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Investigators also find that patients diagnosed with type 1 diabetes later in life do not have a better prognosis compared to those diagnosed earlier.

Adult-Onset Type 1 Diabetes Increases Risk of Cardiovascular Disease

Videos

Rick Sage, Executive Vice President of Innovation & Standards at NCPDP, discusses his role and how his team is using innovation to support the pharmacy profession.  

How NCPDP Uses Innovation to Help Pharmacists Be More Effective | NCPDP 2025

Dae Lee, PharmD, Esq, CPBS and Lucas Morgan, Esq, discuss PBM and board of pharmacy enforcement actions, trends in PBM audits, and more.

Pharmacy Law Lowdown: PBM Audit Trends, Enforcement Actions

Larry King, PharmD, joins Drug Topics at NCPDP 2025 to discuss pharmacy interoperability, changes in its regulations, and how technology will fall into place within the data infrastructure. 

How Interoperability, Data Infrastructure Create New Opportunities for Pharmacies | NCPDP 2025

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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.

Clinical

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

Disney sets the gold standard for customer service, mastering how to charge more while still leaving guests eager to return. While pharmacies face different challenges, such as managing controlled substances, insurance barriers, and low reimbursement, there’s much to learn from Disney’s model, says Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, clinical assistant professor and director of experiential learning at West Virginia University School of Pharmacy.

Pharmacy is, at its heart, a service profession. Garofoli emphasizes that personalized check-ins with patients can go much further than generic satisfaction surveys. Creating meaningful, consistent patient experiences can help foster loyalty and trust—just like the magic that keeps people coming back to Disney.

At the American Associated Pharmacies (AAP) Annual Conference, held April 10 to 12 in Austin, Texas, 

 sat down with Garofoli to discuss how Disney’s approach to customer service can be applied in a community pharmacy setting and what metrics or feedback methods can best evaluate the effectiveness of customer service initiatives.

Q&A: Balancing Patient Care, Compliance Amid Controlled Substance Challenges | AAP 2025

: How can Disney’s approach to customer service be applied in a community pharmacy setting?

Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS

: Disney, the entire entourage, has pretty much mastered customer service. There's very few entities on this planet, present self included, that can charge more for something, and people might have a little gripe, but will pay it and then ask, “Can I do that again?” That's not something we experience in pharmacy often, at least maybe, if ever. They have really recreated the game. There's other organizations that certainly specialize in customer service, guest satisfaction, really mastering the entire ballpark overall, but pharmacy being in service, obviously, patient care is service, there's opportunities along the way too. Is everything going to seamlessly fit right in? Mickey Mouse is not dealing with controlled substances, at least that we know of. It certainly is different. I think that has to be appreciated, because that's usually when eyebrows start going, “Oh, come on.” But there's opportunities, of course.

: What metrics or feedback methods can be used to evaluate the effectiveness of customer service initiatives in a pharmacy setting?

: We in pharmacy actually created the illustrious receipts with the surveys on them that if you don't rate 5, like a 4 is a 0, if not a negative 4. A 1 to 5 scale, it's only 5 there. In the big picture, there's a pain scale, your 7 is my 3, the other ones, 12, which doesn't even exist, is another person’s 2. For me to say that was 5, that was perfect for customer service, is like you really had to knock someone’s socks off. But that's my scale. That's not everyone's scale overall. You have to take them with a grain of salt. I'll use it to point out any opportunities, great, but there's excellence out there that might be different. I find it interesting that, we created the game, along with loyalty cards, we created a lot of things in pharmacy. We had a pharmacist create the 6 pack, for crying out loud. A lot of things within society.

It's really the feedback. The ideas is, being able to take those moments these days, label it like, “Hey, would you like some feedback?” That's more so for colleagues, then for patients. Is there a good time to talk about something in a quieter location whenever possible, of course, along the way. I think the wording out there is “Disneyland dads.” I think I now can identify as a Disney cruise dad, because good golly, when you go to a Disney establishment or one of the many parks, it's like you enter a whole new world, one of them called Disney World, of course. When they are literally in charge of your entire world on a ship, then it's game on. They have that, that's the customer version. There's also an institute that people could go to and learn more of the Disney way overall. I encourage folks to look into that if they're interested.

Be sure to keep up with all of our coverage from AAP 2025 here.

A conversation with Mark Garofoli, PharmD, MBA, BCGP, CPE, CTTS, clinical assistant professor and director of experiential learning at West Virginia University School of Pharmacy, at AAP 2025.

Q&A: Borrowing the Disney Touch for Better Pharmacy Customer Service | AAP 2025

A conversation with Douglas Hoey, RPh, MBA, CEO of NCPA, on the chain pharmacy’s announcement of a second Chapter 11 bankruptcy.

