Journal Of The American Pharmacists Association[JOURNAL]
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200 papers
Transforming clinical pharmacy practice models: the impact of a transitions of care model on patient outcomes.
Espinoza Ramirez J, Durango M, Santalo O … +1 more , Allison S
J Am Pharm Assoc (2003) · 2026 Jun · PMID 42229846 · Publisher ↗
BACKGROUND: Many organizations have developed criteria for pharmacy practice models; however, most of these models are not based on studies evaluating clinical outcomes. Currently, there is no consensus on the ideal phar...
BACKGROUND: Many organizations have developed criteria for pharmacy practice models; however, most of these models are not based on studies evaluating clinical outcomes. Currently, there is no consensus on the ideal pharmacy practice model. OBJECTIVES: The objectives of this study were to compare the difference in length of stay (LOS), and 30-day all-cause readmission rates between each pharmacy practice model. METHODS: This is a retrospective cohort study that evaluated three pharmacy practice models in a small-community hospital. The models evaluated in this study included a traditional staffing model (generalist model), hybrid staffing model (clinical model), and a transitions of care (TOC) model. RESULTS: The TOC model was found to have the largest observed reduction in LOS compared to the generalist and clinical model (-23.5%, p < 0.001). For 30-day all-cause readmission rates, the generalist model had the lowest rate (10.5%) compared to a rate of 12.0% in the clinical model and a rate of 11.2% in the TOC model (p = 0.32). CONCLUSION: The findings of this study suggest that a pharmacy practice model that emphasizes providing TOC services was associated with a significant reduction in LOS. However, there were no significant differences in 30-day all-cause readmission rates. Further studies are warranted to determine the most beneficial pharmacy practice model to improve patient outcomes.
Improving Medication Adherence in the Medicaid Population Through Community Pharmacist-Provided Services.
Salvati S, McGrath S, Linn K … +3 more , Kirisci L, Bhosle M, Coley KC
J Am Pharm Assoc (2003) · 2026 May · PMID 42219110 · Publisher ↗
BACKGROUND: The Pennsylvania Pharmacists Care Network established a payor program with a Medicaid Managed Care Organization (MCO), to provide adherence services to health plan members including medication synchronization...
BACKGROUND: The Pennsylvania Pharmacists Care Network established a payor program with a Medicaid Managed Care Organization (MCO), to provide adherence services to health plan members including medication synchronization, medication reconciliation, medication adherence packaging, and medication home delivery. These services are documented through the Pharmacist eCare Plan (PeCP); however, medication adherence metrics cannot be evaluated using PeCP data alone. OBJECTIVE: To evaluate medication adherence using both PeCP and claims data in patients who received community pharmacist-provided adherence services as part of a Medicaid MCO payor program. METHODS: Medication adherence was measured before and after the initiation of the payor program using Proportion of Days Covered (PDC) for three targeted medication classes: Renin Angiotensin System Antagonists (RASAs), HMG-CoA Reductase Inhibitors (Statins), and noninsulin diabetic medications (NIDM). Two-sided paired t-tests were used to compare the percentage of change in PDC values for each of the three target medication classes. An additional analysis was conducted for nonadherent patients, defined as those with PDC less than 80% during the baseline period. Regression analyses were used to assess if any factors impacted the likelihood of baseline nonadherent patients achieving a PDC above 80% during the intervention period. RESULTS: There were 1,361 Medicaid patients that met inclusion criteria for the analyses. Average PDC across all three target drug classes increased significantly during the intervention period. Furthermore, average PDC significantly increased to at least 80% for all three drug classes in baseline nonadherent patients. Patients on RASAs or statins with baseline PDC <80% that received medication adherence packaging services were more likely to achieve a PDC of at least 80% during the intervention period. CONCLUSION: This study demonstrates that community pharmacist-provided adherence services as part of a Medicaid MCO payor program positively impacted patient adherence as measured by PDC for RASAs, Statins, and NIDMs.
Evaluating the role of pharmacists in providing care with long-acting injectables for HIV and PrEP.
Barde S, Lahrman R, Kissel J … +5 more , Vaughn T, Choy A, Seifert J, Li J, Hall LE
J Am Pharm Assoc (2003) · 2026 May · PMID 42202989 · Publisher ↗
BACKGROUND: Ending the HIV epidemic remains a global public health priority, with ongoing efforts to minimize infections by 2030. Pharmacists play a crucial role in managing HIV prevention (PrEP) with cabotegravir (CAB)...
