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Addressing the impacts on patients and the overall pharmacy market, Joey Mattingly, PharmD, MBA, PhD, discusses trends in pharmacies opening and closing across the country.

Independent, Chain Pharmacy Turnover Reflects Retail Business Churn

Articles

Liraglutide is the first glucagon-like peptide-1 to have a generic equivalent for both type 2 diabetes and obesity indications.

FDA Approves First Generic GLP-1 Liraglutide for Weight Loss

The approved vaccines include Novavax’s Nuvaxovid and Moderna’s Spikevax and mNexspike.

FDA Approves COVID-19 Vaccines for Patients 65 Years and Older

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

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

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Razanne Oueini, PharmD, MSc, CPHQ, discusses how rates of persistence to basal insulin were impacted after the IRA monthly cap.

Q&A: Insulin Cost Cap Linked to Better Treatment Persistence | PQA 2025

A conversation with Razanne Oueini, PharmD, MSc, CPHQ, senior manager of Performance Measurement at PQA, at PQA 2025.

Impact of IRA Insulin Cap on Rates of Persistence to Basal Insulin | PQA 2025

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

OTC oral contraceptive pills improve access to effective contraception in the United States, especially for patients with structural barriers to care. In an article published in 

, investigators showed that OTC oral contraception was accessed by many patients who used no methods or less-effective methods of contraception.

“If we see maybe a patient in the aisle who has that inquisitive look, or if they come and speak to us, it's going to be important first to make sure that we talk to them in a noncoercive, nonjudgmental-type environment,” Jasmine Cutler, PharmD, CPh, assistant professor in the department of pharmacy practice at Taneja College of Pharmacy, 

 “I think accessibility is important along with education, so I think they should go hand in hand.”

 as an OTC option for pregnancy in 2023, which marked the first approval of an oral contraceptive pill in the United States that is available without a prescription. Norgestrel has been approved as a prescription medication since 1973, and the manufacturer applied for OTC approval in July 2022. The FDA required the applicant to show that the product could be used safely by consumers and that the drug label was easily readable without assistance.

With the approval, the OCT availability was aimed at reducing barriers to access for people to obtain the medication without the need for a prescription. It is available in stores and online, with 

 for a direct-to-consumer e-commerce platform. Patients can purchase Opill when eligible, and it is available for home delivery.

In the cross-sectional study, investigators evaluated whether OTC oral contraception improved access for patients with structural barriers, including adolescents, patients in rural areas, and patients who are uninsured. Further, they evaluated whether the availability helped reach patients who had not previously used or had used less-effective contraception. Patients aged 15 to 49 years who obtained oral contraception at the pharmacy or online retailers were included in the study. There were 63 pharmacies across 31 states included, according to the study investigators. Additionally, investigators collected demographic, health history, pregnancy intention, and preference data for all patients. The study outcomes included moving from nonuse to using oral contraception and moving from less-effective methods to oral contraception.

The study included 986 patients, with 70.2% being single and 34.4% being aged 20 to 24 years. Regarding race and ethnicity, 2.4% of patients were American Indian or Alaska Native, 13.3% were Asian, 9.8% were Black, 11.8% were Hispanic or Latina, 1.2% were Native Hawaiian or Pacific Islander, 73.1% were White, and 0.1% were of unknown race and ethnicity. Investigators found that a higher proportion of young patients aged 15 to 20 years used OTC oral contraception compared with prescription methods, as did more patients who were uninsured, identified as Black or Latina, had a lower level of education, and lived in the Southern United States.

The study authors reported that 10 of 17 states in the South had more than 3 OTC users for every 4 prescription users, which was the highest region in the US, and only 1 of 13 states in the West had 3 OTC users for every 4 prescription users. However, 8 of 13 states in the US had fewer than 1 OTC user for every 4 prescription users. States with the greatest OTC to prescription ratio included Arkansas, Delaware, Florida, Kentucky, Louisiana, and Oklahoma.

Patients using OTC oral contraception were more likely to have a history of pregnancy and had more frequent reports of vaginal intercourse than prescription users. Further, they were also less likely to receive contraceptive counseling within the last 12 months and use any modern method of contraception at baseline, according to the study authors. Of OTC users, 42.2% were already using a more or the most effective contraception method before their pharmacy visit compared with 83.9% of prescription users. 

The most common reasons for patients using OTC contraception included not requiring an appointment, not having a regular physician, and efficiency. The study authors reported that OTC users had a probability of approximately 50% of moving from no contraception or less-effective contraception. Furthermore, OTC users were estimated to be 31.8 percentage points more likely to move from nonuse of contraception and 41 percentage points more likely for less-effective contraception.

“OTC OCP [oral contraceptive pill] users in our sample were more likely to be uninsured and reside in rural areas, underscoring the promise of OTC availability in bridging gaps where health care access is limited,” the study authors said. “These findings are particularly salient in the context of ongoing threats to reproductive health care access under proposed federal and state-level policy changes.”

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1. Rodriguez MI, Burns H, Sheridan R, Edelman AB. Over-the-counter oral contraceptive use and initiation of contraception. 

