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The approval covers Pfizer and BioNTech’s LP.8.1-adapted monovalent COVID-19 vaccine, which is also indicated for patients aged 5 to 64 with at least 1 underlying condition.

FDA Approves Updated 2025-2026 COVID-19 Vaccine for Patients 65 Years and Older

Through considerations regarding cost, scalability, safety, and regulations, researchers provided an end-to-end perspective on microneedle-based vaccine strategies.

Microneedle-Based Vaccine Systems Emerging as Viable Future Option

Pharmacies face time, workload, and sustainability challenges when integrating social care, but support and reimbursement can make these efforts viable.

Q&A: Addressing Barriers to Social Care in Pharmacies

However, caution with empagliflozin use should be taken for patients who were previously on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.

Real-World Data Show Dapagliflozin, Empagliflozin Are Safe Options for Diabetes

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

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On June 26, 2024, the FDA approved ensifentrine (Ohtuvayre) for the treatment of COPD.

FDA Approves Ensifentrine, Novel Treatment for Chronic Obstructive Pulmonary Disease

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.

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

When it comes to expanding pharmacy services and improving reimbursement, independent pharmacies must understand the basics of medical billing, value-based care, partnerships, and daily expansion opportunities.

"It can feel really overwhelming to think of creating a net-new service, being a credentialed provider,” said Tara Pfund, PharmD, chief strategy officer with Cascadia Pharmacy Group. “What type of technology would you use to submit your claims? Will they be paid? A lot of times, I see pharmacy teams putting it off until they’ve got enough time. If you don’t put the big rocks in first, you’ll never get them in at all.”

 Solutions Summit Summer 2025, Pfund hosted a session titled Expanding Revenue Streams in Independent Pharmacy: Strategies for Today and the Future. Sponsored by American Associated Pharmacies (AAP), Pfund’s presentation received AAP support because of the organization’s close relationship with Cascadia Pharmacy Group.

“AAP is one of America’s largest independent pharmacy organizations, a national cooperative of more than 2000 member pharmacies,” according to AAP. “Cascadia Pharmacy Group represents more than 40 of those member locations. Cascadia’s CEO, Jeff Harrell, is chairman of AAP’s board of directors and also currently serves as president of [the National Community Pharmacists Association’s] board and [is] a member of the AlignRx board.”

Unlocking Pharmacy Value Through Payer Program Engagement

Read on for key takeaways from Pfund’s presentation:

“One of the things I always talk to teams about...is a lot of times when you want to launch a clinical service or do medical billing or create a provider-payer partnership, it’s something that we think we have to put off until we have enough time to do it,” said Pfund. “It can feel really overwhelming to think of creating a net-new service, being a credentialed provider.” With this potential barrier in mind, Pfund believes the best step forward is to simply begin expanding the clinical services that are already offered. Once more services are offered and others are improved, pharmacies have a significant opportunity to expand revenue streams.

Pfund explored the 6 steps in implementing medical billing and value-based care services. Those steps included identifying the services, credentialing and contracting, documentation, billing, training, and revenue cycle management (RCM). After finding the services they can bill for, pharmacies should get these services credentialed and contracted to be viable options for billing in their state. Finally, Pfund mentioned how pharmacies need to establish documentation, how they should bill for services, and what training is necessary. Pharmacies can then implement their services and diversify revenue through RCM solutions.

“We really want to look at alternative payment models where there is a link to quality and value, where we can make sure that patients are being cared for in a way that improves overall quality, and that pharmacists and pharmacies are reimbursed for those types of programs,” continued Pfund. Speaking to value-based care initiatives, Pfund believes these alternative payment models can enhance the pharmacists’ role while also diversifying revenue streams within pharmacy businesses that may be struggling with reimbursement.

She delved into the core principles of operating a pharmacy business and the regulations in place that impede pharmacists from billing for more medical services. Although community pharmacies are mainly employed to dispense medications and health care products, Pfund advises pharmacists to have conversations with payers, patients, and health care providers to better understand the needs of patients in their communities. Pfund also provided advice focused on engaging the entire pharmacy team and working with other stakeholders on ways to improve bottom lines, as well as patient outcomes.

