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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

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The FDA also grants the biosimilar provisional interchangeability designation, making the drug substitutable at the pharmacy level.

FDA Approves Denosumab-Kyqq as Biosimilar for Prolia, Xgeva

In part 3 of our interview with Andrew Maiorini, PharmD, FAHM, vice president of clinical programs at PerformRx, he discusses the ways in which his company is helping patients stay adherent on their medications.

Q&A: Using Data, Addressing Patient Barriers Can Effectively Improve Medication Adherence

Calvin Hunsicker, founder & chief product officer at SureCost, discusses ongoing pharmacy procurement challenges in 2025 and how his company is helping businesses tackle common obstacles.

Proactive, Data-Driven Approach Necessary to Improve Pharmacy Purchasing

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

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Measuring Medication Adherence: Exploring Issues and Better Solutions

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

Amid recent events within the emergency care space, a group of health care leaders convened to confirm the role of pharmacists on intensive care unit (ICU) teams. Now formalized as essential members of emergency care teams, pharmacists across the country—not just those working in critical care—have garnered further support from several reputable organizations regarding their crucial roles on interprofessional health care teams.

“I would say that the concept that pharmacists are considered essential members of the ICU team, I don't think that's new,” Andrea Sikora, PharmD, MSCR, FCCM, FCCP, BCCCP, associate professor of biomedical informatics at the University of Colorado School of Medicine, told 

. “What the problem has been is that it's lip service, to some extent. We say this really great thing about, ‘Oh, we need pharmacists,’ but then when you actually go into the unit, you'll find that if someone is on vacation or PTO, you're asked to take on 2 teams that day.”

Sikora recently led a group of experts to provide recommendations for integrating critical care pharmacists within ICU teams. Published in the 

Journal of the American College of Clinical Pharmacy 

in August, the paper details what many experts agree is the need for critical care pharmacists to be part of the greater ICU team, working with other professionals and providing their medication expertise.

recently caught up with Sikora to discuss what went into leading this committee and how these guidelines are expected to impact the greater pharmacy community going forward. While there are certainly details and next steps to iron out following the release of these guidelines, Sikora believes her and her team’s work can truly uplift the profession as a whole.

Q&A: New ICU Guidelines Highlight, Confirm Role of Critical Care Pharmacists

: The guideline updates formalize pharmacists as “essential clinical partners.” Can you elaborate on the difference between this formal recognition and the role pharmacists held previously?

I would say that the concept that pharmacists are considered essential members of the ICU team, I don't think that's new. I think that, generally, that is something that has been endorsed by the Society of Critical Care Medicine and is generally accepted as being very important. Interestingly, the burn ICU accreditation requires a pharmacist to be part of the burn ICU process. What the problem has been is that it's lip service, to some extent. We say this really great thing about, ‘Oh, we need pharmacists.’ But then, when you actually go into the unit, you'll find that if someone is on vacation or PTO, you're asked to take on 2 teams that day. Well, you can only round on one team at a time, so you know that you're not going to be present and giving the best quality of care for a team you're not even with. Again, holidays, weekends, evenings, these are real gaps in the quality of care that we can provide, and we see it in terms of medication errors and adverse drug events.

To me, what this document is saying, as opposed to just saying they're essential clinical partners, [is that] you have to make sure that there is a pharmacist for every ICU patient. These are members of the team that need to be there 24/7, 365. Think of how crazy it would be to go into an ICU and not have a nurse or a physician. I think that this document is trying to say that is similarly not best practice to lack a pharmacist.

: What do these developments mean for the pharmacy profession as a whole regarding how pharmacists will choose their career paths and professional duties in the future? In other words, do you think these recommendations will result in greater calls to pharmacists entering the emergency care space?

A big conversation that this panel had was, if we start saying that you need to have weekends, overnights, holidays, evening shift,...there is going to be a potential increase in demand for highly trained critical care pharmacists. But I see that as being a good thing. My hope is that, as we start seeing more positions open up, you're going to see that people are going to have an interest in being in those positions. I think that these guidelines, to me, also provide validation for how important the role is on the team.

I had a pharmacist colleague who was basically in charge of the rollout of all the continuous renal replacement therapy services in the hospital. You might think, ‘Oh, that should be the nephrologist,’ but it was actually the medical ICU pharmacist, and it was a beautifully done process. I have other pharmacist colleagues who identified gaps in the medication safety process and put together protocols, order sets, and guidelines. I think this is really trying to kind of say, ‘I see you, and I see the work that you're doing and how important that is.’

I also think that at times, just in clinical pharmacy in general, we have struggled with asking a lot of the individuals in those roles. You're a teacher, you're an educator, you're doing QI, you're doing direct patient care, all these different things, but not always being recognized for all of those different hats that you're wearing that are improving outcomes. I do feel that this document does a good job of saying we know that all of those things provide value to the health care system and to patient care.

Not only do we want to celebrate that, but we want to actively put infrastructure in to support it. I hope people want to go into it. My years as a critical care pharmacist are some of the best of my life. I still look back very fondly and think of that as a special thing. Even though, at this point in my career, I’ve transitioned into more of a research space, I still think of it as a wonderful career and profession to be in....

Q&A: Equity in Pharmacy Means Meeting Patients Where They Are

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Sikora A, Murray B, Henry K, et al. Consensus recommendations for the integration of critical care pharmacists on intensive care unit teams: endorsed by the American Association of Critical‐Care Nurses, American College of Clinical Pharmacy, American Society of Health‐System Pharmacists, Institute for Safe Medication Practices, and Society of Critical Care Medicine. 

Andrea Sikora, PharmD, MSCR, FCCM, FCCP, BCCCP, led a 21-member panel on critical care pharmacists and joined us to discuss how guideline updates may impact the greater pharmacy industry.

James Lee, Director, Innovation Solutions – Medication Adherence Jones Healthcare Group

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