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The new approval is an oral suspension for patients with hypertension and left ventricular hypertrophy and for the treatment of diabetic nephropathy.

FDA Approves Losartan Potassium for Reduction in Risk of Stroke

Videos

A conversation with Lydia Newsom, PharmD, clinical associate professor of pharmacy practice at Mercer University College of Pharmacy.

Pharmacists Play Key Role in Supporting Patients Using GLP-1s

Pharmacists are resilient, community-focused professionals who played a pivotal role in navigating the unprecedented challenges of the COVID-19 pandemic.

5 Years of COVID-19: How Pharmacists Became Community Heroes During the Pandemic

Jennifer Zilka and Kyle Pudenz, DBA, from Cencora joined Drug Topics to discuss the role of independent pharmacies in addressing pharmacy deserts across the US.

Support for Community Practices Crucial in Addressing Pharmacy Deserts

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Kyle Pudenz is the Senior Vice President of Enterprise Data & Analytics at Cencora. He has an extensive background in analytics and usually works with companies looking to use smarter solutions to achieve their goals.

Representatives from Cencora’s Good Neighbor Pharmacy Network discussed legislation created to improve declining pharmacy rates and who is accountable for addressing pharmacy deserts.

Q&A: Who is Responsible for Addressing the Growing Issue of Pharmacy Deserts?

Jennifer Zilka and Kyle Pudenz, DBA, introduced the issue of pharmacy deserts and discussed what has been driving store closures across the US.

How Pharmacy Deserts are Being Defined, Identified

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

With the recent closure of thousands of chain and independent pharmacies, experts from several industries are coming together to address the issue of pharmacy deserts. One of the most prominent entities working to alleviate the issue includes pharmacy advocacy and solutions groups like Cencora and Good Neighbor Pharmacy.

“I believe it's all of us,” said Jennifer Zilka, Senior Vice President of Community and Specialty Pharmacy at Cencora and President of Good Neighbor Pharmacy. “It's crucial that pharmacies, trade organizations, advocates, peers, and even patients relentlessly push for the changes that are needed to support the longevity of these pharmacies and the care that they provide to their patients.”

was also joined by Kyle Pudenz, DBA, Senior Vice President of Data & Analytics at Cencora. His team is filled with data experts trained to identify areas vulnerable to pharmacy deserts, the resources needed for pharmacy businesses, the characteristics of an area’s pharmacy services, and so much more.

The duo suggested that it takes the efforts of multiple players within the pharmacy industry to truly enact change. However, they were sure to highlight the utmost importance of community pharmacies and how they are uniquely positioned to address pharmacy deserts.

“Community pharmacies are a huge part of the solution to combat these health care deserts, whether it's a pharmacy desert or an overarching, larger-scale health care desert,” continued Zilka. In this part of our interview, Zilka and Pudenz discussed what’s being done to address pharmacy deserts and how their team is assisting pharmacies and communities across the country.

Stay tuned for more from our conversation with Zilka and Pudenz as they provide even more valuable insights into pharmacy deserts and what is being done to address them.

: Who do you believe holds the responsibility of addressing pharmacy deserts across areas of the US?

 I'll start because I feel really strongly about it, but I believe it's all of us. It's crucial that pharmacies, trade organizations, advocates, peers, and even patients relentlessly push for the changes that are needed to support the longevity of these pharmacies and the care that they provide to their patients. Community pharmacies are a huge part of the solution to combat these health care deserts, whether it's a pharmacy desert or an overarching, larger-scale health care desert. Just given who they are, they're already taking care of these underserved and socially vulnerable communities.

 members work tirelessly to look for gaps in care where they're able to maybe provide different services, different products. We have outreached into different communities to make sure that they're caring for their entire community. And then, the teams within Good Neighbor Pharmacy, and Kyle's team within Cencora, we're very passionate about supporting their efforts. In addition to all of us doing all the things we're doing that are really important, one thing we've done internally is worked with Kyle’s team to help our members with detailed snapshots of their communities, and again, look for those gaps where they might be able to provide tailored services or products to those patients.

As part of this effort, we worked with NCPDP (the National Council for Prescription Drug Programs), the CDC’s social vulnerability index, the US Census and American Community Survey. We pulled all of that information together, and this is Kyle’s team that did that, so Kyle, we are eternally grateful for it. We always knew where our Good Neighbor Pharmacies (GNP) were positioned, and we always had a good feel for who their patients were. But through Kyle's team's efforts, we were able to identify that 20% of GNP stores either directly serve or are adjacent to pharmacy deserts, 93.5 million US households are within reach of a GNP store, and 20 million of those reside in a low-pharmacy-access area. We also know that GNP pharmacies can serve more than 47.7 million low-income individuals.