“I’ve been really lucky to have a career where I’m part of small changes coming together to create a big tidal wave of change. We’re able to make a big difference and change one person’s life that slowly helps change one more person’s life,” concluded Pfund. “Next thing you know, [you have] an entire small community where the payers and the providers and the pharmacies are all engaged in this way to keep independent pharmacies in business and have there be more access points of patient care. It’s really neat, and I’ve seen it happen firsthand.”

Tara Pfund, PharmD, chief strategy officer with Cascadia Pharmacy Group, discusses various ways community pharmacists can expand services and support clinical reimbursement.

Strategies for Expanding Revenue Streams in Independent Pharmacy Today and in the Future

AstraZeneca will now provide a home delivery option for its nasal spray flu vaccine FluMist, according to a press release from the company.

With FluMist Home, patients who are prescribed the vaccine can place an order through the independent online specialty pharmacy ASPN Pharmacies and have it delivered to their home via Polaris Pharmacy Services.

“As influenza vaccination rates decline, especially among younger populations, this first-of-its-kind, at-home, needle-free option offers a critical opportunity to help make protection more accessible, convenient, and better aligned with the realities and current preferences of people’s lives,” Ravi Jhaveri, MD, professor of pediatrics at Northwestern University School of Medicine, said in the release.

FluMist is the first and only seasonal flu vaccine approved to be self-administered by adults 18 to 49 years of age or by a caregiver to individuals 2 to 17 years of age. The live attenuated vaccine was first approved by the FDA in 2003 and received approval for self-administration in 2024. The self-administration approval was based on data that showed the vaccine instructions were appropriately designed so recipients and caregivers could safely and effectively use the vaccine.

 FluMist is approved for the prevention of flu caused by influenza virus subtypes A and B.

FluMist Home is delivered in a consumer-friendly format with clear, at-home specific instructions that support proper handling, administration, and disposal. The vaccine should be stored in the refrigerator until it is ready to be used. The most common adverse effects of FluMist include a runny or stuffy nose, a sore throat, and a fever over 100 °F. FluMist should be avoided if a patient is allergic to eggs or other flu vaccines.

“Seasonal influenza can have a serious, even life-altering, impact on individuals and families, especially for those most vulnerable,” Michele Slafkosky, executive director of Families Fight Flu, said in the release.

 “Providing flexible vaccination options makes it easier for individuals and caregivers to...get protected. This can help to improve protection for individuals and strengthen collective immunity against influenza.”

AstraZeneca said in the release that FluMist Home will be available in 34 states and eventually all 48 contiguous states. Although the service is not allowed in certain states due to local pharmacy laws, it is available for administration in doctors’ offices and pharmacies nationwide.

“For the first time, consumers can receive and administer an influenza vaccine entirely at home—marking a historic shift in how preventive care is delivered,” Ami Patel, executive vice president of hub operations at ASPN Pharmacies, said in the release.

 “Through FluMist Home, we’re seeing a new model of care that puts consumers in control, offering a seamless, end-to-end experience from determining eligibility to convenient home-delivery and administration. This milestone not only redefines convenience in vaccine delivery but also sets the stage for a more accessible, patient-centered future in health care.”

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our

1. FLUMIST (Influenza, Vaccine Live, Intranasal), the nation’s only nasal spray flu vaccine, now available for home delivery. News release. AstraZeneca. August 15, 2025. Accessed August 15, 2025. 

https://www.astrazeneca-us.com/media/press-releases/2025/FLUMIST-the-nations-only-nasal-spray-flu-vaccine-now-available-for-home-delivery.html

2. FDA approves nasal spray influenza vaccine for self- or caregiver-administration. News release. FDA. September 20, 2024. Accessed August 15, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-approves-nasal-spray-influenza-vaccine-self-or-caregiver-administration

AstraZeneca now offers FluMist Home, allowing eligible patients to receive and self-administer the flu vaccine entirely at home.

