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This episode explores how recent trends in the retail community pharmacy industry are informing the actions of pharmacy leadership and their teams across the country.

Dispensing Leadership: The Dominoes Are Falling in Community Pharmacy

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The FDA also grants the biosimilar provisional interchangeability designation, making the drug substitutable at the pharmacy level.

FDA Approves Denosumab-Kyqq as Biosimilar for Prolia, Xgeva

In part 3 of our interview with Andrew Maiorini, PharmD, FAHM, vice president of clinical programs at PerformRx, he discusses the ways in which his company is helping patients stay adherent on their medications.

Q&A: Using Data, Addressing Patient Barriers Can Effectively Improve Medication Adherence

Calvin Hunsicker, founder & chief product officer at SureCost, discusses ongoing pharmacy procurement challenges in 2025 and how his company is helping businesses tackle common obstacles.

Proactive, Data-Driven Approach Necessary to Improve Pharmacy Purchasing

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

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Many individuals have been asking if they can take things at home, such as vitamins and OTC medications, to decrease their risk of contracting the virus or to self-treat themselves

OTC Considerations for COVID-19

CVS and Walgreens will limit their offerings for the COVID-19 vaccine, even for those who meet the new criteria from the FDA, according to 

 The new criteria limit who can receive a COVID-19 vaccine, with 4 different vaccines having different indications on who can receive the immunization.

CVS will now offer COVID-19 vaccines in 13 of 16 states and the District of Columbia to those who have a prescription from their physician or other medical provider. The states include Arizona, Colorado, Florida, Georgia, Kentucky, Louisiana, Maine, North Carolina, New York, Pennsylvania, Utah, Virginia, and West Virginia. CVS will not offer COVID-19 vaccines in Massachusetts, Nevada, and New Mexico. According to 

, CVS will offer updated COVID-19 vaccines in the remaining states pending Advisory Committee on Immunization Practice (ACIP) guidelines. For Walgreens, patients need prescriptions for 16 states but not all of them overlap with CVS, and it is unclear which states include these 16, according to 

The FDA recently approved 4 updated COVID-19 vaccines: Pfizer and BioNTech’s Comirnaty, Novavax’s Nuvaxovid, and Moderna’s Spikevax and mNexspike. All have been approved for adults 65 years and older to prevent COVID-19. Other indications include

Nuvaxovid: for patients aged 12 years through 64 with at high risk of severe disease with least 1 underlying condition

Spikevax: for patients 6 months through 64 years at high risk of severe disease with at least 1 underlying condition

mNexspike: for patients aged 12 through 64 years at high risk of severe disease with at least 1 underlying condition

Comirnaty: for patients aged 5 through 64 years at high risk for severe disease with at least 1 underlying condition

Guidance and information on the upcoming 2025-2026 respiratory season have been met with confusion. Recommendations, which were once aligned across organizations, are now conflicting, which included government organizations, such as the CDC, as well as the health care organizations, such as the American Academy of Pediatrics (AAP). Pregnancy has been removed from the adult schedule, even though some health care providers consider it an underlying condition leading to severe disease.

“We need to take the politics out of immunizations and rely on medical experts with years of education, the experience, and the knowledge to interpret that data to provide evidence-based recommendations," Laura Knockel, PharmD, BCACP, clinical associate professor at the University of Iowa College of Pharmacy, said.

AAP published its annual immunization schedule, which covers guidance for influenza, respiratory syncytial virus, and COVID-19. Although recommendations from the organization typically follow ACIP guidelines, this year the schedule differs from the recent recommendations from the committee.

“[Patients are] understandably confused. The space around vaccines is changing so rapidly,” Knockel said.

 “There's so much misinformation and disinformation out there, so I really think the first step is to acknowledge that concern, and again, coming from the point of they want to do what's best for their child.”

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

1. Astor M, Blum D. CDC uncertainty upends COVID vaccine access at CVS and Walgreens. 

. August 28, 2025. Accessed September 2, 2025. https://www.nytimes.com/2025/08/28/well/cvs-pharmacy-covid-vaccine-16-states.html

2. Levy S. CVS, Walgreens limiting offerings of new COVID-19 vaccines. 

. September 2, 2025. Accessed September 2, 2025. https://drugstorenews.com/cvs-walgreens-limiting-offerings-new-covid-19-vaccines

3. Gallagher A. FDA approves COVID-19 vaccines for patients 65 years and older. 

. August 23, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/fda-approves-covid-19-vaccines-for-patients-65-years-and-older

4. Gallagher A. New COVID-19 vaccine recommendations cause confusion among public, health care providers. 

. June 10, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/new-covid-19-vaccine-recommendations-cause-confusion-among-public-health-care-providers

5. Gallagher A, Knockel L. Q&A: pharmacist advocates for evidence-based immunization guidelines for COVID-19 vaccines. 

. September 1, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/q-a-pharmacist-advocates-for-evidence-based-immunization-guidelines-for-covid-19-vaccines

6. Gallagher A. FDA approves updated 2025-2026 COVID-19 vaccine for patients 65 years and older. 

. August 27, 2025. Accessed September 2, 2025. https://www.drugtopics.com/view/fda-approves-updated-2025-2026-covid-19-vaccine-for-patients-65-years-and-older

CVS will not offer COVID-19 vaccines in Massachusetts, Nevada, and New Mexico.

Clinical

CVS, Walgreens Will Limit COVID-19 Vaccine Offerings in 16 States

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

Don’t get left behind: Sign up today for our 

 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.

