ADA 2026: Pharmacist Impact, VA System Insights, and Practical Lessons in Cardio-Renal Diabetes Care

Pharmacy Times interviews Tracey Taveira, Pharm.D., CDOE, CVDOE, to discuss pharmacist impact, VA system insights and practical lessons in cardio-renal diabetes care that she discussed in her presentation at ADA 2026.

Taveira described her greatest impact as a clinical pharmacist practitioner as centering on medication optimization, which naturally extends into patient education and interdisciplinary care coordination. She emphasized that patients with diabetes and cardiometabolic disease often qualify for multiple evidence-based therapies due to overlapping conditions such as cardiovascular disease, heart failure, chronic kidney disease, and obesity. A major barrier in practice, she noted, is therapeutic inertia—where eligible patients are not started on appropriate therapies or are not titrated to the target doses demonstrated in clinical trials. From her perspective, pharmacists are uniquely positioned to identify these gaps in guideline-directed therapy, close them through proactive intervention, and support long-term medication adherence.

Taveira also reflected on her experience practicing within the VA system, clarifying that her views are personal and not representative of the Department of Veterans Affairs. She highlighted the VA’s system-wide commitment to evidence-based, value-driven care as a major advantage in optimizing cardiometabolic treatment. Unlike fee-for-service environments, the VA allows clinicians to focus less on insurance coverage uncertainty and more on selecting the most appropriate therapy based on clinical evidence. Clear formulary pathways and established criteria support access to medications when clinical need is demonstrated, even if a drug is non-formulary. This structure reduces delays, minimizes administrative burden, and helps clinicians more efficiently initiate and intensify therapy in alignment with national guidelines.

In contrast, Taveira noted that commercial insurance environments often introduce variability and opacity in coverage criteria, leading to delays, appeals, and increased therapeutic inertia. This can hinder timely initiation of optimal therapy. She emphasized that the VA model allows pharmacists to devote more time to clinical decision-making and patient education rather than navigating payer restrictions.

Key takeaways from the case included the importance of treating patients holistically rather than focusing on isolated risk factors, recognizing and addressing therapeutic inertia, and acknowledging the broader influence of lifestyle and social determinants of health. Taveira stressed that sustainable improvements require coordinated, team-based care and leveraging the full scope of practice of all clinicians. Empowering pharmacists to practice at the top of their license through collaborative care models can expand access, improve medication optimization, and ultimately enhance cardio-renal-metabolic outcomes for high-risk patients.