Addressing Clinical Challenges and Expanding Pharmacy Roles | Recap ASHP Midyear 2025

The American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition 2025, held in Las Vegas, Nevada, highlighted the rapid acceleration of the pharmacy profession into complex clinical domains and multidisciplinary health care. Sessions focused on optimizing core responsibilities, such as managing the opioid crisis and addressing complex comorbidities like depression and diabetes, while critically evaluating emerging therapies for pediatric patients. A unifying theme was the strategic utilization of the entire pharmacy team, including specialized technicians, to free up pharmacists for high-level clinical decision-making, underpinned by the professional necessity of confidence and teamwork shared by keynote speaker Caitlin Clark.

Specialized Pharmacy Technicians Assume Clinical Roles

The pharmacy profession's evolution toward clinical roles necessitates utilizing highly trained and skilled pharmacy technicians in specialized positions, allowing pharmacists to dedicate their expertise to complex patient care. This structural change helps address workforce shortages and supports career advancement for technicians. Institutions implementing these new models have demonstrated substantial returns on investment (ROI). For example, WVU Medicine implemented a technician career ladder, which, despite requiring a pay increase, reduced monthly turnover rates by approximately 20% and proved financially viable by capitalizing on medication history technician roles to increase prescription capture at the discharge pharmacy. Patients who received a medication history were 75% more likely to utilize the institution's discharge pharmacy.

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Optimizing Medication for Opioid Use Disorder (MOUD)

The fight against the opioid crisis is seeing progress, with drug overdose deaths projected to fall by 34% in 2025, which would represent the lowest level since 2019. However, fentanyl remains the primary driver of fatalities, accounting for about 70% of overdose deaths. The 3 MOUD agents—methadone, naltrexone, and buprenorphine—possess unique pharmacological profiles demanding individualized care. Buprenorphine, a partial μ-agonist, has a superior safety profile compared to full agonists due to a ceiling effect on respiratory depression. For patients with chronic fentanyl use, avoiding precipitated withdrawal is crucial due to fentanyl’s tendency to linger in the body. Therefore, microdosing strategies are increasingly employed for induction. Furthermore, long-acting injectable formulations, such as weekly buprenorphine (Brixadi), offer significant clinical benefits by being "one shot and done," reducing diversion risk, and removing the need for daily patient compliance.

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Navigating Comorbid Depression and Diabetes

Pharmacists are essential in addressing the significant clinical challenge presented by the comanagement of diabetes and depression, as individuals with diabetes are at least twice as likely to develop depression. The goal of integrated care is to stop treating these issues in silos and combine effective concurrent treatments. A key step is distinguishing clinical depression, which involves persistent severe symptoms like depressed mood or anhedonia, from common diabetes distress, which stems purely from the emotional burdens of managing the chronic condition. Lifestyle measures, including exercise and healthy eating, are important for both glucose control and mood improvement, supported by the theory that insulin resistance may reduce levels of neuroprotective brain-derived neurotrophic factor.

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The Debate on GLP-1 Agonists in Pediatrics

With pediatric obesity affecting approximately 1 in 5 US children, treatment strategies are evolving. Intensive health and behavior lifestyle treatment, a formal, family-based program, remains the nonpharmacological gold standard for pediatric obesity, though adherence is challenging. Liraglutide and semaglutide are GLP-1 agonists currently FDA-approved for weight loss in children aged 12 and older. Trials have shown impressive efficacy, such as the STEP TEENS trial, where semaglutide resulted in a -16.1% change in body mass index. However, critical concerns exist, including the high cost (estimated to reach $71.7 billion) and the expected lack of Medicare or Medicaid coverage by 2026. Safety challenges involve common, severe gastrointestinal adverse effects and the concerning lack of long-term data on the impact of these agents on growth, development, puberty, and fertility in children. Pharmacists must also counsel families that weight regain is likely upon cessation of therapy.

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Confidence and Teamwork as Foundations for Patient Care

In the opening session, Women’s National Basketball Association guard Caitlin Clark drew parallels between the team environment in sports and the collaborative nature of health care, emphasizing that both rely on working toward the shared goal of improving outcomes. Clark stressed that successful teamwork begins with building intentional relationships and trust among team members, acknowledging that everyone comes from different backgrounds. She highlighted that confidence is paramount, noting that difficult and challenging moments are valuable teaching opportunities that ultimately improve performance and resilience. Clark concluded her address by giving a pep talk to the audience, reminding the pharmacists that while she "throw[s] a ball into hoops," they are actively saving people’s lives.

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Conclusion

The 2025 ASHP Midyear reinforced the centrality of the pharmacist as a clinical expert, capable of navigating pharmaceutical intricacies across diverse patient populations. Whether by leveraging specialized technicians to enhance workflow efficiency, guiding complex MOUD inductions, or managing the intersection of mental and chronic health, the profession is continuously expanding its clinical footprint, relying on strong teamwork and confident decision-making to achieve the best patient outcomes.

READ MORE: ASHP Midyear Clinical Meeting and Exhibition

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