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

Women with a history of pregnancy complications could be at an increased risk of ischemic stroke at a younger age, particularly atherosclerotic stroke, according to results of a study published in 

 Although stroke is not common in pregnancy or childbearing years, pregnancy can increase the risk.

“While the overall risk of stroke is still very low, our study found pregnancy complications may be an early warning sign of stroke risk—even before age 50,” Frank-Erik de Leeuw, MD, PhD, of Radboud University in Nijmegen, the Netherlands, said in a news release.

 “Knowing this history could help doctors identify those who may benefit from early prevention and cardiovascular care.”

Some risk factors leading to stroke after pregnancy include high blood pressure during pregnancy, preeclampsia, gestational diabetes, and blood clots, according to the CDC. Pregnancy creates added stress in the body, which can strain the heart and blood vessels, either through carrying more weight in the body or changing hormones. Often, women may mistake stroke symptoms for issues related to pregnancy or post birth, which can include headache, dizziness, and tingling arms. Other symptoms of stroke include sudden numbness or weakness in the face, arm, or leg; sudden confusion, trouble speaking, or difficulty breathing; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance, or lack of coordination; or a sudden severe headache with no known cause.

The study included 358 women with ischemic stroke, including 736 previous pregnancies, and 714 women without stroke, with 1413 pregnancies. Approximately 50.8% of women with ischemic stroke experienced 1 or more pregnancy complications compared with 30.7% of those without stroke. The most common complications included hypertensive disorders of pregnancy (HDP; 24.9%), HDP in multiple pregnancies (10.3%), preeclampsia (12%), small for gestational age (SGA) infants (24.4%), preterm birth (19.4%), gestational diabetes (5.3%), stillbirth (3.4%), and miscarriage (33.5%). Further, ischemic stroke at a younger age was likely due to large artery disease, which includes risk factors such as HDP, HDP in multiple pregnancies, SGA, and preterm birth.

“Doctors should ask about pregnancy history when assessing stroke risk,” de Leeuw said in the news release. “Our study suggests we may need to start thinking about cardiovascular prevention earlier in life—not just after menopause. Future studies should investigate the effects of lifestyle modification aimed at reducing cardiovascular risk in women with complications during pregnancy.”

1. Verburgt E, Hilkens NA, Verhoeven JI, et al. History of pregnancy complications and the risk of ischemic stroke in young women. 

. 2025;105(5):e214009. doi:10.1212/WNL.0000000000214009

2. About pregnancy and stroke. CDC. June 6, 2024. Accessed August 8, 2025. https://www.cdc.gov/stroke/about/pregnancy-and-stroke.html

3. Complicated pregnancies linked to higher risk of early stroke. News release. American Academy of Neurology. August 6, 2025. Accessed August 8, 2025. https://www.eurekalert.org/news-releases/1093620

Although stroke is not common in pregnancy or childbearing years, pregnancy can increase the risk.

Pregnancy Complications Increase Risk of Ischemic Stroke at Younger Age

In a review of 34 studies, investigators identified community pharmacies as safe and accessible locations for adolescents seeking care for sexual and reproductive health. Adolescents often face greater barriers to reproductive health care than adults, and community pharmacies are very accessible within urban and rural settings.

Adolescents often are at higher risk of unwanted pregnancy, unsafe abortion, and sexually transmitted infections due to inadequate knowledge of protective practices, according to the World Health Organization (WHO). Furthermore, adolescent pregnancy can also be associated with higher risks of health issues, including anemia, postpartum hemorrhage, and mental disorders, including depression. WHO states that for sexual and reproductive health services for adolescents, “these are either not available or are provided in a way that makes adolescents feel unwelcome and embarrassed.”

The investigators of the current study conducted a systematic review to examine adolescents’ experiences and acceptability of contraception and abortion clinical and dispensing services in community pharmacies. Due to a shift in the pharmacist’s scope of practice since 2000, eligible studies were those published from 2000 onward. Studies of any design were considered and included, or they focused on data on patients aged 10 to 19. 

Investigators ultimately included 34 studies in the final analysis, with 24 from the US, 4 from the UK, 2 from Australia, and 1 each from Switzerland, Canada, and New Zealand. Of the studies, 21 focused on emergency contraceptive pills and 10 focused on broader contraceptive methods; 32 studies were considered high quality, with the other 2 being moderate quality.

Investigators found that adolescents and pharmacists agreed that the delivery of contraceptive services for adolescents was accessible at the pharmacy level, and pharmacists were considered knowledgeable sources of information. Furthermore, adolescents viewed pharmacists as acceptable sources of information regarding contraception and preferred them as health care professionals for the information. 

Pharmacies were seen as accessible and convenient for these services; however, adolescents did anticipate judgmental attitudes and were concerned about confidentiality, specifically related to the layout of the pharmacy. Pharmacists also identified lack of access to medical history as a potential reason that pharmacies were not suited for these services, and they identified needs for additional training regarding providing contraceptive information and counseling adolescents.

However, investigators found that adolescents experienced embarrassment and pharmacist judgment that impacted their overall experience. They mentioned feeling embarrassed due to poor privacy, awkwardness when interacting with pharmacy staff, and judgment from pharmacy staff. Furthermore, embarrassment for patients was worth it when they felt that the pharmacy staff lacked sensitivity, were dismissive, were unhelpful or negative, or asked repetitive or intrusive questions unrelated to care.

Adolescents often are at higher risk of unwanted pregnancy, unsafe abortion, and sexually transmitted infections due to inadequate knowledge of protective practices.

Tracy D Mahvan, RPh, PharmD, MBA, BCGP

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