Zuckerman A, Pierce G, Diamantides E
… +4 more, Loucks J, Canfield S, Tong K, DeClercq J
Am J Health Syst Pharm
· 2026 Apr · PMID 42033752
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PURPOSE: Results of the second ASHP Survey of Health-System Specialty Pharmacy Practice: Clinical Services are presented. METHODS: The 2024 clinical services survey questionnaire was reviewed by a panel of specialty phar...PURPOSE: Results of the second ASHP Survey of Health-System Specialty Pharmacy Practice: Clinical Services are presented. METHODS: The 2024 clinical services survey questionnaire was reviewed by a panel of specialty pharmacy experts and reduced to 64 questions. The convenience survey sample of 298 unique health-system specialty pharmacies (HSSPs) was compiled from ASHP member lists, the presence of specialty pharmacies indicated in previous ASHP surveys, and outreach to ASHP member organizational leaders. The survey was hosted using Qualtrics. RESULTS: The response rate was 23.8% (71/298). Most respondents reported dispensing less than 45,000 specialty prescriptions annually, have offered specialty pharmacy services for more than 7 years, and are part of an academic medical center. Over half of HSSPs (61%) reported being able to fill less than half of the specialty medication prescriptions at their health system, most commonly due to payer network restrictions. HSSPs provide many access-related services to all patients of the health system regardless of their ability to fill the specialty prescription, and most respondents (77%) reported offering services beyond basic specialty medication prescription fulfillment. Most HSSPs reported tracking patient response to therapy using disease state-specific outcomes and documenting all interventions in the electronic health record. HSSPs heavily contribute to the field of specialty pharmacy through research and education. CONCLUSION: The HSSP model is a continually maturing, integrated advanced practice model focused on providing patient-centric care to all health-system patients regardless of network status, yet access to fill prescriptions written at the health system remains limited.
Am J Health Syst Pharm
· 2026 Apr · PMID 42033237
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PURPOSE: To identify and evaluate cardiovascular outcome trials for glucagon-like peptide-1 receptor agonists (GLP1RAs) in various patient populations, including those with or without type 2 diabetes (T2D). SUMMARY: A sy...PURPOSE: To identify and evaluate cardiovascular outcome trials for glucagon-like peptide-1 receptor agonists (GLP1RAs) in various patient populations, including those with or without type 2 diabetes (T2D). SUMMARY: A systematic search of MEDLINE identified 12 cardiovascular outcome-based randomized controlled trials: 10 in patients with T2D, one in patients with overweight/obesity and atherosclerotic cardiovascular disease (ASCVD) but not T2D, and one in patients with obesity and heart failure with preserved ejection fraction (HFpEF). Most trials had a low risk of bias. The GLP1RA was administered as a weekly subcutaneous injection in 8 trials, and 2 trials used once-daily oral semaglutide. Follow-up ranged from 1.2 to 5.4 years. GLP1RA therapy showed a consistent reduction in major adverse cardiovascular events (MACE) in patients with T2D. The effect on cardiovascular and all-cause death was less certain. Individually, only liraglutide demonstrated a reduction in MACE, cardiovascular death, and all-cause death. In patients with overweight/obesity and ASCVD (but without T2D), weekly subcutaneous semaglutide lowered the risk of MACE but not cardiovascular death. In patients with obesity and HFpEF (with or without T2D), tirzepatide lowered the occurrence of the composite endpoint of adverse heart failure events and cardiovascular death. Discontinuation of GLP1RA therapy due to gastrointestinal adverse events was common across the trials. CONCLUSION: These data support the use of GLP1RAs to lower MACE in patients with T2D. A cardiovascular benefit with GLP1RA therapy was also observed in 2 additional patient populations: those with overweight/obesity and ASCVD but without T2D and those with obesity and HFpEF with or without T2D.
