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Topline results from a phase 3 trial showed 64.1% of patients on atogepant achieved a 50% or greater reduction in mean monthly migraine days during months 4 to 6.

Atogepant Shows Superiority Over Topiramate for Migraine Prevention

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Real-world effectiveness data showed semaglutide reduced the risk of major kidney disease events by 26%.

Semaglutide Lowers Risk of Kidney Disease Events in Patients With Type 2 Diabetes, CKD

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Education, honesty, and communication skills are key when it comes to creating treatment regimens.

Addressing Patients Adherence with Topical Therapies 

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 

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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

Pharmacists played a critical role during the COVID-19 pandemic, administering vaccines at a higher rate than other health care professionals.

 Through the Federal Retail Pharmacy Program, they delivered over 300 million COVID-19 vaccine doses nationwide. This high level of engagement not only improved vaccination rates and patient satisfaction but also reshaped the role of community pharmacies.

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

sat down with Greg Mitchell, owner of United Drug Superstore in Hatch, New Mexico, to discuss how important vaccine administration is to a pharmacy’s overall profitability, what strategies pharmacists can use to maximize vaccine uptake and patient engagement, and how retail pharmacies can leverage vaccine services to build long-term patient relationships.

Importance of Vaccination to Independent Pharmacy Profitability | AAP 2025

 How significant is vaccine administration to a pharmacy’s overall profitability?

 It's just been huge for us. It's been amazing. We jumped into the vaccination business in 2020, before the COVID-19 vaccines came out. We were very fortunate to have been one of the states where our wholesalers supplied the federal supply of vaccines. We jumped right in with both barrels and finished that year with about 5800 vaccines. The profitability that year was well above anything we'd seen in previous years. What we look at now is that typically, if vaccines are 5% of our business, they're 10% of our gross margin. That tells you that it's very significant.

 What strategies can pharmacists use to maximize vaccine uptake and patient engagement?

 That was a question that I had after looking at the deck that Scott shared with us today when I saw that another classic chain was actually up in vaccine administration, whereas our stores, independent stores, all seem to be down. My store was down 30% this last year. We went into some of the grocery stores to see what was going on, and they did a fantastic job of point of purchase advertising. They had advertising when you walked in the door, advertising when you picked up your cart, advertising on the end caps, advertising at the checkouts, to try and get the patients over to the pharmacy. For us, we've got to really concentrate on doing that this next year.

The other thing is, you can mine your state immunization information system database. We've started doing that in the last 3 months and we've had a huge uptake. We're actually calling the patients and saying, “Hey, we see where you got your first shingles vaccine. You didn't get your second one. We need to get you in here.” That's really bringing people in. We are concentrating on having our staff mining that immunization information system every time we fill a prescription for somebody. On the state site it shows exactly what they're due for. Then we're going to call them and say, “Hey, when you come in, you might want to get your COVID-19 shot, or your second Shingrix, or whatever it is. That's been tremendous for us.

How can retail pharmacies leverage vaccine services to build long-term patient relationships?

: it's interesting that you asked that. We're in a rural area, and when we started off doing the COVID-19 vaccines, we actually did more vaccines in our small, rural pharmacy in Hatch, New Mexico, than any other pharmacy in our county. Our county includes the second most populous city in the state, with multiple Walgreens, multiple CVS, multiple Walmarts, every chain pharmacy you could think of. We did a great job on it, and a lot of the patients were so happy that we've made patients out of them and they've come 40 miles to our pharmacy from the city where there's plenty of pharmacies to choose from. They've decided to come back and do business with us. Just do a good job and people will stay with you.

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

1. Carroll JC, Herbert SMC, Nguyen TQ, et al. Vaccination equity and the role of community pharmacy in the United States: A qualitative study. 

. 2024 Jan 25;42(3):564-572. doi: 10.1016/j.vaccine.2023.12.063. Epub 2024 Jan 9. PMID: 38195264.

2. Religioni U, Vaillancourt R, Kazmierczak J, et al. Patient Opinions and Satisfaction Regarding Pharmacists Delivering Vaccinations in Community Pharmacies. 

. 2025 Mar 13;12:23743735241309473. doi: 10.1177/23743735241309473. PMID: 40092975; PMCID: PMC11907534.

A conversation with Greg Mitchell, owner of United Drug Superstore in Hatch, New Mexico, at AAP 2025.

Q&A: Strategic Vaccine Management Can Drive Pharmacy Success | AAP 2025

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.

How Pharmacy Deserts are Being Defined, Identified

: 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

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?

Despite repeated promises, Congress has continued to delay pharmacy benefit manager (PBM) reform, leaving independent pharmacies in crisis. With a new administration in the White House that has signaled support for PBM reform, there is renewed hope for change. However, Douglas Hoey, RPh, MBA, CEO of the National Community Pharmacists Association (NCPA), warns that while there is optimism, patience is wearing thin—the time for meaningful reform is now.

® sat down with Hoey at the American Associated Pharmacies (AAP) Annual Conference, held April 10 to 12 in Austin, Texas, to discuss if he is hopeful that PBM reform will be passed under the new administration, what needs to be done to get PBM reform passed, and his take on Optum Rx’s announcement that it plans to introduce a cost-plus prescription reimbursement model.

Medicare Drug Price Negotiation Could Expose Pharmacies to Significant Financial Risk | AAP 2025

: Despite bipartisan support, PBM reform continues to be brushed aside. Are you at all hopeful that some type of PBM reform will be passed under the new administration? What do you think needs to be done to get PBM reform passed?

: I'm extremely optimistic, if for no other reason that it saves over $5 billion for taxpayers. As far as it being delayed and delayed and delayed, we've said to members of Congress, “Look, we've been the bridesmaid left at the altar three different times with continuing resolutions that were passed to fund the government and pharmacy not being included.” They continue to assure us that PBM reform will be included. The latest that we've been told by the leadership of Congress is that it will be done through the reconciliation process, so as the budgets are reconciled between the Senate and the House, PBM reform will be included in that. That does make some sense, because they're going to need some ways to save money. And again, PBM reform saves $5 billion, so it should be attractive for that. We are beyond impatient, though, and in fact, our fly in is coming up, and the message is, “When are you going to get this done?” I mean, we want to be polite to a certain extent, but we're almost beyond politeness because it hasn't been done. Pharmacies are closing. Patients are suffering. Prices are going up. And Congress continues to sit on its hands. Am I optimistic? Yes. Am I done waiting? Yes.

At AAP 2025, Douglas Hoey, CEO of NCPA, discussed the possibility of PBM reform under the new administration and his take on Optum Rx’s plans to introduce a cost-plus reimbursement model.

Raj Chovatiya, MD, PhD

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