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Articles

Amid increased concerns of vaccine hesitancy among the parents of pediatric patients, researchers sought the most effective communication methods to curb this growing phenomenon.

Communication Interventions Can Reduce Vaccine Hesitancy

Videos

Pharmacists can close health literacy gaps by prioritizing clear communication and ensuring patients leave with confidence in managing their care.

Pharmacists Play Key Role in Closing Health Literacy Gaps

While experts have been measuring the impacts stemming from US pharmacy deserts, they are also working to establish a path forward to reduce closures and increase access.

Strategies Necessary to Correct the Trajectory of US Pharmacy Deserts

Simultaneous vaccination with IIV4 and PPSV23 proves safe and effective for patients with chronic diseases, matching results of healthy individuals.

Simultaneous Influenza, Pneumococcal Vaccination Shows Noninferiority for Patients With Chronic Disease

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

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Pharmacies, just as expected, have showed up in meaningful ways to support their communities.

Communicating with Patients in the Time of COVID-19

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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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.

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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

In an era of evolving health care delivery, community pharmacies are emerging as critical access points for patient care, with point-of-care testing (POCT) positioned to revolutionize pharmacy services. In a Pharmacist View video program, Duane Jones, BSPharm, regional pharmacy supervisor and clinical program director at Harps Food Stores, discussed the pharmacist’s role in POCT.

“We are the only profession that can see everything, all the prescriptions that people have, and how we deal with those patients and relationships we have with them,” Jones said in the program. “We can actually close those care gaps by creating a point-of-care testing program in your pharmacies. It will offer you that destination point.”

The current health care landscape presents a critical challenge that demands innovative solutions. With more than half the population struggling to access adequate medical care, community pharmacies are emerging as unexpected heroes in the health care delivery system. These local health care hubs serve patients an average of 33 times annually compared with physicians at 3 visits annually, positioning pharmacists among the most accessible health care providers.

The geographical disparities in health care access are particularly stark in rural and urban health care deserts. In many communities, pharmacies are the sole health care touchpoint, bridging critical gaps in medical service delivery.

“There are so many people in need today, not just in rural America, but also in urban areas, just navigating to get through crowds and very densely populated areas,” Jones said. “There are health care deserts, but there are pharmacies there, and even with our pharmacies, we’re in some towns where we’re the only pharmacy in town, and oftentimes, we’re the only health care provider in town.”

Traditionally, concerns existed about POCT potentially disrupting physician-pharmacist relationships. However, emerging evidence suggests a more collaborative approach, with pharmacists becoming critical partners in comprehensive patient care. By providing immediate testing and treatment, pharmacies can fill crucial health care gaps, especially in these areas with limited medical access.

Health care providers increasingly recognize pharmacies as valuable partners in comprehensive care delivery. Jones highlighted case studies where pharmacies provide critical services, such as rapid testing and treatment, complementing rather than competing with traditional medical practices. This approach transforms pharmacists from medication dispensers to integral health care providers.

Technological, Operational, and Marketing Considerations

Effective POCT implementation demands strategic technological and operational planning. Pharmacies must integrate existing pharmacy management systems, develop efficient billing processes, create staff training templates, and leverage technology to streamline services. This technological evolution requires a strategic approach that balances innovation with practical implementation. Modern POCT capabilities have expanded dramatically, encompassing a wide range of diagnostic services. From COVID-19 testing and influenza screenings to hemoglobin A

 monitoring and cholesterol testing, pharmacies can offer a comprehensive suite of diagnostic services.

Successful implementation requires strategic marketing approaches. Pharmacies are developing informational brochures, utilizing social media platforms, creating targeted bag-stuffer campaigns, and leveraging word-of-mouth referrals. Research indicated that POCT patients are typically aged 18 to 44 years, with approximately one-third lacking primary care physicians. According to Jones, this presents pharmacies with a significant opportunity to attract and retain new patient populations.

The Centers for Medicare & Medicaid Services is driving a fundamental shift toward value-based care by 2030, positioning pharmacies as crucial health care partners. The financial implications extend beyond immediate revenue generation. By positioning themselves as comprehensive health care providers, pharmacies can develop long-term relationships with patients and insurance providers. The ability to offer immediate, accessible testing and treatment represents a significant value proposition in an increasingly complex health care ecosystem.

The financial landscape of pharmacy services is undergoing a significant transformation, with POCT emerging as a potentially game-changing revenue stream. Traditional pharmacy models have struggled with thin profit margins, typically around 2% per prescription, according to Jones. POCT offers a compelling alternative, with pharmacies able to charge approximately $90 per screening test, equivalent to the revenue generated from filling approximately 90 prescriptions.