 2025;8(8):e2527438. doi:10.1001/jamanetworkopen.2025.27438

2. Gallagher A, Cutler J. Q&A: Education, Accessibility Is Key for Reproductive Health Care | APhA 2025. 

. April 3, 2025. Accessed August 19, 2025. https://www.drugtopics.com/view/q-a-education-accessibility-is-key-for-reproductive-health-care-apha-2025

3. Meara K. FDA Approves First OTC Birth Control Pill in United States. 

. July 13, 2023. Accessed August 19, 2025. https://www.drugtopics.com/view/fda-approves-first-otc-birth-control-pill-in-united-states

4. Massaro L. GoodRx, Opill Partner on OTC Delivery Program to Address Gaps in Access. 

. October 31, 2024. Accessed August 19, 2025. https://www.drugtopics.com/view/goodrx-opill-partner-on-otc-delivery-program-to-address-gaps-in-access

Investigators found that Opill increased access for patients who were uninsured, identified as Black or Latina, had lower education, and lived in the Southern United States.

OTC Birth Control Improves Access to Contraception for Patients With Structural Barriers

A better understanding of socioeconomic and infrastructure factors can help pharmacists reduce health inequalities, according to study data published in 

“Access to medications and health services is an important public health priority related to the ongoing national discussion on health care disparities across the US,” the study authors said.

 “The increasing number of pharmac[ies] closing nationwide represent a growing obstacle for patients to access medications.”

According to findings from a review published in 

, community pharmacies play a large role in public health services beyond traditional filling of medication. Pharmacists can now offer primary or secondary disease prevention, including smoking cessation, weight management, alcohol misuse, syringe and needle exchange, inoculation, screening, and chlamydia testing. In the review, the majority of studies reported on health inequalities with targeted interventions, which can help close the gap between the least and most disadvantaged patients.

Health disparities can cause social, economic, and environmental disadvantages, which can be used by pharmacists to better inform their clinical practices. Because of the access to pharmacies, pharmacists can help improve the disparities in vaccination rates as well as increase patient trust. Further, pharmacists can also help to reduce or eliminate structural inequality in health care.

In the current study, data from the 2020 decennial Census and the 2021 five-year American Community Survey were used, including population counts and estimates of social and demographic characteristics. Approximately 83,398 census tracts had population and income data, and investigators included these in the analytic cohort. Overall, 3105 census tracts were classified as pharmacy deserts, including over 10 million people, which equated to 3.1% of the US population. Pharmacy deserts typically had lower proportions of female patients and patients over the age of 65 years. 

Additionally, they also had a higher proportion of inhabitants with a high school education or less, no health insurance, and ambulatory disability. Median income was also lower in pharmacy deserts, which had more Black, Hispanic, and American Indian and Alaskan Native (AIAN) inhabitants. Furthermore, pharmacy deserts had a higher median digital divide index (DDI), more prominent infrastructure development, and a high redlining index.

Investigators found that census tracts with a high redlining index had a 2-fold increase in being in a pharmacy desert, and census tracts with moderate or high DDI were more likely to be a pharmacy desert. Further, the investigators found that census tracts categorized as more segregated in relation to Black, Hispanic, or AIAN populations were more likely to be characterized as pharmacy deserts, as well as populations with higher proportions of less than high school education, no health insurance, and ambulatory disabilities.

“These data suggest that vulnerable communities already facing economic and social challenges are being left with reduced access to pharmacy services, potentially exacerbating existing health disparities,” the study authors said.

 “Census tracts affected by contemporary redlining had a greater risk of being pharmacy deserts, highlighting how systemic underinvestment may play a significant role in exacerbating health disparities among already disadvantaged populations.”

1. Catalano G, Woldesenbet S, Pawlik TM. Distribution of pharmacy deserts and its association with digital divide and residential redlining across the United States. 

. 2025;20(8):e0330027. doi:10.1371/journal.pone.0330027

2. Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: a review of reviews. 

. 2019;124:98-109. doi:10.1016/j.ypmed.2019.04.003

3. Hurley-Kim K, Unonu J, Wisseh C, et al. Health disparities in pharmacy practice within the community: let's brainstorm for solutions. 

. 2022;10:847696. doi:10.3389/fpubh.2022.847696

Pharmacists leverage socioeconomic insights to combat health disparities, enhancing access to medications and public health services in underserved communities.

Community Pharmacies Help to Improve Access to Health Care

Amid a fast-approaching respiratory virus season, the time for keeping a closer eye on common infectious diseases is here. From independent community pharmacies to larger chains such as Walgreens, pharmacists are ramping up to continue the trend of setting themselves apart from other providers when it comes to boosting vaccine uptake and counseling patients on vaccine regimens.

“Health care is local, and so are pharmacies. Our pharmacists are deeply embedded in their communities and have long-standing relationships with many of their patients,” Samantha Picking, PharmD, senior director of immunizations at Walgreens, told 

. “At Walgreens, we strive to be that most convenient and accessible place, especially to get recommended vaccines.”

Aside from discussing Walgreens’ initiatives and approaches to boosting vaccine uptake among its communities, Picking also highlighted the pivotal role pharmacists have played, and will continue to play, regarding vaccines for infectious diseases and more. With trust, access, and knowledge being at the heart of pharmacists’ immunization skills, Picking believes her peers will continue to show why pharmacies are the most ideal health care destinations for receiving vaccines.

Read on to gain insights from Picking’s expertise in the immunization space, and stay tuned as she shares further knowledge on specifically vaccinating during respiratory virus season and so much more.

Samantha Picking, PharmD, senior director of immunizations at Walgreens, discusses how pharmacists have emerged as the ideal providers to manage vaccine administration.

Razanne Oueini, PharmD, MSc, CPHQ

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