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Expert pharmacy business researcher Joey Mattingly, PharmD, MBA, PhD, joined Drug Topics to discuss recent trends in pharmacy churn and how it directly impacts patients.

Independent Pharmacy Turnover Significantly Impacts Patient Outcomes

The FDA removes the prior requirement for a patient who is already diagnosed with a cardiovascular disease.

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Palmer addresses the limitations of alternative methods such as acetaminophen, herbal supplements, and cannabis products, urging patients to consult health care professionals.

Q&A: Dosing Timing of NSAIDs Is Essential for Menstrual Pain

In association with patients’ race, ethnicity, and social determinants of health, researchers explored the off-label prescribing of GLP-1s approved for type 2 diabetes.

Rise in Off-Label GLP-1 Prescribing Highlights Need for Equitable Access 

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

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Among the questions asked were what is expected for sales, salaries, and staffing for 2008.

FAIR OR FOUL?

In a move that could significantly improve the monitoring and tracking of retail drugs, RFID (radio frequency identification) solution providers have developed an inventory tracking system for the pharmaceutical industry that uses ultrahigh-frequency (UHF) RFID tags.

RFID tracking system tags drugs at item level

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.

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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

Kimberly Jones, RPh, is the pharmacy manager of Austin Pharmacy & Medical Supplies, located in Cockeysville, Maryland, about 25 minutes north of Baltimore. “During pharmacy school, my internship was at an independent pharmacy in my hometown, and I realized I preferred that atmosphere,” Jones said. “I value the opportunity to truly get to know my patients, understand their stories, and connect with their families. Working for an independent company provides the time and flexibility to cultivate these relationships with both patients and health care providers.”

Initially, Jones started working on a part-time basis at Austin Pharmacy. “As luck would have it,” she said, “a pharmacist position opened up, and they needed someone to fill in. I started as a part-time pharmacist and became full-time within a year. I became the manager in 2019. As they say, the rest is history."

Austin Pharmacy was started by Charles Austin in Towson, Maryland—a suburb of Baltimore—in 1940. It was originally a classic neighborhood drugstore, complete with a soda fountain. The current owners are Donna and John Wolk. Wolk bought the business in 1989, and by that time, it had been remodeled and looked more like pharmacies seen today. In 2012, they opened a larger second location in Cockeysville, and in addition to the pharmacy, they also carried medical supplies and equipment. In 2021, after the COVID-19 pandemic, the Wolks closed the original Towson location and moved all the pharmacy customers to Cockeysville. With most customers receiving deliveries to their homes, the transition was easy.

“At our store, we do a bit of everything. On the medical supply side, we have certified specialists who can help with diabetic, compression, and orthopedic fitting needs. We also have a licensed DPT [doctor of physical therapy], WOCN [wound, ostomy, and continence nurse], and ATP [assistive technology professional] on staff,” Jones said.

The pharmacy is located near 2 major East Coast fertility centers, Shady Grove and Johns Hopkins. Having gone through fertility treatments, Jones feels very empathetic toward these patients. Austin Pharmacy stocks various fertility medications for intrauterine insemination and in vitro fertilization (IVF) and works with manufacturers to get discounts. The pharmacists—Jones, along with Robyn Sabo, RPh—take the time to show patients how to administer injections. Patients have shared that they especially appreciate this service because fertility treatments are often time sensitive.

“There have been several times where I have stayed after closing to wait for a patient who needed to pick up medicine to take their shot that evening, or for someone who was traveling a distance and was delayed because of traffic,” Jones said. “I understand the range of emotions people have when going through this fertility journey, and I like to try and make the process a little smoother for them. I often share my own experience with patients that I had undergone IVF treatment and gave birth to 2 sons. I offer encouragement to keep going when it gets hard and think positively. So many women appreciate that small personal connection.”

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Kimberly Jones, RPh, shares how Austin Pharmacy & Medical Supplies combines pharmacy and medical supply services under one roof.

Independent Pharmacy Wants to Be a “One-Stop Shop for Our Patients”

During the COVID-19 pandemic, the federal Public Readiness and Emergency Preparedness (PREP) Act consistently expanded the authority for pharmacists, technicians, and interns nationwide to administer COVID-19 vaccines to individuals 3 years and older. It was subsequently expanded to include all routine pediatric vaccines. Set to expire in 2024, it was extended in December 2024 to 2029.