“To make that same $90, you’re going to have to fill 90 prescriptions,” Jones said. “Now, if I can spend 15 to 20 minutes and do a point-of-care test for a patient, make a difference in their life, actually get positive feedback, and make that money, I would rather do that than try to fill 90 prescriptions in 15 to 20 minutes.”

This economic model represents more than just a financial opportunity; it is a fundamental reimagining of pharmacy’s value proposition. By diversifying services beyond medication dispensing, pharmacies can create more meaningful patient interactions while addressing their own economic sustainability. The potential for POCT to exceed immunization revenues signals a profound shift in how pharmacies can generate revenue and provide value to their communities.

We are the only profession that can see everything, all the prescriptions that people have, and how we deal with those patients and the relationship we have with them. — Duane Jones, BSPharm

“When we started our point-of-care testing in Arkansas, the law was silent, so it didn’t say whether we could or could not do point-of-care testing,” Jones said. Now 48 states allow pharmacists to perform POCT, with critical requirements including obtaining a Clinical Laboratory Improvement Amendments waiver, checking local regulatory requirements, and developing comprehensive testing protocols. Successful implementation requires a holistic approach to pharmacy operations, including staff training, workflow optimization, and technological integration. Pharmacies must invest in creating robust systems that seamlessly incorporate POCT into their existing service models, ensuring regulatory adherence and operational efficiency.

Pharmacies must navigate several challenges, including overcoming initial resistance to change, learning complex medical billing processes, investing in staff training, and developing efficient workflow models. Successful implementation requires proactive legislative engagement, including collaborating with state pharmacy associations, building relationships with local legislators, and demonstrating the value of expanded pharmacy services. This advocacy is crucial in creating a supportive regulatory environment that enables pharmacies to fully realize their potential as comprehensive health care providers.

Pharmacies considering POCT should carefully assess their capabilities, research local regulations, develop comprehensive staff training programs, explore testing options, begin credentialing processes, and create strategic implementation plans. POCT offers community pharmacies a transformative pathway to improve patient care, generate new revenue, expand clinical services, and establish themselves as essential health care providers.

As health care evolves, pharmacies that embrace innovation, invest in staff development, and prioritize patient access will be best positioned to thrive in an increasingly complex medical landscape. 

“The future of pharmacy is not just about dispensing medications but about becoming an integral, accessible, and proactive health care partner for communities across the nation,” Jones said.

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With more than half the population struggling to access medical care, community pharmacies are emerging as unexpected heroes in the health care delivery system.

Pharmacists Emerge as Access Points for Patient Care in Evolving Health Care Industry

Five years ago, we moved from central Pennsylvania to Morgantown, West Virginia. Our goal was to live closer to my grandson, Luke. “Living closer” turned out to be “next door.” Since then, we have added Leo, now 2 years old. Luke, my 8-year-old grandson, is on summer vacation.

My older grandson is beginning to understand the importance of money. He has conceived several ambitious projects, such as opening a lemonade stand on our street, which experiences minimal traffic. Granddad came up with a few ideas.

Recycling is not mandatory in our area, so we take the recycling for both households to the transfer station. I decided to make an additional stop at Jack’s Recycling, where Luke could redeem our aluminum cans. The owner provided him with an informative lecture about financial management and compensated him with $6. Luke has developed a keen interest in recycling now that he recognizes its economic benefits.

Weeds were appearing in the mulch beds at our homes, so I offered to pay Luke “a penny per weed.” Luke meticulously counted each weed he pulled and placed them in the bucket. He collected over 300 weeds and received $3 for his work. Luke recognizes the financial benefit of completing tasks around the house and is willing to perform these duties to earn money.

As pharmacists, we face numerous challenges daily while striving to provide optimal pharmaceutical care for our patients. We often encounter situations where we have a significant backlog of prescriptions, multiple phones ringing simultaneously, dissatisfied customers, and individuals awaiting their shingles vaccinations. Amid these demanding circumstances, we receive notifications to prioritize the completion of comprehensive medication reviews (CMRs).

Pharmacists play a pivotal role in modern health care, extending their expertise far beyond dispensing medications from “the bench.” CMRs represent one of the most impactful contributions pharmacists make to optimizing health outcomes for our Medicare Part D patients. By conducting thorough evaluations of patients’ medication regimens, pharmacists identify potential issues such as drug interactions, inappropriate dosages, or adherence challenges. These reviews ensure the safety and efficacy of treatments and empower patients with the knowledge to manage their medications effectively.