BACKGROUND: Ending the HIV epidemic remains a global public health priority, with ongoing efforts to minimize infections by 2030. Pharmacists play a crucial role in managing HIV prevention (PrEP) with cabotegravir (CAB) and treatment with cabotegravir/rilpivirine (CAB/RPV) by optimizing antiretroviral (ARV) therapies and adherence. An Ohio-based not-for-profit organization with healthcare clinics and in-house pharmacies has implemented a pharmacist-led program managing long-acting injectable antiretrovirals (LAI-ARVs) using collaborative practice agreements (CPAs) with clinic providers. The innovative workflow addresses LAI-ARV implementation challenges and leverages pharmacist expertise to optimize patient care. OBJECTIVES: The primary objective of this study is to evaluate the role of ambulatory care pharmacists in a LAI-ARV program by describing approval/denial to the program after primary care provider (PCP) referral. The secondary objective is to quantify the ambulatory care pharmacist interventions during HIV treatment/PrEP LAI program Referral Review. METHODS: A CPA was developed at five clinic locations to implement a pharmacist-led LAI-ARV program for the treatment and prevention of HIV. Referral data were retrospectively reviewed to assess approval or denial of potential injectable candidates and to describe pharmacist interventions. RESULTS: Out of the 1103 referrals reviewed, 893 were approved and 210 were denied. CAB/RPV referrals had more denials due to safety and efficacy concerns. Of the 893 approved referrals, 264 required at least one clinical intervention to address logistic, safety and efficacy considerations before initiation of LAI-ARV. Pharmacist interventions often address safety concerns such as hepatitis B virus (HBV) risk, drug interactions, and risk of in adherence to appointments. CONCLUSION: This study highlights the impact of pharmacist-led processes in optimizing LAI-ARV therapy through patient-specific evaluation and clinical interventions. Pharmacist involvement ensures appropriate candidate selection, safe therapy implementation, and supports the broader public health efforts to reduce HIV transmission and end the HIV epidemic.
Overview of clinical trials on deprescribing: A comprehensive analysis of the ClinicalTrials.gov database.
Wang Y, Gong Y, Zhong X … +6 more , Li C, Yin H, He W, Hong H, Yuan G, Yan K
J Am Pharm Assoc (2003) · 2026 May · PMID 42202988 · Publisher ↗
BACKGROUND: Understanding the current features of deprescribing clinical trials is crucial for improving trial designs and identifying research gaps. OBJECTIVE: This study aims to provide a comprehensive overview of depr...
BACKGROUND: Understanding the current features of deprescribing clinical trials is crucial for improving trial designs and identifying research gaps. OBJECTIVE: This study aims to provide a comprehensive overview of deprescribing trials registered in ClinicalTrials.gov. METHODS: We searched the ClinicalTrials.gov database for deprescribing clinical trials and evaluated the characteristics of these relevant studies. For the primary completed trials, we also searched PubMed and Google Scholar to confirm their publication statuses. RESULTS: We identified 125 deprescribing trials for analysis. Only 39.2% were completed, 88.0% were interventional trials, 56.0% enrolled only the elderly, 70.4% were single-center clinical trials, and 35.2% were sited in the United States. The number of interventional trials registered before patient recruitment from 2021 to 2025 was higher than that from 2012 to 2020 (P < 0.05). Compared with unpublished clinical trials, published ones had larger sample sizes, more parallel intervention models, and more registered after recruitment (all P < 0.05). The cumulative publication rate within five years after the completion of primary trials was 60.7%. The journal with the highest Impact Factor (IF) for publication was JAMA Psychiatry (Q1, IF 22.5), and the one with the largest number of publications was BMC Geriatrics (Q2, IF 3.4). CONCLUSION: Our study showed that deprescribing trials are mostly large-scale and single-center studies, mainly carried out in developed countries, and most of them are incomplete, lacking results and publications. Therefore, it is necessary to carry out such trials in developing countries, and to pay more attention to improving their completion rates, as well as promoting the publication and dissemination of their results.
Primary care pharmacy technicians as medication access experts: A new era in primary care.
Highsmith M, North K, Dahl B … +1 more , Moore J
J Am Pharm Assoc (2003) · 2026 May · PMID 42202987 · Publisher ↗
Pharmacy technicians are well known and respected for their invaluable contributions to patient care in pharmacy settings. Pharmacy technicians have skills in practical medication information, medication access, insuranc...