Kyle and his team also did some research around disabled individuals, and there's 26 million disabled individuals, including 5.5 million who face limited access, that are within reach of a Good Neighbor Pharmacy store. Through that data, we've been able to really validate which patient populations our pharmacies are caring for. And we're really passionate about ensuring that our pharmacies have access to that information and are able to tailor their services accordingly. So Kyle, please feel free to expound on that.

No, I love all the facts and figures. You could join our team anytime, Jenni. But as Jenni said, we really developed this solution, understanding our place in Cencora. How can we help enable our pharmacies [to] serve their communities? The idea is that we can access this data. We can integrate a lot of this together in such a way to give them better visibility and insights into, not just the customers and patients that are coming through their doors already, but what does that greater community actually look like? [We] give some visibility into the broader surroundings and help them better plan some accessible services that they may be able to provide these communities. For many [pharmacies], they can now leverage the data to really prioritize resources. Now they have this understanding of what that larger population looks like and [can] provide some support and interventions in areas where there [is] a greater need for medicine, health care services, and vaccines. All of those things, I think, are super important.

We really went out and found some publicly available data. This is available through US Census information to give us a lot of demographics, but we coupled that with some geospatial analytics to really give us that overlay of the demographics and other factors that really impact social vulnerability. In addition to some of the things Jenni highlighted, [something] like access to transportation [is] a real big one. I think sometimes people wonder ‘Why is the limit within an urban area just 1 mile?’ Well, you have different access to transportation in different areas. The likelihood that someone who's ill or elderly would have to go that far in that scenario without transportation really starts to limit whether or not they are going to be able to access that. By giving our pharmacies information and insights, they can actually develop services to help them reach and connect with these patients to provide those services that they're looking for.

So far, the data has really challenged what our prior assumptions and biases would have led us to previously believe. Pharmacy owners often find that the pharmacy deserts aren't necessarily where they expected them to be previously. In fact, the data and insights shared helps some of those pharmacies recognize that they're actually situated, as Jenni mentioned, either in or directly adjacent to a desert themselves. I think that's been pretty eye-opening. By doing that, where they suddenly have this visibility, now it can help those pharmacists identify new clinical and marketing opportunities that really help them serve their communities even better than they were before.

: What is being done on both state and federal levels to address the growing issue of pharmacy deserts in the US?

There is a lot of activity. In fact, we've had some wins that we're very excited about at both the national and the state levels. But there's still so much more work to be done that we together can achieve what's needed for pharmacies to remain financially viable. It includes improving reimbursement frameworks, but it also includes helping to expand the clinical care services that pharmacies are able to provide. There is a lot of activity. Unfortunately, we were hoping that some of it would make it across the finish line at the end of the year, and it didn't. And I think, as we all know, we're in the midst of a new administration, which is highly unpredictable, but there does continue to be a lot of activity, visibility, and even legislative bills that are on the table. We are very hopeful, or watching very, very closely, that they will cross the finish line and be included in an upcoming package.

One of them is around stabilization of reimbursement rates. Again, we're watching that one very, very closely. The other one is the Equitable Community Access to Pharmacists Services Act. We call it ECAPS because it's a mouthful. That was introduced last Congress. It had robust bipartisan support. The goal was aiming to ensure, as I mentioned before, that Medicare beneficiaries have access to the essential services, including test and treatment of common infectious diseases, by establishing a Part B reimbursement pathway for pharmacies to deliver those services. Those are a couple examples. There's a lot happening.

Positive change is not guaranteed. But I truly believe—this is an area I'm really passionate about and I spend a lot of time on—if we continue to advocate and ensure that legislators are aware of the danger of losing these pharmacies, and really the danger to their patients and their constituents, I'm very hopeful. That advocacy is essential to ensure accessible health care for our patients and will serve as really our industry's primary defense against the spread of these pharmacy deserts. A lot [is] happening on that front. We're keeping a very, very close eye on it, and we're hopeful that we will see some federal activity. And there's just a ton happening in the states as well. [There’s] a lot of activity and a lot of hope.

Rochester Pharmacy Access Coalition Uniting to Fill Gaps from Pharmacy Closures

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Insight into US pharmacy deserts. Cencora. August 7, 2024. Accessed March 10, 2025. 

https://view.ceros.com/amerisourcebergen/cencora-pharmacy-desert-map/p/1

The American Pharmacists Association’s (APhA) 2025 Annual Meeting and Exposition is set to kick off in Nashville, Tennessee on Friday, March 21 and run through Monday, March 24. The event is taking place at the Music City Center convention center and is sure to be a meeting that pharmacists from across the country won’t want to miss.

"The focus of the meeting this year is inspiration,” said Lauren Angelo, PharmD, MBA, associate dean of academic affairs and associate professor of pharmacy practice at the Rosalind Franklin University of Medicine and Sciences. “With so many changes in healthcare and pharmacy lately, we could all use a little inspiration. Many of the education sessions will help take our profession to the next level. These range from digital health, new technologies, and clinical updates to leadership and advocacy. The awards and recognition of our pharmacy superstars will also inspire us to continue to advance patient care. I look forward to being inspired."