Rite Aid’s Closure is a Call to Action to Address Pharmacy Payment Model

Rite Aid, which was once one of the largest pharmacy chains in the United States, recently announced it has filed its second Chapter 11 bankruptcy and will be closing all of its stores or selling them.

The company, which has continued to face financial hardships since filing for its first Chapter 11 bankruptcy in 2023, said its stores will remain open for the next few months so that patients can continue to receive care.

Rite Aid currently has 1240 stores located in 15 states, down from about 2100 when it filed its first bankruptcy. The company said in a letter to customers it is “working to facilitate a smooth transfer of customer prescriptions to other pharmacies.”

According to a previous survey from the National Community Pharmacists Association (NCPA), 43% of respondents said they are located near a chain pharmacy that has been impacted by closures or reduced hours.

Although nearly 90% of respondents said they would be able to absorb patients who were receiving care at one of the chain stores, but low reimbursement, and not enough staff or resources would make it difficult.

® recently sat down with Douglas Hoey, RPh, MBA, CEO of NCPA, to discuss how Rite Aid store closures will impact independent pharmacies across the country, what independent pharmacies can do to effectively handle an influx of patients, and what Rite Aid’s situation means for the pharmacy landscape.

“Without payment reform, pharmacies as we know them are moving toward extinction—that won’t happen—but it’s a call to action for legislators who have been sitting on their hands and employers who have been unaware of the situation that they need to do something different,” Hoey said. “What they need to do differently is they need to pay pharmacies fairly. Cost-plus, a fair dispensing fee, transparency, simplicity, [and] predictability is what is needed to fix this broken system.”

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. Rite Aid Is Pursuing a Strategic and Value-Maximizing Sale Process. News Release. Rite Aid. May 5, 2025. Accessed May 8, 2025. 

https://news.riteaid.com/press-releases/press-release-details/2025/Rite-Aid-Is-Pursuing-a-Strategic-and-Value-Maximizing-Sale-Process/default.aspx

2. NCPA Survey: Chain Pharmacy Closures an Opportunity and a Threat for Independents. News Release. NCPA. September 28, 2023. Accessed May 8, 2025. 

https://ncpa.org/newsroom/news-releases/2023/09/28/ncpa-survey-chain-pharmacy-closures-opportunity-and-threat

How AI Can Improve the Pharmacist’s Workload 

Artificial intelligence (AI) has gradually become commonplace in pharmacy practices and has shown its ability to improve pharmacy employees’ workloads, from everyday tasks within the pharmacy to backend support for claims and prior authorizations.

At the National Council for Prescription Drug Programs (NCPDP) 2025 Annual Conference, held May 5 to May 7 in Scottsdale, Arizona, 

 was joined by Stanley V. Campbell, Jr., CEO, and Yi Deng, PhD, Senior Vice President of Engineering, of EagleForce Associates. In the second part of our discussion with Deng and Campbell, they discussed AI’s use from the perspectives of pharmacists, technicians, and any other day-to-day pharmacy employees.

Watch this video to gain further insights into the ever-adapting AI landscape, both within pharmacy and health care as a whole. The implementation of AI into health care has come with arguably an even split of opportunities and challenges. While some may be skeptic of AI’s accuracy and effectiveness, others have hit the ground running with AI implementation and have been helping pharmacists save time and make more at the pharmacy counter.

Through their work at EagleForce, Deng and Campbell have been helping pharmacists understand and adapt AI into their practices. From streamlining common tasks to freeing up pharmacists’ time like never before, learn about the real-world instances where pharmacies are reaping AI’s proven benefits.

Read more from our coverage of NCPDP 2025

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.

Stanley V. Campbell, Jr., CEO of EagleForce Associates, Inc., and Yi Deng, PhD, Senior Vice President of Engineering at EagleForce, explore real-world examples of AI giving time back to pharmacists.

How AI Can Improve the Pharmacist’s Workload | NCPDP 2025

Take Control of Your Pharmacy's Bottom Line

Confused by some of the details in your purchasing plan? How do you know if your purchasing behaviors are aligned with what’s best for your bottom line?

You're not alone—and this guide is here to change that.

 breaks down complex rebate structures, shows you how to unlock hidden value, and gives you the confidence to make smarter, more profitable buying decisions. Whether you're new to a program or simply want to ensure you're not leaving money on the table, this free quick-read resource from AAP is your key to maximizing earnings and minimizing stress.

Clear, actionable and empowering… Learn what to look for to make sure you're getting the best deal for your business.

Lucas Morgan, Esq

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