Farzadfar D, Liaw S, Escober Doran C
… +3 more, Ho C, Galla AR, Cha A
Am J Health Syst Pharm
· 2026 Apr · PMID 42019042
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PURPOSE: To describe the design of a pharmacist-led telehealth transitions-of-care (TOC) program and its implementation across multiple hospitals within a large health system containing onsite health system-owned pharmac...PURPOSE: To describe the design of a pharmacist-led telehealth transitions-of-care (TOC) program and its implementation across multiple hospitals within a large health system containing onsite health system-owned pharmacies. SUMMARY: The telehealth TOC program led by centralized pharmacists was implemented in 2 phases. Eligible patients included those with 3 or more discharge medication prescriptions filled at the onsite health system-owned pharmacy following a hospital or emergency department visit. During the pilot phase, the service was offered to patients 18 years of age or older discharged from a single hospital in the health system while the expansion phase included patients discharged from 5 additional hospitals and those of all ages. Additional services were also implemented during the expansion phase, including the incorporation of pharmacy services coordinators (PSCs) who assisted with patient outreach and prior authorizations, a bedside medication delivery service, and dedicated pharmacy personnel who brought medications to the bedside and offered enrollment into the TOC program at that time. Enrolled patients were contacted by a pharmacist within 2 to 3 business days after discharge for a TOC visit via telephone or video call at no cost. During the visit, the pharmacist provided education on discharge medications, performed a postdischarge medication reconciliation, and resolved any medication-related problems. Implementation of this service involved collaboration with organizational leadership and multidisciplinary colleagues throughout the health system. CONCLUSION: Successful implementation of the TOC program enabled continuity of care and optimized medication management following discharge, with the goal of improving patient outcomes.
Liaw S, Escober Doran C, Farzadfar D
… +3 more, Ho C, Galla AR, Cha A
Am J Health Syst Pharm
· 2026 Apr · PMID 42019010
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PURPOSE: Hospital discharge poses risks of adverse outcomes for patients, especially those at high risk for readmission. While some evidence suggests that pharmacist-led transitions-of-care (TOC) programs may be effectiv...PURPOSE: Hospital discharge poses risks of adverse outcomes for patients, especially those at high risk for readmission. While some evidence suggests that pharmacist-led transitions-of-care (TOC) programs may be effective in reducing readmission rates, evidence of long-term effectiveness is limited. The aim of this study was to evaluate the impact of a pharmacist-led telehealth TOC program on 30- and 90-day hospital readmission rates. METHODS: This retrospective study analyzed 116,251 adult patients discharged from a large health system in 2024. Of these, 2,253 patients participated in the TOC program, which included a meds-to-beds program, prior authorization support, medication reconciliation, and counseling by pharmacists within 2 to 3 days of discharge. Using propensity score matching, TOC and non-TOC groups were matched on age and LACE (length of stay, admission acuity, comorbidities, and emergency department use) score, designed to predict readmissions. Outcomes were compared using χ2 tests and logistic regression. RESULTS: After matching, with all LACE levels combined, the TOC group had significantly lower readmission rates than the non-TOC group for both time periods (30 days: 8.6% vs 11.8%; 90 days: 16.2% vs 20.0%; P < 0.01). The TOC group was associated with 30% (30 days) and 24% (90 days) lower odds of readmission. Differences in readmission were significant between the groups for patients with a high LACE score but not for those with low to medium LACE scores. CONCLUSION: The pharmacist-led telehealth TOC program significantly reduced hospital readmission rates. These findings support the implementation of pharmacist-led TOC programs and suggest the importance of risk stratification in targeting interventions.
Rybolt E, Bohnenkamp C, Cascone V
… +2 more, Schieber T, Martin GA
Am J Health Syst Pharm
· 2026 Apr · PMID 41955513
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PURPOSE: Hypersensitivity reactions to chemotherapy impact treatment plans and patient outcomes, and there are no direct guidelines for management of this adverse effect. Desensitization to chemotherapy has become a stan...PURPOSE: Hypersensitivity reactions to chemotherapy impact treatment plans and patient outcomes, and there are no direct guidelines for management of this adverse effect. Desensitization to chemotherapy has become a standard practice at this institution to maintain preferred treatment in oncology patients. This study reports on the effectiveness and tolerability of chemotherapy desensitization in a large population and management of subsequent infusions following a breakthrough reaction. METHODS: A retrospective review was conducted of patients who received chemotherapy desensitization as a 3-step or 12-step infusion protocol at the University of Kansas Hospital from March 2011 to October 2023. The primary outcome was the desensitization infusion completion rate. RESULTS: Among the 191 patients assessed, 151 met the inclusion criteria and were included in the final analysis. A total of 747 desensitization infusions were attempted, 735 of which were complete infusions (98.4%). Thirty-seven patients (24.5%) reacted to their first desensitization, and 17 patients were unable to complete the full infusion (11.3%). The mean number of desensitization infusions (treatment doses) in total completed per patient was 5 infusions (SD, 6), with a range of 0 to 52 infusions. While most patients were desensitized to a platinum or taxane agent, desensitizations were also completed for other agents including cisplatin, liposomal doxorubicin, irinotecan, methotrexate, and cabazitaxel. CONCLUSION: Patients can safely tolerate desensitization infusions to chemotherapy, and many can continue with an agent until therapy completion. Breakthrough reactions can be mitigated through desensitization protocol modifications.
