previously on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Real-World Data Show Dapagliflozin, Empagliflozin Are Safe Options for Diabetes

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

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HEAT Zones and Their Impact on Pharmacy Transactions

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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 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.

Clinical

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

The Pharmacy Quality Alliance (PQA) is dedicated to improving safe, effective, and appropriate medication use and addressing issues that impact an individual's ability to access and use medications.

Access to medications and pharmacy services is important for high-quality, value-based health care. Whether individuals can obtain their medications, use them optimally, maintain proper use, and access related services greatly impacts medication-related outcomes.

Access is a complex issue, and the availability, location, and convenience of community pharmacies and pharmacy services are important factors.

There has been significant news and research on pharmacy closures. The pace of pharmacies closing is outpacing the opening of new pharmacies, according to 

 in December 2024, and the net loss of pharmacies has been greatest in communities with limited access to care and services in both urban and rural settings.

The impact on community pharmacy is serious and has been much discussed. Less attention, however, has been devoted to understanding pharmacy closures from the perspective of arguably the most important stakeholders, the patients.

There are 2 notable issues. The first is pharmacy deserts, the areas where individuals must travel significant or costly distances to access medications and pharmacy services. Findings from a recent 

 indicated that 48.4 million Americans lack adequate access to a pharmacy.

The second is the disruptive impact of having to change pharmacies, which can cause patients emotional stress, decrease the use of needed services, and increase the risk of medication therapy problems or nonadherence. The opening and closing of community pharmacies is often referred to as “churn,” and the downstream implications for patients and communities need more study, according to a 

These issues are important for all patients, but especially important for Medicare beneficiaries, who are more likely to have multiple chronic conditions and rely heavily on pharmacy services.

To ensure pharmacy access for Medicare Part D beneficiaries, the Centers for Medicare & Medicaid Services requires all Part D plan sponsors to have a sufficient pharmacy network in their service area. The 

 for retail pharmacy access are as follows, based on level of urbanicity:

At least 90% of Medicare beneficiaries in urban areas served by the Part D plan must live within 2 miles of a network retail pharmacy;

At least 90% of Medicare beneficiaries in suburban areas served by the Part D plan must live within 5 miles of a network retail pharmacy; and

At least 70% of Medicare beneficiaries in rural areas served by the Part D plan must live within 15 miles of a network retail pharmacy.

These important standards are designed to ensure patients have adequate pharmacy access. Given the pattern of pharmacy closures and the disruption it may cause for patients, we need to better understand how beneficiaries are affected.

More specifically, what challenges or barriers do patients face when pharmacies close or when they must change pharmacies? Additionally, what impact do pharmacy closures have on beneficiaries’ use of a range of pharmacy services such as immunizations, medication counseling, chronic disease management, health screenings, and treatments?

PQA aims to begin research on pharmacy access in 2026 that will help address these questions.

Understanding these issues can shed light on the impact of pharmacy closures, disruptions to health care access, and whether today’s approach to pharmacy networks meets the needs of beneficiaries in a rapidly changing health care environment.

If your organization is interested in supporting PQA in this work, contact the PQA Quality Innovation and Research Center at QuIRC@PQAalliance.org.

Micah Cost is the CEO of the Pharmacy Quality Alliance (PQA). PQA is dedicated to improving safe, effective, and appropriate medication use and addressing issues that impact individuals' ability to access and use medications. Through quality measurement, research, and education, PQA’s consensus-driven initiatives help improve health care outcomes and lower costs. PQA communications intern Naila Muhammad provided research and writing support for this article.

Pharmacy closures are reducing access to medications and services, raising concerns about their impact on patient care, especially for Medicare beneficiaries.

Pharmacy Access and Its Impact on Medicare Beneficiaries 

When it comes to expanding pharmacy services and improving reimbursement, independent pharmacies must understand the basics of medical billing, value-based care, partnerships, and daily expansion opportunities.

"It can feel really overwhelming to think of creating a net-new service, being a credentialed provider,” said Tara Pfund, PharmD, chief strategy officer with Cascadia Pharmacy Group. “What type of technology would you use to submit your claims? Will they be paid? A lot of times, I see pharmacy teams putting it off until they’ve got enough time. If you don’t put the big rocks in first, you’ll never get them in at all.”

 Solutions Summit Summer 2025, Pfund hosted a session titled Expanding Revenue Streams in Independent Pharmacy: Strategies for Today and the Future. Sponsored by American Associated Pharmacies (AAP), Pfund’s presentation received AAP support because of the organization’s close relationship with Cascadia Pharmacy Group.

“AAP is one of America’s largest independent pharmacy organizations, a national cooperative of more than 2000 member pharmacies,” according to AAP. “Cascadia Pharmacy Group represents more than 40 of those member locations. Cascadia’s CEO, Jeff Harrell, is chairman of AAP’s board of directors and also currently serves as president of [the National Community Pharmacists Association’s] board and [is] a member of the AlignRx board.”

Unlocking Pharmacy Value Through Payer Program Engagement

Read on for key takeaways from Pfund’s presentation:

“One of the things I always talk to teams about...is a lot of times when you want to launch a clinical service or do medical billing or create a provider-payer partnership, it’s something that we think we have to put off until we have enough time to do it,” said Pfund. “It can feel really overwhelming to think of creating a net-new service, being a credentialed provider.” With this potential barrier in mind, Pfund believes the best step forward is to simply begin expanding the clinical services that are already offered. Once more services are offered and others are improved, pharmacies have a significant opportunity to expand revenue streams.