Pharmacy technicians are well known and respected for their invaluable contributions to patient care in pharmacy settings. Pharmacy technicians have skills in practical medication information, medication access, insurance and cost navigation, and patient and provider communication strategies. In the current healthcare landscape, costly prescription medications save lives, but insurance complexities, patient social determinants of health, and other system factors create barriers. A lesser-known area of practice where pharmacy technicians significantly impact patients is primary care. Primary care pharmacy technicians (PCPhT) improve timely patient access to medications through cost mitigation and formulary navigation, provide support in the medication procurement process, and educate patients and providers on best practices to get patients the medications they need in an efficient, cost-effective manner. This commentary articulates the rationale for establishing this role, along with the PCPhT designation, as an emerging and important member of the primary care team.
2026 Remington Honor Medal Address: The power of "WE!".
Menighan TE
J Am Pharm Assoc (2003) · 2026 May · PMID 42201293 · Publisher ↗
Abstract loading — click title to view on PubMed.
Prescribing and dispensing: Pharmacists navigating financial conflicts of interest.
APhA Ethics Advisory Committee
J Am Pharm Assoc (2003) · 2026 May · PMID 42191071 · Publisher ↗
In many states, pharmacists are now able to provide services and receive compensation for both prescribing and dispensing medications. This practice transformation presents potential financial conflicts of interest (FCOI...
In many states, pharmacists are now able to provide services and receive compensation for both prescribing and dispensing medications. This practice transformation presents potential financial conflicts of interest (FCOIs) for the pharmacist, who now must navigate prioritizing patient or community interests amidst new opportunities for personal financial gain or professional advancement. APhA's Ethics Advisory Committee takes up the challenge of analyzing direct FCOIs in such scenarios and presenting guidance on how the prescribing pharmacist can fulfill their professional and ethical responsibility to their patients and communities. Pharmacists should know how expanded prescribing and practice opportunities present FCOIs (both direct and indirect). Transparency, competency, and respect for patient autonomy are key considerations for all pharmacist-patient interactions, especially when prescribing and dispensing may occur in the same patient encounter and FCOI's may emerge.
Patient response to changes in available Medicare Part D coverage plans: A case study.
Dougherty TS, Mahida K, Nguyen E
J Am Pharm Assoc (2003) · 2026 May · PMID 42178136 · Publisher ↗
BACKGROUND: Medicare Part D provides prescription coverage for Medicare beneficiaries. Community pharmacies dispense a substantial share of Part D prescriptions but face growing financial strain because pharmacy benefit...
BACKGROUND: Medicare Part D provides prescription coverage for Medicare beneficiaries. Community pharmacies dispense a substantial share of Part D prescriptions but face growing financial strain because pharmacy benefit manager reimbursement rates can be less than acquisition and operating costs. Community pharmacies can choose not to accept an insurance plan, though this has implications for patient access and pharmacy revenue. OBJECTIVE: The purpose of this study is to determine patient behavior changes in relation to a community pharmacy's decision to no longer accept certain Medicare Part D plans. METHODS: A retrospective analysis was conducted to evaluate patterns after a notice letter was sent to beneficiaries specifying which plans will be accepted and not accepted in 2026. The data focused on Medicare Part D plans from 2025 to 2026 and further broken down by accepted or non-accepted plans. The study evaluated participants continuing to purchase prescriptions at the community pharmacy despite having a non-accepted Medicare Part D plan. RESULTS: A total of 119 participants were included in the analysis, and 61 participants (51.26%) switched their Medicare Part D plan while 58 (48.74%) remained on the same plan from 2025. However, 80 (67.23%) continued to use the community pharmacy, with 10 patients having pre-existing accepted secondary plans, and 12 continued to obtain prescriptions at the pharmacy despite their Medicare Part D plan not being accepted. Twenty-three (19.33%) patients who did not have an accepted plan in 2026 transferred prescriptions to a different pharmacy. CONCLUSION: This study evaluated Medicare Part D plan switching in relation to a community pharmacy's decision to no longer accept certain Medicare Part D plans during open enrollment. Medicare Part D plan switch rates were higher than national estimates. Clear communication may decrease loss of patients when a community pharmacy chooses to no longer accept a Medicare Part D plan.
Effects of a pharmacist-led GAIN approach on long-acting injectables in schizophrenia.
