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President of 3 Axis Advisors and CEO of 46brooklyn Research joins Drug Topics to discuss nuances surrounding pharmacy benefit managers and the way they are perceived in the public eye.

Demystifying PBMs, Their Role in the Drug Supply Chain

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A conversation with Douglas Hoey, RPh, MBA, CEO of NCPA, on the chain pharmacy’s announcement of a second Chapter 11 bankruptcy.

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

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Guselkumab is the first and only IL-23 inhibitor to demonstrate robust data as a fully subcutaneous regimen.

Tremfya Demonstrates Sustained Response Up to 92 Weeks

Stanley V. Campbell, Jr., CEO of EagleForce Associates, Inc., and Yi Deng, PhD, Senior Vice President of Engineering at EagleForce, explore real-world examples of AI giving time back to pharmacists.

How AI Can Improve the Pharmacist’s Workload | NCPDP 2025

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Stanley V. Campbell, Jr., CEO of EagleForce Associates, Inc., and Yi Deng, PhD, Senior Vice President of Engineering at EagleForce, discuss how AI is being used to benefit patients.

AI’s Ability to Directly Impact Patient Outcomes | NCPDP 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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 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

Take Control of Your Pharmacy's Bottom Line

Confused by some of the details in your purchasing plan? How do you know if your purchasing behaviors are aligned with what’s best for your bottom line?

You're not alone—and this guide is here to change that.

 breaks down complex rebate structures, shows you how to unlock hidden value, and gives you the confidence to make smarter, more profitable buying decisions. Whether you're new to a program or simply want to ensure you're not leaving money on the table, this free quick-read resource from AAP is your key to maximizing earnings and minimizing stress.

Clear, actionable and empowering… Learn what to look for to make sure you're getting the best deal for your business.

Demystify Your Purchasing Plan

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

AAP Members are Nationally Recognized Community Leaders

How PBMs Gained Notoriety in the Prescription Drug Market

In part 2 of our interview with Antonio Ciaccia, President of 3 Axis Advisors and CEO of 46brooklyn Research, he explained the history of pharmacy benefit managers (PBMs) and what led them to gain such significant market power. Furthermore, he discussed the many nuances surrounding pharmacy benefits, how PBMs have grown to control drug prices, and why they are now one the most scrutinized entities in all of health care.

“I think it's important to first table set that PBMs are providing savings in the marketplace, and they are substantial savings relative to prices charged by manufacturers and pharmacies. But I think that that if I just ended there, that would lack a lot of nuance and context that better contextualizes what those savings are.”

From the government programs established decades before to the current narrative pinning PBMs against other smaller entities within health care, Ciaccia provided a timeline for the prescription drug middlemen’s claims to infamy. He also offered several insights into the complexity of drug pricing and where PBMs have fit into it all in the past, present, and future.

Stay tuned for more from our conversation with Ciaccia, as he discusses further developments regarding PBM reform and the misconceptions that surround these middlemen. Also be on the lookout for our full-length conversation with Ciaccia on our Over the Counter podcast channel.

The 3 Types of PBM Reform Aiming to Change the Pharmaceutical Market

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Expert on drug pricing and pharmacy benefits, Antonio Ciaccia joined Drug Topics to discuss how PBMs came to hold so much control of the pharmaceutical supply chain.

Yi Deng, PhD

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