 As this provision will eventually sunset, states must make this authority permanent in state law. This state-by-state variability poses a significant barrier for providers striving to deliver care and patients seeking convenient access to essential vaccinations. Understanding these post-PREP implications is therefore not just academic; it is critical for evaluating current public health delivery, identifying ongoing access, and informing future policy.

Pharmacy-Based Immunization, Before vs After Pandemic

Before the PREP Act, pharmacist vaccination authority lacked uniform national standards and varied widely by state. According to the June 2020 American Pharmacists Association (APhA)/National Alliance of State Pharmacy Associations (NASPA) survey, 47 states allowed pharmacists to administer any vaccine, with most of those states using a combination of protocol or prescription requirement with age restrictions.

 There are 3 primary models in which pharmacists are authorized to administer immunizations: prescription from another provider, patient-specific or state vaccination protocol (aka collaborative practice agreement), or independently without a prescriber’s order or protocol. As of January 2025, all 50 states allow pharmacists to administer any Advisory Committee for Immunization Practices (ACIP)/CDC–recommended vaccine.

 State laws still impose diverse restrictions on vaccine types and varying minimum age limits, and the model used to authorize pharmacists creates a regulatory patchwork.

For example, in Texas, pharmacists can give the influenza vaccine to individuals aged 7 and older, aged 14 and older for other vaccines pursuant to a protocol, and of any age with a patient-specific protocol. Pharmacy-based immunization is moving in the right direction, but without the federal PREP Act framework, we will continue to have a patchwork of state-based laws. The authorization granted for pediatric vaccination has not advanced as far as adult vaccination.

According to the APhA/NASPA 2024 data, only 19 states plus Washington, DC, allow pharmacists, independently or by protocol, to administer all ACIP-recommended vaccines to individuals 3 years and older.

 This includes states with no minimum age. Research data demonstrate that allowing pharmacists to vaccinate children increases vaccination access and uptake, particularly in underserved and rural areas, without delaying other aspects of preventive care such as well-child visits.

 Parents report a strong willingness to have their children vaccinated at pharmacies, and studies show that community pharmacies can effectively serve as Vaccines for Children providers, supporting public health goals by improving human papillomavirus and COVID-19 vaccination rates among children and adolescents.

 Expanding pharmacist authority in pediatric immunization can help close gaps in vaccine coverage, reduce missed opportunities, and enhance public health preparedness.

Pharmacy technician vaccination authority is not uniform across states and remains typically more limited and restricted than the authority granted to pharmacists. States may limit the types of vaccines technicians can administer, with seasonal influenza and COVID-19 being the most common. As of January 2025, 47 states plus Washington, DC, allow pharmacy technicians to vaccinate compared with only 6 in 2020 (

 Findings from a 5-year review revealed that US pharmacy technicians administered more than 1 million vaccines from 2016 to 2021 with no reported serious adverse events.

 The data showed that more than 90% of supervising pharmacists and 85% of technicians supported technician-administered immunizations, and more than 80% of patients were comfortable receiving vaccines from trained technicians. The inclusion of pharmacy technicians as vaccinators represents a significant strategic shift that improves pharmacy workflow efficiency, safely expands vaccination service capacity to reach more patients, increases pharmacist clinical time for complex patient care activities such as medication therapy management and counseling, and enhances technician job satisfaction, all without compromising patient outcomes.

State authority for who can administer vaccines is not directly granted or dictated by the FDA, CDC, or ACIP. Instead, individual states determine a pharmacist’s and a technician’s scope of practice. The FDA is responsible for licensing vaccine products, ensuring their safety and efficacy for specific uses through rigorous review processes. The CDC and its advisory committee, ACIP, are responsible for developing and adopting clinical guidelines and recommendations on how and to whom vaccines should be administered based on scientific evidence and public health needs.

 of past ACIP members warns that the abrupt dismissal and replacement of ACIP members in June 2025 could erode public and professional confidence in future ACIP recommendations, potentially diminishing their influence on US vaccine policy and uptake.

States set requirements for education and training, specifying required levels of supervision, imposing age limits, and determining the mechanisms by which the authority is granted. The impact of the ACIP/CDC on state law illustrates that although ACIP’s guidance is nonbinding, it profoundly influences state and territorial vaccine policy. It appears in nearly 600 statutes and regulations across 49 states, 3 territories, and Washington, DC, informing school vaccine mandates, insurance coverage, provider scope, standing orders, vaccine purchasing, professions that immunize, and immunization notifications.