This year’s meeting includes tons of education and business sessions for pharmacists, staff and students alike. The meeting will also feature opportunities for continuing professional education credits and other types of APhA education and training activities. Keynote speakers at this year’s meeting include Ben Nemtin, author of 

 and Jade Simmons, a transformational speaker and world-class concert artist.

“One of the things I most look forward to every year at the APhA Annual Meeting is what I’d call the ‘Little Moments,’” said Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, clinical assistant professor and director of experiential learning at West Virginia University School of Pharmacy. “The big stages, workshops, exhibit hall, and receptions are always well worth the journey, but the magic is in the moments in between those scheduled events. Whether passing in a hallway or elevator, or ending up at the same restaurant or bar, someone you haven’t seen in years will be there, everywhere, because this is where it all happens.”

The Drug Topics team will be onsite at the meeting providing coverage of all the most important happenings. Be sure to follow along 

Country Roads to Care: Pharmacists Role in Reproductive Health

Pharmacists in reproductive health has evolved significantly over the years. In this session, Jasmine Cutler, PharmD, will discuss the role of community pharmacists in educating patients on OTC contraceptives, emergency contraception and identifying resources for sexual health concepts.

Moonshine vs Tennessee Wine: Debate on Controversies in Diabetes

In this session, Heather Johnson, PharmD, BCACP and Heather Roth, BSPharm, will hash out some of the most controversial topics in diabetes, including SGLT2i or GLP-1 for CVD outcomes, CGMs for patients not using insulin, and whether patients should get their diabetes care in the clinic or community pharmacy.

A significant amount of pharmacies have shut their doors across the country recently, leading to low access to community pharmacies. In this session, Lucas Berenbrok, PharmD, MS, will discuss trends in pharmacy closures, the impact on patients across the US, and potential solutions to mitigate the issue.

We Gotta Fight for our Right to Partake: An Update on PBM Reform

Pharmacy Benefit Managers (PBM) have been in the hot seat lately, facing scrutiny from the Federal Trade Commission, Congress, pharmacy organizations and pharmacists. In this sessions, Antonio Ciaccia will discuss PBM reform at the state and federal level and their impact on pharmacy practice.

This year’s meeting will take place from March 21 to 24 in Nashville, Tennessee.

Conference Preview: APhA 2025 Annual Meeting and Exposition

GLP-1 Use Requires Specific Counseling Among Various Indications

Glucagon-like peptide-1 (GLP-1) medications have seen a notable rise in demand and popularity in recent years. With increasing indications for growingly prevalent disease states, these medications require proper counseling before starting, when taking, and after stopping, in order for patients to reap the true benefits of GLP-1s.

“I still remember back in 2005 when the first [GLP-1] was approved,” said Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, Endocrine Clinical Pharmacy Specialist with Cleveland Clinic Endocrinology & Metabolism Institute. “At the time, that was just for type 2 diabetes. It’s been so exciting to see it evolve. Through all of these years—it’s been 20 years—we’ve seen how this medication class now has all of these other indications.”

, Isaacs discussed her experience as a clinical pharmacist managing patients’ GLP-1 regimens. From the highs of patient success with these drugs to the lows of difficult-to-manage side effects, she detailed everything she needs to know about her patients before managing their GLP-1 prescription.

While this class of medications may be relatively new to non-medical experts, pharmacists like Isaacs have known about the potential effects and impacts GLP-1s could have on large patient populations. As further research is conducted and more indications are approved, she will continue to coach her patients through their GLP-1 prescriptions, whether they are meant for obesity, diabetes, or another indication.

Stay tuned for more content from our interview with 

 as she discusses further her experience managing GLP-1 medications.

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, discussed her experience when beginning to counsel patients using GLP-1 medications.

GLP-1 Use Requires Specific Counseling Among Each Indication

According to Chris Robinson, MD, PhD, a future with no acute and chronic pain is much further down the line than optimists may expect. However, throughout his work researching new technologies for the treatment of pain, he believes there is a future where chronic is mitigated beyond what has been capable in the past.

“I think we have to understand what is pain, why it's there, and not have our hopes up that we think we can get 100% pain relief,” he told 

. “Our bodies do degenerate, and we have to understand that. My goal, and especially with these newer technologies, is to use it to mitigate pain in the present moment.”

With emerging technologies in the pain management space, as well as an immense amount of capital pouring into it, he believes finding objective measures for chronic and acute pain is the first step in advancing what we know about this subject.

Robinson, who is Director of Pain and Headache Rounds at Harvard-Massachusetts General Hospital, sat down with us to discuss the future of pain management in emerging technology, including virtual reality (VR), neuromodulation, artificial intelligence, wearable technology, and psychedelics.

In a third installment of our interview series with Chris Robinson, MD, PhD, we looked at the future of pain management and emerging technologies being used for treatment.

Kyle Pudenz, DBA

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