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Articles

Glucagon-like peptide-1 receptor agonists have been associated with improvements in quality of life (QOL), restrained eating, and emotional eating behavior.

GLP-1 Usage Does Not Increased Risk of Psychiatric Events, Study Finds

Jeff Goad, PharmD, MPH, discusses hesitancy for hepatitis vaccines and the necessary advice pharmacists can utilize to help patients manage these misconceptions.

Q&A: Myths, Misinformation Surrounding Hepatitis Vaccines

Novavax’s COVID-19 vaccine has been available in the US under emergency use authorization since July 2022.

FDA Approves Nuvaxovid for the Prevention of COVID-19

Researchers conducted a clinical review detailing the intersection of dermatology and suicide, explaining why skin conditions lead to increased risk of poor mental health.

Suicide Risk Management Crucial in Dermatological Care

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Oncologists recognize the potential of artificial intelligence (AI) in improving the quality of care and patient outcomes according to new research.

Optimism for AI in Cancer Care

The 2018 oncology drug market had a record number of new treatments and continued a trend of growth.

Oncology Market Remains Robust, Says Report

How targeted therapy could be the pathway to improved cancer treatment.

4 Ways Precision Medicine Impacts Cancer Treatment

Study validates benefits of pharmacists on healthcare teams.

Pharmacist-Driven Intervention Program Reduces Readmissions

Pharmacists should prepare to advise patient consumption methods and THC drug interactions as use and manufacturing models continue to grow and legalize.

Prescription Counseling Equally Applicable to THC Products

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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 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

As Rite Aid has filed its second Chapter 11 bankruptcy with plans to close or sell all of its locations, what will the impact be on independent 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 and nearly 90% said they would be able to absorb patients who were receiving care there. However, many said low reimbursement and not enough staff or resources would make it difficult.

® sat down with Douglas Hoey, RPh, MBA, CEO of NCPA. In the conversation, we talked about how Rite Aid 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.

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

: How will the closure of Rite Aid stores across the country impact independent pharmacies? Is this an opportunity or a serious problem?

: It's both an opportunity and a serious problem. It's a serious problem because pharmacies are closing throughout America. Here's another almost 1300 stores that are closing. There's been more than 7000 pharmacies that have closed over the last 7 years. There's been a net contraction, which is an even more important number. There's 7000 fewer pharmacy choices for consumers since 2017. Just in that short amount of time, there's 7000 fewer choices. Now, here's 1200 fewer choices from Rite Aid. Walgreens has announced they're going to close 1200 pharmacies. They announced that 6 months ago, and there will be more closures in addition to those. That's a problem.

It could be an opportunity for independent pharmacies, because those patients need to go somewhere, those patients need to land somewhere. It could be an opportunity to attract more business. However, not all business is created equally, and unfortunately, not all patient insurance plans are created equally. If those patients’ insurance plans are poor pain insurance plans, the pharmacy may be in a position where they don't want to accept that patient. Just like doctors and dentists don't accept all patients’ insurance plans, some pharmacies may be in a position where they have to say, “I'm not going to accept you as a patient because your mix of drugs or your payer is so bad it's going to force me to lose money.” It's an opportunity to have more business, but it's not like it was 10 years ago where all business was good business. Unfortunately, now not all business is good business. Pharmacies have to be really discerning how many of these patients they take on.

Frankly, it may put some patients in some tough positions, which we don't want to see. We don't want to see any patient do without or suffer. Period. Exclamation point. With that said, it may take some patients to scream to their employer, scream to the government, to say, “No pharmacy will take me. You've got to do something about our messed up payment system for pharmacies.”

: What can independent pharmacies do to effectively handle an influx of patients?

: That's the second problem that our members are facing, is having enough staffing and qualified staffing. One thing that we've seen is that certified technicians stay in the job longer, on average, so there's less turnover, which is less of a problem for our independent pharmacies than with the chains. We know that certified technicians, like through [the Pharmacy Technician Certification Board], will stay with the pharmacy longer, and are often able to take on more responsibilities. Making sure you have enough staffing is very important. But with the delicate balance of profit and loss in pharmacies, not having too much is also important.

Use of technology. Any pharmacies that aren't fully taking advantage of technology, this is the time to make that investment, to look into those new tools that can help you be more efficient, have your staff more efficient. Really creating systems where that pharmacist is involved in the checking, making sure before that prescription gets in the hands of the patient that a pharmacist has looked at it, checked it, verified it, validated it, is important. That filling process may be up to that point you can have some of our best operators have a technician that do most of that physical filling of the prescription. For operators who aren't already doing that, which many of them are, now's the time to take that leap to implement more workflow efficiencies, technology efficiencies, and then also the training of your staff to help them help you even more.

: Is there anything else you wanted to say?

: Rite Aid is a brand name that is known to a lot of casual consumers. Walgreens, CVS, Rite Aid, that's the rundown of the big chains and Rite Aid is gone. I wouldn't say Walgreens is hanging by a thread, but to see what's happened to Walgreens in the last 10 years is shocking. Going from a $100 billion company to one that was just purchased for $10 billion by private equity. CVS has the cushion of its PBM to protect it, but its stock has not done very well compared to the S&P 500 over the last 10 years. So even it's gotten bruised a little bit despite having the anti-competitive advantage of its PBM. I think it's a real shot across the bow to any casual observer in the community pharmacy space to say, “What is going on here?” It's also a call to action for policy makers and for employers. Employers really need to pay attention to this and say, “You know what? It's going to be difficult for my employees to find a prescription which they need to be healthy, productive employees.”

One other thing I'll say is that some people say, “Well, Amazon mail order will solve this. They'll fill the gap.” If history is a guide, no, they won't. Patients don't prefer mail order, unless they're coerced into going into mail order. There's always some exceptions, but by and large, patients want a brick and mortar pharmacy, with a real pharmacist—not an 800 number with someone posing as a pharmacist—that they can talk to, that they can get medication from, get advice from.

Without payment reform, pharmacies as we know them are moving toward extinction—that won't happen—but again, it's a call to action for legislators who've been sitting on their hands and employers who have been unaware of the situation that they need to do something different. 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. 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

Douglas Hoey, CEO of NCPA, discusses what independent pharmacies can do to handle an influx of patients and what the chain’s situation means for the pharmacy landscape.

Q&A: Douglas Hoey on How Rite Aid’s Closure Will Impact Independent Pharmacies

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, 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.”

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

Tracey Walker

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