Karashima M, Hiraide M, Onuma K … +5 more , Kamasako M, Fukasawa A, Sugi T, Ishii-Nozawa R, Koriki N
J Am Pharm Assoc (2003) · 2026 May · PMID 42176740 · Publisher ↗
BACKGROUND: Long-acting injectable antipsychotics (LAIs) effectively prevent relapse in patients with schizophrenia; however, their utilization rate remains markedly lower in Japan than in other countries. The effectiven...
BACKGROUND: Long-acting injectable antipsychotics (LAIs) effectively prevent relapse in patients with schizophrenia; however, their utilization rate remains markedly lower in Japan than in other countries. The effectiveness of a pharmacist-led GAIN approach on the initiation and persistence of LAI therapy in Japan has yet to be quantitatively evaluated. METHODS: This retrospective observational cohort study examined the effectiveness of the GAIN approach, a structured communication tool led by ward pharmacists to facilitate LAI initiation. We analyzed 180 patients with schizophrenia admitted to our hospital between April 2018 and March 2023 for whom LAI treatment was considered. Outcomes were compared between an intervention group (n = 79), in which pharmacists implemented the GAIN approach, and a non-intervention group (n = 101), in which physicians provided conventional oral explanations. RESULTS: The LAI initiation rate was significantly higher in the intervention group than in the non-intervention group (86.1% vs. 59.4%, p < 0.010). Furthermore, the primary endpoint of one-year LAI persistence was significantly higher in the intervention group (88.2% vs. 61.7%, p < 0.010). Within the intervention group, Drug Attitude Inventory-10 and Schedule for Assessment of Insight-Japanese version scores showed significant improvements following the intervention (p < 0.010). CONCLUSIONS: These results suggest that a pharmacist-led GAIN approach improves patients' insight and medication attitudes, facilitating both the initiation and long-term maintenance of LAI therapy. In the context of burdened clinical settings, pharmacist involvement via task shifting represents an effective strategy for optimizing psychiatric pharmacotherapy.
2026 Prescott Lecture: Patient centered advancement-Reframing why we advocate.
Murphy EM
J Am Pharm Assoc (2003) · 2026 May · PMID 42167652 · Publisher ↗
Abstract loading — click title to view on PubMed.
Defining the role of pharmacists in food pharmacy.
Mai K, Vuong H, Franey E … +4 more , Womack Z, Hong S, Geier C, McNamara A
J Am Pharm Assoc (2003) · 2026 May · PMID 42155679 · Publisher ↗
BACKGROUND: Hypertension and diabetes disproportionately impact Black/African American and Latinx communities in the U.S. These disparities are driven by structural factors such as food insecurity and limited healthcare...
BACKGROUND: Hypertension and diabetes disproportionately impact Black/African American and Latinx communities in the U.S. These disparities are driven by structural factors such as food insecurity and limited healthcare access. Clinic-based Food Pharmacy (FP) programs aim to reduce nutrition insecurity and support chronic disease management, but the optimal role of clinical pharmacists within these programs remains unclear. OBJECTIVES: This retrospective exploratory cohort study evaluated five models of pharmacist involvement in San Francisco Health Network FPs and examined their relationship with patient new engagement with the pharmacist. Secondary aims assessed the effect of FP on blood pressure (BP) and A1c. METHODS: Patients newly enrolled or re-engaged in FP between July 1, 2022, and July 1, 2024, were grouped by model: Individual, Coordinated Care, Community, Referral, or No Involvement. Patient data and clinical measures were extracted from electronic health records. Statistical comparisons used ANOVA, t-tests, and chi-square tests. RESULTS: Among 178 participants, pharmacist engagement varied significantly across models (p < 0.001), with the Individual model showing the highest visit rate (58.3%) and Community and No Involvement the lowest (6.3%). Despite minimal new engagement, the Community model showed the largest A1c reduction (-1.0%). No significant differences in BP or A1c change were observed across models. CONCLUSION: Despite being underpowered, this study demonstrates the feasibility and variability of pharmacist integration within real-world FP programs. The individual model showed higher patient engagement with pharmacists but was not clearly associated with improved clinical outcomes. Findings suggest that baseline disease burden and patient access to food may influence outcomes more than pharmacist involvement alone. These results provide preliminary estimates to inform future prospective studies and highlight the importance of standardized recruitment, clearer pharmacist roles, and improved accessibility to optimize program impact.
Seeking oral contraceptives information from pharmacists among female adolescents and young adults.