Am J Health Syst Pharm
· 2026 Apr · PMID 41955285
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PURPOSE: The purpose of this article is to discuss the pathophysiology, epidemiology, clinical assessment, and management of elevated lipoprotein(a) (Lp(a)) levels in atherosclerotic cardiovascular disease (ASCVD) and ca...PURPOSE: The purpose of this article is to discuss the pathophysiology, epidemiology, clinical assessment, and management of elevated lipoprotein(a) (Lp(a)) levels in atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS). SUMMARY: Lp(a) is a unique lipoprotein consisting of 2 components: a low-density lipoprotein (LDL) moiety and a single molecule of apolipoprotein(a) (apo(a)), which binds to apolipoprotein B in the LDL moiety. The cholesterol content of the LDL moiety promotes atherosclerosis while apo(a) confers additional atherogenic and inflammatory properties to Lp(a). Lp(a) is an independent and causal risk factor for ASCVD and CAVS as well as all-cause mortality. Elevations in Lp(a) levels are genetically determined with minimal reductions observed in response to nonpharmacological risk factor modification. Currently available lipid-lowering drugs produce minimal or only modest percent changes in Lp(a) levels. As a consequence, Lp(a) is rarely measured in clinical practice. Several investigational agents designed to specifically target Lp(a) reduce levels by 80% to 100%. These agents work by decreasing the synthesis of apo(a) or by inhibiting the binding of apo(a) to apolipoprotein B. Phase 3 ASCVD outcome trials for several of these agents have completed enrollment. CONCLUSION: Elevated Lp(a) levels are a known risk factor for ASCVD and CAVS. Several investigational drugs produce 80% to 100% reductions in Lp(a) levels. However, until these therapies are proven to lead to favorable clinical outcomes, management of patients with elevated Lp(a) levels will continue to be limited to early and intensive ASCVD risk factor management.
Dean C, Aliaj E, Dandino M
… +3 more, Hassan G, Levitsky AM, Rim MH
Am J Health Syst Pharm
· 2026 Jun · PMID 41955267
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PURPOSE: Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support p...PURPOSE: Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support pharmacists by providing updates on new and anticipated novel drug approvals. SUMMARY: Selected drug approvals anticipated in the 12-month period covering the 4 quarters of 2026 are reviewed. The analysis emphasizes drugs expected to have significant clinical and financial impact in hospitals and clinics, as selected from 52 novel drugs awaiting US Food and Drug Administration approval. This year's pipeline features novel therapies for various disease states, including rare and inherited genetic disorders as well as immunologic and inflammatory diseases, and continued advancements in both targeted oncology and gene therapies. CONCLUSION: Novel therapies continue to strengthen the current drug pipeline.
Stepanovic M, Bright CL, Doan UN
… +5 more, Kim S, Kirollos A, Raman T, Eckel SF, Morbitzer KA
Am J Health Syst Pharm
· 2026 Apr · PMID 41952519
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PURPOSE: To identify and establish core concepts through expert consensus, providing a standardized framework for curriculum development in pharmacy administration and leadership (PAL) training. METHODS: A modified Delph...PURPOSE: To identify and establish core concepts through expert consensus, providing a standardized framework for curriculum development in pharmacy administration and leadership (PAL) training. METHODS: A modified Delphi methodology was employed in the spring and summer of 2024, utilizing iterative rounds of surveys distributed via Qualtrics to an expert panel of 85 pharmacy administrators and leaders. The initial list of 13 core concepts was derived from prior research on healthcare management programs. Through multiple rounds of feedback and refinement, consensus was determined using an a priori 80% endorsement threshold, consistent with or more rigorous than previous Delphi studies in pharmacy education. Qualitative responses were analyzed using thematic analysis to refine definitions and core concept titles. RESULTS: In round 1, 11 of 13 core concepts met the consensus threshold, while "operations management" (79%) and "innovation and entrepreneurship" (74%) were refined based on feedback. "Supply chain management" was added as a standalone concept. In round 2, 14 concepts were reviewed, with 13 achieving consensus and "innovation and entrepreneurship" recommended to be further integrated into other concepts. Round 3 finalized 13 core concepts, 9 of which received 100% endorsement. CONCLUSION: The 13 core concepts provide a standardized framework to guide curriculum development in master's programs, residencies, and other PAL training initiatives. These core concepts can help address the leadership gap in pharmacy by ensuring graduates acquire the essential knowledge and competencies needed to lead healthcare organizations effectively. Future research should explore integrating these concepts into accreditation standards and assessing their impact on educational outcomes.
