Advancing Pharmacy Practice: Innovative Approaches to Chronic Disease Management and Financial Sustainability in Health Care

As health care evolves, innovative strategies continue to emerge to address chronic conditions, enhance medication access, and manage operational challenges in pharmacy settings. Heart failure (HF), diabetes, and performance-based reimbursement models each present unique complexities in care delivery and financial sustainability.

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HF affects an estimated 6.7 million Americans over the age of 20, with projections reaching 8.7 million by 2030. In the cover feature on page 8, we look at studies that show that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can aid in weight loss and cardiovascular benefits, which could reduce HF risk, particularly for patients with HF with preserved ejection fraction (HFpEF), which is often associated with obesity. Clinical trials like SELECT (NCT03574597) and STEP-HFpEF (NCT04788511) indicate GLP-1 RAs such as semaglutide (Ozempic, Wegovy; Novo Nordisk) significantly improve HF symptoms, exercise capacity, and weight loss outcomes.

In the peer-reviewed case description on page 10, authors Nazia Somani Babul, PharmD, BCACP; Christine Hong, PharmD candidate; John Garofalo, PharmD; Gabrielle Pierce, PharmD, MBA; and Samantha Bagnola, PharmD, explore a protocol that enables pharmacists at University of Illinois Hospital outpatient pharmacies to initiate and adjust prescriptions for diabetes management supplies, such as insulin syringes and glucose monitors, without prescriber intervention. Expanding such protocols could improve timely access to diabetes supplies and reduce workflow delays for both pharmacists and prescribers.

In the peer-reviewed case description on page 15, authors Alexander Swick, PharmD, MBA; Omar Hajmousa, PharmD; and Mahmoud Abdel-Rasoul, MS, MPH, discuss a quality improvement initiative at Nationwide Children’s Hospital outpatient pharmacies to improve performance scores and reduce direct and indirect remuneration (DIR) fees. Ultimately, the initiative highlighted challenges with the pay-for-performance model and the lack of transparency in DIR fee calculations, reinforcing the financial strain DIR fees place on pharmacies.

These case descriptions illustrate the transformative potential of pharmacy-led initiatives in addressing chronic disease management and operational challenges in health care. By expanding the role of pharmacists in managing diabetes supplies and exploring the efficacy of GLP-1 RAs in HF treatment, health care systems can make meaningful strides toward improving patient outcomes. Additionally, the analysis of DIR fees highlights the urgent need for transparent reimbursement practices to support financial sustainability in pharmacy operations. Together, these insights reinforce the importance of innovative strategies and collaborative efforts in advancing pharmacy practice to meet evolving patient care demands.