Leong NI, Barnard M, Rosenthal M … +1 more , Holmes E
J Am Pharm Assoc (2003) · 2026 May · PMID 42155678 · Publisher ↗
BACKGROUND: Over-the-counter oral contraceptives can reduce barriers to access birth control among female adolescents and young adults. Pharmacists play an important role in providing information about these products whe...
BACKGROUND: Over-the-counter oral contraceptives can reduce barriers to access birth control among female adolescents and young adults. Pharmacists play an important role in providing information about these products when needed. However, reasons why female adolescents and young adults may or may not seek information about over-the-counter oral contraceptives from pharmacists is not well understood. OBJECTIVE(S): This study aimed to examine predictors of willingness to seek assistance from pharmacists for over-the-counter oral contraceptive use and to determine the difference in the effect of these predictors between female adolescents (age 16 to 17) and young adults (age 18 to 24). METHODS: A cross-sectional survey was designed to collect the intention to seek pharmacist's assistance, guided by the Theory of Planned Behavior. Females aged 16 to 24 were recruited using an online panel. Structural equation modeling was used to understand the predictors of their intention. RESULTS: A total of 697 responses were eligible for data analysis. The psychometric properties were evaluated using purification analysis (n=210). Among the 487 responses included in the final analysis, respondents reported a moderately high intention to seek assistance, with mean of 10.31 out of 15. Overall, subjective norms (0.450, p<0.001) and attitudes (0.363, p<0.001) had a significant positive impact on their intention. The effects of subjective norms and attitudes remain significant for both female adolescents and young adult females. The effect of perceived control on intention among female adolescents (-0.400, p=0.085) was found to be significantly different than that among young adult females (0.024, p=0.831). CONCLUSION: These findings shed light on the importance of subjective norms and attitudes among young populations. Interventions can highlight the value of seeking help from pharmacists while addressing their concerns about judgment from others. Involving family and friends can be prioritized to show their support and encourage acceptance of consulting pharmacists for information.
A retrospective, matched-tool comparison of the opioid risk tool (ORT) and revised opioid risk tool (ORT-R) in community pharmacy screenings.
Ratz I, Hodges A, Strand MA
J Am Pharm Assoc (2003) · 2026 May · PMID 42142709 · Publisher ↗
BACKGROUND: The Opioid Risk Tool (ORT) was compared with the Revised Opioid Risk Tool (ORT-R) in a large community pharmacy population. The ORT-R removes the preadolescent sexual abuse (PSA) item and sex-based scoring we...
BACKGROUND: The Opioid Risk Tool (ORT) was compared with the Revised Opioid Risk Tool (ORT-R) in a large community pharmacy population. The ORT-R removes the preadolescent sexual abuse (PSA) item and sex-based scoring weights used in the original ORT. OBJECTIVES: To compare opioid risk classification between the ORT and ORT-R in community pharmacy screenings, with a focus on reclassification patterns, PSA-related sex differences, and agreement between tools. METHODS: A retrospective, matched-tool comparison was conducted among 21,295 patients screened with the ORT in community pharmacy settings. Identical patient data were rescored using the ORT-R. Descriptive analyses summarized overall distributions, reclassification patterns, and PSA-related sex differences. Because no external clinical outcomes were available, measures of predictive performance such as sensitivity and specificity could not be assessed. RESULTS: 90.7% and 93.4% of participants were classified as low risk on the ORT and ORT-R, respectively. The ORT-R produced modest shifts in classification. Approximately 6% of patients classified as moderate on the ORT were reclassified as either low or high risk on the ORT-R. Nearly 80% of women with PSA histories were reassigned under the ORT-R, reflecting the structural removal of the PSA item from scoring, compared with fewer than half of men. The factors most strongly associated with reclassification were family (OR 16.21, C.I. 13.82-19.02) or personal alcohol abuse (OR 6.04, C.I. (4.85-7.52), depression (OR4.64, C.I. 3.99-5.39), and psychiatric disease (OR 4.41, C.I. 3.63-5.36). CONCLUSION: These findings suggest potential sex-based differences associated with PSA weighting in the ORT. In the ORT, PSA contributes to scoring for women but not for men, and the item may also trigger survivors during pharmacy-based screening. The ORT-R may represent a simpler scoring approach with similar overall classification patterns, though outcome-based validation is needed.
Data accuracy of prescriptions reported to the Arkansas prescription drug monitoring program.