FluMist Nasal Spray Vaccine Is Now Available for Home Delivery

A limited number of community pharmacies are providing nutrition-related services, despite an increase in pharmacies with registered dietitians, according to data in an article published in the 

Journal of Health, Population, and Nutrition

. The investigators of the study explore how to optimize the role of the pharmacist and registered dietitians to enhance patient outcomes through counseling efforts.

“We found that pharmacists and dietitians shared the same perspectives on the importance of screening, assessment, and intervention processes for both nutritional disorders and lifestyle-related diseases to facilitate nutritional interventions in community pharmacies,” the study authors said.

 “In addition, the following challenges in promoting nutritional interventions were identified: establishing nutritional intervention flow, educating health care providers, publicizing to patients, and implementing institutional reforms.”

, results showed that pharmacist-driven interventions improved anthropometric and clinical outcomes related to patients’ nutrition. Further, the interventions resulted in dietary behavior changes. The review authors stated that there is a need for interventions to address nutrition and dietary health goals, especially with holistic approaches to health and food.

In general, pharmacists are playing a bigger role in community-based care and patient outcomes, according to Wolters Kluwer. Pharmacies are highly accessible, and patients tend to trust community pharmacists beyond just dispensing, with 58% of Americans more likely to seek nonemergency care at pharmacies. Pharmacists are often on the front line to counsel and advocate for patients and mediate between patients, providers, and insurance companies.

In the current study, investigators aimed to determine ways to enhance nutritional interventions at the community pharmacy level. They conducted qualitative interviews, which included 15 respondents. Of the respondents, 5 pharmacists completed training related to health support, 5 were working with a registered dietitian, and 5 were registered dietitians employed at community pharmacies. Interviews were conducted between May and June 2022, lasted approximately 1 hour, and included 2 main categories: patients with malnutrition and patients with lifestyle-related diseases.

According to the results, pharmacists and dietitians acknowledged that older adults and patients have misconceptions about or poor knowledge of diet. Furthermore, patients who typically give up on dieting usually need interventions for lifestyle-related diseases. Interventions identified by investigators included correcting dietary misconceptions, providing guidance on a balanced diet, and offering advice on the importance of protein. Pharmacists in particular can help identify and assess at-risk patients during medication reconciliation, screen for malnutrition, and check meal frequency and food awareness. The investigators also found that pharmacists can help patients who have difficulties swallowing and have financial barriers regarding nutrition.

Interestingly, pharmacists viewed lifestyle modification similarly to medication adherence and preferred to refer patients with malnutrition to a registered dietitian, as it is more challenging to treat in comparison with lifestyle-related diseases. However, investigators acknowledged that incorporating nutrition into the workflow was difficult for pharmacists.

“To enhance the quality of nutritional interventions, both pharmacists and dietitians indicated the importance of the flow of screening, assessment, and educating patients who need nutritional interventions,” the study authors concluded.

 “Pharmacists need to focus on screening and assessing at-risk patients and collaborating with dietitians to improve their knowledge.”

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our 

1. Kumaki R, Hatamoto M, Iida R, Kishimoto K. Toward enhanced nutritional interventions in community pharmacies: personal attitude construct analysis. 

. 2025;44(1):287. doi:10.1186/s41043-025-01035-6

2. Acar G, Frost R, Kaur Bhamra S, Heinrich M. Community pharmacy-delivered interventions for nutrition and diet-related health promotion. 

. 2023;91(1):274. doi:10.3390/proceedings2023091274

3. Community-centric care: the pharmacist’s role in bridging health care gaps. Wolters Kluwer. April 15, 2025. Accessed August 15, 2025. https://www.wolterskluwer.com/en/expert-insights/community-centric-care-the-pharmacists-role-bridging-healthcare-gaps

Pharmacists and dietitians acknowledge that older adults and patients with misconceptions about or poor knowledge of diet should be screened for interventions.

Molly Csere, PharmD

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