How a state uses the FDA, CDC, or ACIP may dictate whether pharmacists must follow CDC recommendations or have professional discretion to deviate. It is important to note that if they rely on the PREP Act for expanded authority, it also stipulates that vaccines must be approved or authorized by the FDA and administered according to CDC recommendations for COVID-19 and pediatric vaccines.

 At least 1 pharmacy organization removed its endorsement of the recent COVID-19 vaccine recommendation when it deviated from the CDC’s previous recommendation for children and pregnant women.

 A review of the 50 states plus Washington, DC, indicates that 45 explicitly mention the CDC in their statutory language, 3 mention ACIP without the CDC, and 2 do not mention ACIP or the CDC. However, of the latter 2, Alaska has Board regulations that require the use of the CDC for many aspects of the vaccination process. Only Texas does not mention the CDC in regulation or statute, but does indicate that the training program needs to meet CDC standards.

Thus, if the CDC/ACIP recommendations continue to deviate from scientific evidence-based recommendations, pharmacists may be constrained by the laws that regulate them. States may need to review other options to allow the pharmacist the most professional discretion, such as broad standard-of-care models,

 new legislation, or other state-specific remedies.

Postpandemic pharmacy law reforms have expanded independent vaccination authority for pharmacists, widespread technician vaccination privileges, and lower age restrictions for pediatric immunization. The shift from physician protocols to streamlined authority and statewide standing orders improved efficiency and accessibility. The PREP Act’s temporary provisions accelerated these changes, but as authority returns to states, significant variability and reliance on CDC recommendations persist. For long-term resilience, states should grant pharmacists greater autonomy to determine and implement the most appropriate vaccine recommendations for their patients, ensuring continued broad access to lifesaving immunizations.

1. 12th amendment to declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID-19. 89 CFR §99875 (2024). https://www.federalregister.gov/d/2024-29108

2. Wayne SK Jr, Barenie RE. The dilemma of childhood vaccines post pandemic. 

. October 25, 2024. Accessed July 8, 2025. https://www.pharmacytimes.com/view/the-dilemma-of-childhood-vaccines-post-pandemic

3. Pharmacist-administered vaccines. National Alliance of State Pharmacy Associations, American Pharmacists Association. Updated June 2020. Accessed July 8, 2025, https://naspa.us/wp-content/uploads/2019/04/Pharmacist-Administered-Vaccines-June-2020-Final.pdf

4. Pharmacist and pharmacy technician vaccination authority. September 3, 2024. Accessed July 8, 2025. https://naspa.us/blog/resource/2024-pharmacist-immunization-authority/

5. Daniel CL, Lawson F, Vickers M, et al. Enrolling a rural community pharmacy as a Vaccines for Children provider to increase HPV vaccination: a feasibility study. 

. 2021;21(1):1266. doi:10.1186/s12889-021-11304-8

6. Varisco TJ, Downs CG, Sansgiry SS, Al Saadi R, Hastings T, Thornton JD. Parents’ intention to have their child vaccinated at a community pharmacy: a national cross-sectional survey. 

. 2023;63(2):511-517.e8. doi:10.1016/j.japh.2022.10.008

7. Bhardwaj S, Galanter N, Berenbrok LA, Shah PD, Bacci JL. Pediatric vaccination in pharmacies is not associated with delayed well-child visits among commercially insured children. 

. 2025;3(2):qxaf028. doi:10.1093/haschl/qxaf028

8. Kim C, Yee R, Bhatkoti R, et al. COVID-19 vaccine provider access and vaccination coverage among children aged 5-11 years - United States, November 2021-January 2022. 

. 2022;71(10):378-383. doi:10.15585/mmwr.mm7110a4

9. Adams AJ, Bright D, Adams J. Pharmacy technician–administered immunizations: a five-year review. 

. 2022;62(2):419-423. doi:10.1016/j.japh.2021.11.011

10. DeMarco M, Carter C, Houle SKD, Waite NM. The role of pharmacy technicians in vaccination services: a scoping review. 

Understanding post-PREP implications is critical for evaluating current public health delivery, identifying ongoing access, and informing future policy.

Michael Barbella

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