Embry K, Cima L, Turpin J … +3 more , Porter A, Cima M, Rahim A
J Am Pharm Assoc (2003) · 2026 May · PMID 42142708 · Publisher ↗
BACKGROUND: Prescription Drug Monitoring Programs (PDMPs) are databases for controlled substances dispensed from retail pharmacies. Although all 50 states operate their own PDMP, only a few have assessed the accuracy of...
BACKGROUND: Prescription Drug Monitoring Programs (PDMPs) are databases for controlled substances dispensed from retail pharmacies. Although all 50 states operate their own PDMP, only a few have assessed the accuracy of the data being reported, and none have formally published their results. OBJECTIVES: The objectives of this study were to determine the accuracy of prescriptions reported to the Arkansas PDMP and investigate possible associations between pharmacy characteristics and error reporting. METHODS: Between 2022 and 2023, Arkansas pharmacies (n=680) were audited to assess the accuracy of reported prescription data. Prescriptions from each pharmacy were compared to the data reported to the PDMP and assessed for errors ranging in severity from minor to severe. Data were analyzed to determine the accuracy rate of reported prescriptions. Negative binomial and logistic regression analyses were utilized to identify associations between pharmacy characteristics and the number or severity of errors reported. RESULTS: A total of 1,081 (1.9%) errors were found during prescription evaluation. Of the errors found, 369 (34.1%) were considered minor, 582 (53.8%) intermediate, and 130 (12%) were severe. Independent pharmacies were associated with reporting a higher number of errors compared to chain pharmacies (IRR:1.34, 95% CI:1.16-1.56). Pharmacies that internally reported data had higher odds of severe errors compared to pharmacies reporting externally (OR:2.69, 95% CI:1.22-5.90). Rurality of the pharmacy did not have a significant impact on error reporting. CONCLUSIONS: Overall, the study results suggest that data reported to the Arkansas PDMP are accurate, supporting the idea that PDMP data correctly represent the scheduled prescription medications being dispensed to the public. The findings indicate pharmacy characteristics that may have an impact on the number or severity of errors reported. For ongoing quality assurance, the Arkansas PDMP will continue to monitor data accuracy through quarterly audits.
Sulfamethoxazole-trimethoprim-induced Stevens-Johnson syndrome in a NAT2 slow acetylator: A case for pre-emptive pharmacogenomic screening?
Lee SY, Kok Choon RF
J Am Pharm Assoc (2003) · 2026 May · PMID 42142707 · Publisher ↗
OBJECTIVE: Severe Cutaneous Adverse Reactions (SCAR), such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), are serious complications associated with several high-risk medications and can result in...
OBJECTIVE: Severe Cutaneous Adverse Reactions (SCAR), such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), are serious complications associated with several high-risk medications and can result in significant morbidity and mortality. While HLA-mediated SCARs have been well-characterized-particularly involving drugs like carbamazepine, abacavir, and allopurinol-there is limited data on the role of N-acetyltransferase 2 (NAT2) polymorphisms in SCAR pathogenesis. CASE SUMMARY: We present a case of sulfamethoxazole-trimethoprim-(SMX-TMP)- induced SJS (Naranjo probability score: seven), hypothesized to be linked to NAT2 slow acetylator (SA) status. PRACTICE IMPLICATIONS: This case underscores the potential utility of pre-emptive pharmacogenomic screening to reduce the incidence of SCARs. NAT2 SA status has also been strongly associated with isoniazid-induced liver injury; Clinical Pharmacogenetics Implementation Consortium (CPIC) recently published a guideline that NAT2 SA predicted for hydralazine-induced systemic lupus erythematosus (SLE) and were at higher risk of side effects, suggesting broader clinical implications for routine NAT2 genotyping. Aside from G6PD testing, there is an emergent role to test for NAT2 genotype in preparation for SMX-TMP therapy. Clinically relevant NAT2 alleles include *4, *5, *6, and *7. Given that multiple single nucleotide variant (SNV) must be tested, multiplex pharmacogenomic panels may offer a more cost-effective and comprehensive approach than reactive testing. Some multiplex panels that may be employed include: GeneXpert NAT2-PGx Assay--a rapid assay targeting 5 key polymorphisms to predict isoniazid-acetylation, nanopore sequencing-based panels --a scalable targeted sequencing panel useful for NAT2 and other antitubercular genes (rifampicin, linezolid and bedaquiline), Fulgent genetics pharmacogenomics comprehensive panel, CleanPlex® pharmacogenomics kit and GenoPharm®.