Carvalho RA, Amador R, Maltês S
… +7 more, Cunha G, Marques A, Laranjeira T, Brízido C, Mendes M, Aguiar C, Rocha BM
Am J Health Syst Pharm
· 2026 Apr · PMID 41951366
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PURPOSE: The TAFA-CRUZ study evaluated the real-world effectiveness and safety of tafamidis 61 mg in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and heart failure. The primary objective was to evaluate a...PURPOSE: The TAFA-CRUZ study evaluated the real-world effectiveness and safety of tafamidis 61 mg in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and heart failure. The primary objective was to evaluate all-cause mortality, with key secondary outcomes including 30-month survival, cardiovascular-related deaths, and safety. METHODS: This prospective, single-center observational study included 238 patients with ATTR-CM followed between 2019 and 2024 in a structured amyloidosis program. Of these patients, 140 were initiated on tafamidis 61 mg in additional to receiving supportive care guided by the CHAD-STOP strategy, while 98 received only supportive care. Baseline demographics, outcomes, and subgroup analyses, including National Amyloidosis Centre (NAC) stages, were assessed. RESULTS: The cohort was predominantly elderly (mean age, 81.8 years) and male (80.7%). Patients treated with tafamidis were, on average, younger and less symptomatic at baseline than those in the comparator group. After a median follow-up of 21 months, treatment with tafamidis, as compared to supportive care alone, was associated with lower all-cause mortality (16.4% vs 54.1%) and cardiovascular mortality (13.6% vs 39.8%). Thirty-month survival was significantly higher in the tafamidis group (92.1% vs 51.0%; hazard ratio [HR], 0.17 [95% CI, 0.10-0.32]; P < 0.001). Survival benefits were consistent across all NAC stages, with the greatest relative effect observed in NAC stage 3. Tafamidis was well tolerated, with adverse events mostly limited to mild transient gastrointestinal symptoms and rare treatment discontinuations. CONCLUSION: In this real-world cohort, treatment with tafamidis 61 mg was effective and safe, being associated with significantly reduced all-cause and cardiovascular mortality across all disease stages. These findings extend clinical trial evidence into routine practice and highlight the value of specialized amyloidosis programs in optimizing outcomes for patients with ATTR-CM.
Am J Health Syst Pharm
· 2026 Apr · PMID 41949025
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PURPOSE: To evaluate the differences in the incidence and severity of immune-related adverse effects (irAEs) between the pembrolizumab 21-day dosing schedule and the 42-day dosing schedule. METHODS: Patients with solid t...PURPOSE: To evaluate the differences in the incidence and severity of immune-related adverse effects (irAEs) between the pembrolizumab 21-day dosing schedule and the 42-day dosing schedule. METHODS: Patients with solid tumor malignances and no previous immunotherapy exposure were included. This case-control study compared patients on pembrolizumab 200 mg every 21 days with those on 400 mg every 42 days in a 2:1 ratio. The primary outcome was the rate of all grades of irAEs. RESULTS: A total of 160 patients who received treatment every 21 days and 80 patients who received treatment every 42 days were evaluated. All-grade irAEs occurred in 33.1% (53/160) and 32.5% (26/80) of patients in the 21-day group and the 42-day group, respectively. Regarding severe irAEs (grade 3 or worse), these occurred in 32.1% (17/53) and 23.1% (6/26) of patients in the 21-day and 42-day cohorts, respectively (P = 0.444). Additionally, no significant association was found between dosing schedule and steroid initiation (P = 0.595) or treatment discontinuation (P = 0.192). CONCLUSION: The comparison of the 21-day and 42-day pembrolizumab dosing cohorts revealed similar irAE rates and severity of toxicities. Rates of steroid initiation for irAE management and permanent treatment discontinuation due to irAE did not significantly differ between dosing schedules. While severe irAEs correlated with treatment discontinuation, dosing schedule did not differentially affect this outcome. Overall, extending the pembrolizumab dosing interval to 42 days appears safe while maintaining an irAE profile comparable to that with the standard 21-day schedule.