Pharmacists Can Help Overcome Therapeutic Inertia in CKM Care

In an interview with Pharmacy Times, Joshua J. Neumiller, PharmD, CDCES, senior vice president of medical affairs at the American Diabetes Association, discussed his American Society of Nephrology Kidney Week 2026 presentations on the role of clinical pharmacists in multidisciplinary care for diabetes and chronic kidney disease (CKD) and on battling therapeutic inertia to improve implementation of cardiovascular-kidney-metabolic (CKM) therapies in patients with kidney diseases.

Neumiller said people living with diabetes and CKD often have multiple comorbidities and complex care needs and often see multiple providers. Effective care teams, he said, communicate well and coordinate multidisciplinary members to address those needs.

Clinical pharmacists can strengthen care by optimizing guideline-directed medical therapy (GDMT), addressing medication access barriers, providing longitudinal self-management and risk mitigation education, resolving medication therapy problems, and facilitating care coordination.

Neumiller described therapeutic inertia as stemming from 3 groups of factors:

• clinician-related, such as limited time and complex guidelines;
• person-related, such as cost, limited education, and polypharmacy; and
• health system-related, such as formulary barriers and fragmented care.

Pharmacist-based interventions can address many of these barriers, he said. Despite major advances in CKM care, many people who could benefit from these therapies do not receive them, so pharmacists should proactively identify candidates for GDMT initiation and optimization.

Pharmacy Times: What does an effective care team look like for patients with diabetes and CKD?

Joshua J. Neumiller, PharmD, CDCES: People living with diabetes and CKD often live with multiple additional comorbidities and have complex care needs. Additionally, these individuals often receive care from multiple primary and specialty care providers, which requires care coordination for optimal outcomes. Effective care teams are those that communicate effectively and incorporate members of the multidisciplinary care team to comprehensively address their unique care needs in a coordinated fashion.

Pharmacy Times: How can clinical pharmacists strengthen care for patients with diabetic kidney disease?

Neumiller: Many professional organizations and evidence-based treatment guidelines highlight the important role clinical pharmacists can play within the multidisciplinary care team to improve care and outcomes for people living with diabetes and CKD. Clinical pharmacists can address multiple barriers to optimized care in this population. Examples include optimizing use of GDMT, addressing barriers to medication access, providing longitudinal education on self-management and risk mitigation, identifying and resolving medication therapy problems, and helping facilitate care coordination.

Pharmacy Times: What’s driving therapeutic inertia with CKM therapies in patients with kidney disease?

Neumiller: Multiple factors contribute to therapeutic inertia and suboptimal use of GDMT in people with kidney disease. Such factors are often categorized as clinician-related, person-related, and health system-related factors. Clinician-related factors may include lack of clinician time, incorporating complex clinical guidelines into practice, and resource limitations to effectively initiate and titrate GDMT. Person-related factors can include cost-related barriers, lack of education on the importance of GDMT, and challenges related to polypharmacy. Health system-related factors can include formulary barriers and fragmented care. Pharmacist-based interventions can address many of these barriers.

Pharmacy Times: What practical strategies help pharmacists overcome that inertia in everyday practice?

Neumiller: A key action pharmacists can take to proactively address therapeutic inertia in people with CKM conditions is taking an active role in identifying patients who can benefit from initiation and optimization of GDMT. While we have seen incredible advances in the standard of care for patients with CKM, many of the people who could benefit from these therapies do not receive them.