Preparing Army pharmacists for the future fight: An Army pharmacy critical care short course for large-scale combat operations.
O'Brien SK, Masterson JN, Zsido DB … +1 more , Schumaker AL
J Am Pharm Assoc (2003) · 2026 May · PMID 42134467 · Publisher ↗
Large-scale combat operations (LSCO) are expected to produce prolonged care scenarios characterized by delayed evacuation, limited resources, and high patient acuity. In these environments, Army pharmacists are increasin...
Large-scale combat operations (LSCO) are expected to produce prolonged care scenarios characterized by delayed evacuation, limited resources, and high patient acuity. In these environments, Army pharmacists are increasingly relied upon to provide advanced clinical support, particularly in critical care and prolonged field care settings. However, traditional pharmacy training may not fully prepare pharmacists for these expanded roles. The aim of this article is to describe the need for an Army Pharmacy Critical Care Short Course to develop the necessary knowledge, skills, and attributes for deploying Army pharmacists to effectively and confidently support the casualties expected in the setting of prolonged care in LSCO. An Army Pharmacy Critical Care Short Course represents an important step in preparing Army pharmacists for the evolving demands of future LSCO. As future conflicts are expected to challenge traditional medical support paradigms, this course will provide a scalable and relevant training model that enhances readiness and supports the Army's goal of delivering high-quality pharmaceutical care across the continuum of combat operations.
Operational and financial implications of GLP-1 agonist reimbursement among independent community pharmacies.
Pile T, Kimble C, Manne N … +1 more , Coustasse A
J Am Pharm Assoc (2003) · 2026 May · PMID 42105864 · Publisher ↗
BACKGROUND: Independent community pharmacies report increasing exposure to high-cost glucagon-like peptide-1 (GLP-1) receptor agonists with reimbursement that may not cover acquisition costs. How pharmacies operationally...
BACKGROUND: Independent community pharmacies report increasing exposure to high-cost glucagon-like peptide-1 (GLP-1) receptor agonists with reimbursement that may not cover acquisition costs. How pharmacies operationally respond to these reimbursement pressures remains incompletely described. OBJECTIVE: The purpose of this study is to describe the frequency of self-reported below-acquisition-cost reimbursement for GLP-1 receptor agonists and to characterize reported operational adaptations and perceived effects on patient care, referral and retention practices among independent pharmacies. METHODS: An anonymous cross-sectional web survey was conducted from October 2024 to January 2025. Owners and managers of 39 independent community pharmacies in regional pharmacy organizations participated. The questionnaire was based on earlier research on below-cost reimbursement and pharmacy sustainability. It measured GLP-1 dispensing volume, reimbursement, finances, operations, and patient referral practices. RESULTS: Thirty-nine independent community pharmacies were represented. All (100%, n=39) experienced below-acquisition-cost reimbursement for GLP-1 agonists; 92.3% (n=36) said this happened often or always. Revenue losses of 5% or more from GLP-1 dispensing were noted by 82.1% (n=32). Key operational responses included limiting GLP-1 dispensing to patient-specific orders (82.1%, n=32) and reducing high-cost medication inventory (69.2%, n=27). Nearly all (97.4%, n=38) referred patients elsewhere for GLP-1 prescriptions. Sixty-five point eight percent (n=25/38) reported losing other prescription business after referrals. Common qualitative themes included cash flow strain, selective dispensing, disruption of care continuity, and threats to long-term sustainability. CONCLUSION: Independent pharmacies reported substantial operational strain associated with below-cost reimbursement for GLP-1 receptor agonists, leading to adaptive dispensing practices and perceived risks to patient retention. Findings are based on self-reported perceptions and underscore the need for future studies using objective financial and dispensing data to evaluate downstream effects on pharmacy sustainability and patient access.
Impact of pharmacist involvement on blood pressure outcomes following nurse blood pressure visits.
Ialacci R, Russo-Alvarez G, Host AB … +3 more , Hermiller T, Parker M, Kish K
J Am Pharm Assoc (2003) · 2026 May · PMID 42105863 · Publisher ↗
BACKGROUND: Hypertension is a major modifiable risk factor for cardiovascular (CV) disease. National hypertension guidelines recommend a blood pressure (BP) goal of < 130/80 mmHg to reduce CV risk. Existing literature ha...