Pfund explored the 6 steps in implementing medical billing and value-based care services. Those steps included identifying the services, credentialing and contracting, documentation, billing, training, and revenue cycle management (RCM). After finding the services they can bill for, pharmacies should get these services credentialed and contracted to be viable options for billing in their state. Finally, Pfund mentioned how pharmacies need to establish documentation, how they should bill for services, and what training is necessary. Pharmacies can then implement their services and diversify revenue through RCM solutions.

“We really want to look at alternative payment models where there is a link to quality and value, where we can make sure that patients are being cared for in a way that improves overall quality, and that pharmacists and pharmacies are reimbursed for those types of programs,” continued Pfund. Speaking to value-based care initiatives, Pfund believes these alternative payment models can enhance the pharmacists’ role while also diversifying revenue streams within pharmacy businesses that may be struggling with reimbursement.

She delved into the core principles of operating a pharmacy business and the regulations in place that impede pharmacists from billing for more medical services. Although community pharmacies are mainly employed to dispense medications and health care products, Pfund advises pharmacists to have conversations with payers, patients, and health care providers to better understand the needs of patients in their communities. Pfund also provided advice focused on engaging the entire pharmacy team and working with other stakeholders on ways to improve bottom lines, as well as patient outcomes.

“I’ve been really lucky to have a career where I’m part of small changes coming together to create a big tidal wave of change. We’re able to make a big difference and change one person’s life that slowly helps change one more person’s life,” concluded Pfund. “Next thing you know, [you have] an entire small community where the payers and the providers and the pharmacies are all engaged in this way to keep independent pharmacies in business and have there be more access points of patient care. It’s really neat, and I’ve seen it happen firsthand.”

Tara Pfund, PharmD, chief strategy officer with Cascadia Pharmacy Group, discusses various ways community pharmacists can expand services and support clinical reimbursement.

Strategies for Expanding Revenue Streams in Independent Pharmacy Today and in the Future

AstraZeneca will now provide a home delivery option for its nasal spray flu vaccine FluMist, according to a press release from the company.

With FluMist Home, patients who are prescribed the vaccine can place an order through the independent online specialty pharmacy ASPN Pharmacies and have it delivered to their home via Polaris Pharmacy Services.

“As influenza vaccination rates decline, especially among younger populations, this first-of-its-kind, at-home, needle-free option offers a critical opportunity to help make protection more accessible, convenient, and better aligned with the realities and current preferences of people’s lives,” Ravi Jhaveri, MD, professor of pediatrics at Northwestern University School of Medicine, said in the release.

FluMist is the first and only seasonal flu vaccine approved to be self-administered by adults 18 to 49 years of age or by a caregiver to individuals 2 to 17 years of age. The live attenuated vaccine was first approved by the FDA in 2003 and received approval for self-administration in 2024. The self-administration approval was based on data that showed the vaccine instructions were appropriately designed so recipients and caregivers could safely and effectively use the vaccine.

 FluMist is approved for the prevention of flu caused by influenza virus subtypes A and B.

FluMist Home is delivered in a consumer-friendly format with clear, at-home specific instructions that support proper handling, administration, and disposal. The vaccine should be stored in the refrigerator until it is ready to be used. The most common adverse effects of FluMist include a runny or stuffy nose, a sore throat, and a fever over 100 °F. FluMist should be avoided if a patient is allergic to eggs or other flu vaccines.

“Seasonal influenza can have a serious, even life-altering, impact on individuals and families, especially for those most vulnerable,” Michele Slafkosky, executive director of Families Fight Flu, said in the release.

 “Providing flexible vaccination options makes it easier for individuals and caregivers to...get protected. This can help to improve protection for individuals and strengthen collective immunity against influenza.”

AstraZeneca said in the release that FluMist Home will be available in 34 states and eventually all 48 contiguous states. Although the service is not allowed in certain states due to local pharmacy laws, it is available for administration in doctors’ offices and pharmacies nationwide.

“For the first time, consumers can receive and administer an influenza vaccine entirely at home—marking a historic shift in how preventive care is delivered,” Ami Patel, executive vice president of hub operations at ASPN Pharmacies, said in the release.

 “Through FluMist Home, we’re seeing a new model of care that puts consumers in control, offering a seamless, end-to-end experience from determining eligibility to convenient home-delivery and administration. This milestone not only redefines convenience in vaccine delivery but also sets the stage for a more accessible, patient-centered future in health care.”

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1. FLUMIST (Influenza, Vaccine Live, Intranasal), the nation’s only nasal spray flu vaccine, now available for home delivery. News release. AstraZeneca. August 15, 2025. Accessed August 15, 2025. 

https://www.astrazeneca-us.com/media/press-releases/2025/FLUMIST-the-nations-only-nasal-spray-flu-vaccine-now-available-for-home-delivery.html

2. FDA approves nasal spray influenza vaccine for self- or caregiver-administration. News release. FDA. September 20, 2024. Accessed August 15, 2025. 

AstraZeneca now offers FluMist Home, allowing eligible patients to receive and self-administer the flu vaccine entirely at home.

I. Alfonso Zambrano, Shareholder, Brown & Fortunato, P.C.

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