When we have a few minutes of downtime on the bench, we attempt to contact individuals on our roster to complete the CMRs. Unfortunately, we manage to reach a patient less than half the time. Typically, we spend around 10 minutes preparing for these encounters by reviewing medications, completing directions, and verifying ongoing use of the prescribed medications. Subsequently, we dial the phone number provided by the managed care organization (MCO).

Often, the phone line is disconnected, or we reach a voicemail asking us to leave a message. We then cross-check the MCO-provided phone number against our profiles and attempt another contact number. Patients frequently change their contact numbers, which leads to challenges in reaching patients.

It can be challenging for older adults to answer the phone. Many publications aimed at older adults advise against answering unsolicited calls due to the prevalence of “spoof calls” attempting to access personal information. This contributes to difficulties in reaching patients to complete CMRs.

When contact is made with a patient, important information is often provided. These interventions are beneficial for the pharmacy, not only in terms of financial remuneration but also due to their impact on the pharmacy’s Medicare Star Ratings.

MCOs are known to incentivize patients with gift cards for undergoing physical examinations and other beneficial health interventions. The MCOs could easily motivate these patients to contact the pharmacy and arrange a mutually agreeable time for a call and subsequently reward the patient with a $25 gift card. It is important to note that many of our patients would greatly appreciate a gift card, as well as the personalized one-on-one treatment the CMR program was designed to provide.

Whether you are an 8-year-old like Luke or a 68-year-old like me, financial incentives can be effective. Sometimes, a monetary reward is necessary to motivate individuals to complete tasks such as pulling weeds, recycling cans, or finishing a CMR assignment.

download the PDF of the Drug Topics July/August issue here

Pharmacists face numerous challenges daily while striving to provide optimal care for their patients.

Reaching Patients Could Use a Bit of Incentive

Positive results have been announced from a phase 3 trial evaluating the efficacy and safety of orforglipron for weight loss in adult patients with overweight or obesity, Eli Lilly announced in a release.

The therapy is an investigational, small molecule, oral glucagon-like peptide-1 (GLP-1) receptor agonist that can be taken without restrictions on food or water at any time of day.

) clinical trial showed orforglipron met its primary end point of mean percent change in body weight from baseline. The therapy also met all key secondary end points, including mean change in waist circumference from baseline, mean change in systolic blood pressure from baseline, and mean percent change in fasting non–high-density lipoprotein (HDL) cholesterol from baseline.

"Obesity is one of the most pressing global health challenges of our time, driving global chronic disease burden and impacting more than one billion people worldwide," Kenneth Custer, PhD, MBA, executive vice president and president of Lilly Cardiometabolic Health, said in a release.

 "With orforglipron, we're working to transform obesity care by introducing a potential once-daily oral therapy that could support early intervention and long-term disease management, while offering a convenient alternative to injectable treatments.”

ATTAIN-1 is a 72-week, randomized, double-blind, placebo-controlled phase 3 study evaluating the efficacy and safety orforglipron for weight loss in adult patients with overweight or obesity, with weight-related comorbidities and without diabetes. The primary study end point is superior body weight reduction compared with placebo.

The study includes 3127 adult patients who were randomly assigned to 1 of 4 cohorts: 6 mg orforglipron once daily, 12 mg orforglipron once daily, 36 mg orforglipron once daily, or placebo. All patients initially started on 1 mg orforglipron, which was increased in a step-wise approach every 4 weeks until their assigned dose was met. The trial took place at sites in the United States, Brazil, China, India, Japan, South Korea, Puerto Rico, Slovakia, Spain, and Taiwan.

The study data showed that patients who took the highest dose of orforglipron lost an average of 27.3 lb at 72 weeks compared with 2.2 lb for patients taking placebo. Of the patients taking the highest dose of orforglipron, 59.6% lost at least 10% of their body weight, and 39.6% lost at least 15%. The therapy was also associated with reductions in known markers of cardiovascular risk, including non-HDL cholesterol, triglycerides, and systolic blood pressure.

Additionally, the overall safety profile of orforglipron was consistent with the established GLP-1 receptor agonist class. The most common adverse events during the study were constipation, nausea, diarrhea, and vomiting.

Lilly said it plans to present more detailed data from the ATTAIN-1 trial at the European Association for the Study of Diabetes (EASD) Annual Meeting 2025. The company also said that it expects data later this year from the ACHIEVE phase 3 clinical trial program, which is evaluating orforglipron in adult patients with type 2 diabetes.

At 72 weeks, patients who took the highest dose of orforglipron lost an average of 27.3 lb.

Jenni Zilka, Senior Vice President, Good Neighbor Pharmacy Field Programs & Services, AmerisourceBergen

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