BACKGROUND: Hypertension is a major modifiable risk factor for cardiovascular (CV) disease. National hypertension guidelines recommend a blood pressure (BP) goal of < 130/80 mmHg to reduce CV risk. Existing literature has demonstrated that pharmacist involvement in BP management contributes to positive outcomes. Continuing to expand workflows that incorporate pharmacists in an efficient manner would be beneficial. OBJECTIVE: To evaluate the impact of a modified workflow related to pharmacist involvement in nurse BP visits. PRACTICE DESCRIPTION: Usual workflow consisted of provider review of patient chart after the nurse BP visit and provider plan development. PRACTICE INNOVATION: In this modified workflow, the patient chart from the nurse BP visit was routed to a pharmacist if the BP was elevated. After chart review, the pharmacist would provide recommendations to the provider for review and approval. EVALUATION METHODS: This was a retrospective, pre-post intervention study that took place at multiple primary care sites. The population included adults 18 to 79 years old with a baseline systolic blood pressure (SBP) 131 to 179 mmHg or diastolic blood pressure (DBP) 81 to 109 mmHg. RESULTS: The absolute difference in BP from the initial nurse visit to the first primary care follow-up visit was 8.1 mmHg (95% CI 4.8-11.3; p value < 0.001) for SBP and 4.7 mmHg (95% CI 3.0-6.5; p value < 0.001) for DBP. Over half of the patients (53.4%) achieved BP of < 140/90 mmHg at the first primary care follow-up visit. There were a total of 143 pharmacist interventions, most often consisting of medication dose increases, medication initiations, and/or lab orders. CONCLUSION: This workflow demonstrated that pharmacist interventions within the nurse BP workflow can contribute to improvement in BP without requiring a comprehensive pharmacist visit.
Arizona pharmacists' perspectives on prescribing hormonal contraception.
Peluso A, Stoner G, Xiang J … +3 more , El-Ibiary SY, Raney EC, Ashcraft AM
J Am Pharm Assoc (2003) · 2026 May · PMID 42105862 · Publisher ↗
BACKGROUND: Unintended pregnancy remains a significant public health challenge in the United States. In 2021, Arizona passed Senate Bill 1082 authorizing pharmacists to prescribe self-administered hormonal contraceptives...
BACKGROUND: Unintended pregnancy remains a significant public health challenge in the United States. In 2021, Arizona passed Senate Bill 1082 authorizing pharmacists to prescribe self-administered hormonal contraceptives, including oral contraceptive pills, the transdermal patch, and the vaginal ring. Successful implementation of such policies depends on pharmacists' willingness and ability to provide these services. OBJECTIVES: The objectives of this study were to understand Arizona pharmacists' perceived benefits and barriers of providing direct pharmacy access to self-administered hormonal contraception, and to gauge their interest in receiving training on prescribing contraception at their practice. METHODS: We conducted a cross-sectional survey of licensed Arizona pharmacists (n=7,972) in June 2022 through the Arizona Board of Pharmacy's electronic listserv. The survey assessed awareness of Senate Bill 1082, interest in prescribing and receiving training, and perceived benefits and barriers to providing contraceptive services. Chi-square analyses evaluated associations between demographic and practice characteristics and interest in prescribing. RESULTS: The study sample included 295 pharmacists (response rate 3.7%). A majority were aware of Senate Bill 1082 (61.9%) and expressed interest in prescribing hormonal contraception (57.2%), though only 40.3% agreed prescribing was currently feasible in their practice. Female pharmacists showed significantly greater interest than male pharmacists (62.5% vs. 47.6%, p=0.02). Top perceived benefits included increased contraceptive access (90.2%), reduction of unintended pregnancy (90.6%), and expanded scope of practice (84.4%). Top barriers were shortage of pharmacy technician staff (86.4%), liability concerns (88.7%), and lack of reimbursement (87.8%). CONCLUSION: Arizona pharmacists recognize the potential for pharmacist-prescribed hormonal contraception to improve access and reduce unintended pregnancy. However, substantial implementation barriers exist, particularly workforce shortages, liability concerns, and lack of reimbursement. Addressing systemic challenges through workforce development, clear liability guidance, and payment reform will be essential to translating legislative authorization into meaningful patient access.
The Architecture of Access.
Rife-Pennington T
J Am Pharm Assoc (2003) · 2026 May · PMID 42103016 · Publisher ↗
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