In an interview with Pharmacy Times, Tim Pflederer, MD, chief medical officer for Evergreen Nephrology, discussed the pharmacist's role in optimizing sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist therapy for patients with chronic kidney disease (CKD) and what it will take to get more eligible patients on guideline-directed care.
Key Takeaways
- Pharmacists carry out 3 separate jobs here—education on purpose and adverse events, identifying an affordable, covered, tolerable agent among many options, and ongoing dose and therapy adjustment with the provider.
- Prior authorization, adherence checks, and adverse event management fall outside the 15-minute visit entirely. Pflederer identifies the absence of a team — not prescriber reluctance — as the binding constraint on uptake.
- At Evergreen Nephrology, pharmacists work alongside care managers, dietitians, nephrologists, and primary care physicians. Pflederer frames this as what value-based care uniquely enables in the US health care system.
Pflederer was direct: pharmacists are critical for these medications. He identified 3 contributions. The first is education: the benefits of the drug, its purpose, and the adverse events to watch for. The second is cost and access. These medications are expensive, and with multiple options across both classes, a pharmacist is often the person who identifies the agent a patient can afford, that their insurance covers, and that they will tolerate. The third is ongoing adjustment: recommending changes and working with the provider to modify therapy based on response and symptoms.
All 3 serve one goal, in his framing: making sure the patient gets the medication, takes it, and stays on it long enough to see reduced kidney disease progression, fewer cardiovascular events, and lower mortality.
Asked about the biggest opportunity to improve uptake, Pflederer pointed to team infrastructure rather than prescriber behavior. These medications, he said, cannot be delivered by a provider in a 15-minute office visit writing a prescription and sending the patient off. They require patient education, prior authorization to secure coverage, and continuing communication to confirm the patient is taking the drug and not experiencing side effects. That supportive care demands a team: provider, pharmacist, nurse navigator, or care manager. He reported growing success as those systems develop.
He closed by connecting this to the payment model. Value-based care, he said, is at its core team-based care. At Evergreen Nephrology, pharmacists, care managers, and dietitians work alongside nephrologists and primary care physicians throughout the patient's journey—not only at the office visit.
