Pharmacists Take the Lead in GLP-1 Optimization as Demand Accelerates

As glucagon-like peptide-1 (GLP-1) receptor agonists and other cardiometabolic therapies surge in use, pharmacists are emerging as key drivers of safe, effective implementation. In a panel discussion, clinical leaders described how pharmacists are managing complex titration schedules, navigating insurance and access barriers, providing essential patient education, and coordinating care across nutrition, chronic disease monitoring, and population health. Their message is clear: Optimizing these therapies requires a team, and pharmacists are at the center of it.

Olivia Hanson, Member Strategy Specialist, ACC: We touched on this earlier, but how are pharmacists helping drive cardiometabolic optimization as use of GLP-1 receptor agonists and SGLT2 inhibitors expands?

Kristen Campbell, PharmD, BCPS, CPP, FACC: This is really Craig’s area, but having pharmacists manage titrations, ensure financial access, and make sure patients actually receive the medication—those are all things within our niche. In an ideal world, we’d have more time for it, although I know for a fact Glenn is really busy.

Craig Beavers, PharmD, FCCP, BCPS-AQ Cardiology: To your point, GLP-1s involve a lot of titration. It’s an intensive schedule every 4 weeks, and many providers, instead of clogging their office schedules, send patients to pharmacists to manage it and help ensure success. We’re also identifying patients who are falling through the cracks and looking at population health strategies. Glenn, would you add something?

Glenn Herrington, PharmD, FACC, FHFSA, BCCP, CPP, HFCert: Yes. It used to be the SGLT2 inhibitors, but I think we’ve all figured those out. With GLP-1s, there’s still a lot of hands-on titration. In my practice, pharmacists are really the quarterbacks. Our physicians and APPs [advanced practice providers] identify appropriate patients, but they refer them to us because we have those frequent touchpoints. We provide patient education, help them manage blood [glucose] and blood pressure, and sometimes stop medications—which isn’t a bad thing. And it’s not just medications: We connect them with nutritionists, dietitians, and others managing the big picture. It’s bigger than what pharmacists can manage alone, but we know how to get patients set up with the resources they need.

Hanson: With that in mind, what does effective patient counseling look like for these therapies today?

Herrington: My role with GLP-1s and CKM [cardiovascular-kidney-metabolic] is half clinical and half logistical. We provide patient education and teach them how to monitor themselves for safety. But we also make sure documentation is correct. Are we prescribing a medication covered by their insurance? And if it’s covered but still costs $1000 a month, that won’t work. So we navigate that. In the first patient encounter, we set expectations so they understand the plan. It might not be Plan A—it might be Plan B or C—but we’re working through it together, and that approach has been successful.

Campbell: Another big point is nutrition. If you’re starting a GLP-1, you need to maximize protein to maintain muscle, and it’s important to stay active. Monitoring blood pressure and glucose is also critical because if the GLP-1 is successful and patients lose weight, their medication requirements will likely go down. You want to be ahead of that, not catching up.

Hanson: How are pharmacists navigating coverage limitations, prior authorizations, and supply constraints while aligning care with current evidence?

Beavers: We’ve alluded to this. Pharmacists doing titrations are working closely with medication technicians or teams who handle access issues. The specialty pharmacy model has really developed processes for benefits investigations and determining whether injectables fall under the medical or pharmacy benefit. Pharmacists help lead much of that work, and it’s a great role for us.

Campbell: It’s also a huge opportunity for pharmacy technicians or medication technicians—whichever term you use. They’re not what you think of as a “normal tech.” They can do a lot for patients, and we advocate for more of those positions. These processes take time, and keeping up with the paperwork for prior authorizations alone is a lot. It’s a great role and opportunity for technicians to expand.

Herrington: I’ll add: If you’re the pharmacist doing PAs every day, you need to leverage support like pharmacy technicians. Pharmacists need to understand the logistics, but we should all be practicing at the top of our license. Use pharmacy technicians, specialty pharmacy, hospital pharmacy—whoever can help you navigate barriers. And when you’re in clinic, being the face of the plan and getting the patient on board is very important.

Campbell: And it’s important to educate hospital administrators—like Craig—that it’s not just 1 person. You need multiple people.