The Pharmacist’s Expanding, Indispensable Role in Optimizing GLP-1 Management and Patient Outcomes

Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) are rapidly changing the landscape of diabetes care, moving beyond glycemic control to broader organ protection. Pharmacists play a crucial role in patient education, managing adverse effects (AEs), addressing insurance challenges, and integrating these therapies into diverse clinical settings.

At a recent Pharmacy Times Clinical Forum based in Seattle, Washington, pharmacists and other health care professionals shared their insights and experiences on optimizing GLP-1 RA use. They also highlighted the importance of addressing mental health and nutritional support with GLP-1 therapy, emphasizing a holistic, patient-centered approach.¹

“We have a lot of diverse backgrounds and practices here today. I think it’s going to be a very robust discussion about GLP-1s and how pharmacy can promote optimized use of these therapies to improve outcomes,” moderator Joshua Neumiller, PharmD, CDCES, FADCES, FASCP, professor of pharmacotherapy at Washington State University, said during the Clinical Forum.¹

How Has the Treatment Landscape of GLP-1s Evolved?

Since their initial FDA approval in 2005, the role of GLP-1s for the treatment of type 2 diabetes (T2D) has evolved, offering additional treatment for overweight and obesity. GLP-1s are most often administered subcutaneously, aiding in lowering blood glucose levels and promoting weight loss; however, a newer class of oral formulations is available.¹

Commonly used GLP-1s include semaglutide injection (Ozempic; Wegovy and Novo Nordisk), semaglutide tablets (Rybelsus; Novo Nordisk), dulaglutide (Trulicity; Eli Lilly and Company), liraglutide (Victoza; Novo Nordisk), and a GLP-1/glucose-dependent insulinotropic polypeptide RA known as tirzepatide (Mounjaro; Eli Lilly and Company). It is important to note that GLP-1s alone cannot treat type 2 diabetes (T2D) or obesity, as both conditions also require lifestyle and dietary changes to maintain weight-loss effects.²

“It’s fairly obvious, but the weight loss is a unique part of GLP-1s. Sodium-glucose cotransporter-2 inhibitors have modest weight loss, but GLP-1s are unique in that class,” Nathan Ramsbacher, PharmD, ambulatory care pharmacist at MultiCare Health System, said during the discussion.¹

The American Diabetes Association Standards of Care reflect a phenomenal footprint for GLP-1s, according to Neumiller, covering glucose lowering, weight benefit, and organ protection for atherosclerotic cardiovascular disease and metabolic dysfunction–associated steatotic liver disease or obesity.¹

Results from various clinical trials, such as SUSTAIN (NCT02054897, semaglutide) and SURPASS (NCT04255433, tirzepatide), have demonstrated significant clinical benefits, including positive effects in combination with background treatments. Additionally, the SOUL trial (NCT03914326) demonstrated cardiovascular benefits with oral semaglutide, and the FLOW trial (NCT03819153) found a 24% relative risk reduction in major kidney disease events in T2D with chronic kidney disease.¹

“Coverage is always a challenge, but we’ve really seen how these medications can help reduce insulin requirements and really optimize diabetes management for a lot of people that don’t have [T2D] and have other forms of diabetes,” Faaiza Alibhai, PharmD, a clinical pharmacist at University of Washington School of Medicine, said during the clinical forum.¹

What Is the Pharmacist’s Role in GLP-1 RA Management?

Differentiating Among Products

As more GLP-1 products become available and the market grows, pharmacists can guide choices between injectables (eg, Ozempic) and orals (eg, Rybelsus) based on patient preference, potency, and tolerability. However, Ramsbacher noted that in his practice, subcutaneous is often preferred due to its 100% bioavailability and strong data, whereas oral semaglutide is a valuable option for needle-hesitant patients, but it is generally less potent for weight loss.¹

Notably, Rybelsus requires specific timing relative to meals and other medications. It should be taken on an empty stomach first thing in the morning and requires a 30-minute wait before consuming any food, drink, or other oral medications. Ramsbacher said pharmacists can provide counseling on the administration of oral GLP-1s to make sure patients take them correctly.¹

“I would say if [the patient] is super hesitant to the injectables, I’d bring up Rybelsus, the oral semaglutide, but then say that the weight loss is not as important as the injectables. Have your pick.” Vivian Cheng, PharmD, BCPS, BCACP, ambulatory care clinical pharmacist at Valley Medical Center, said in the discussion.¹

Abby Winter, PharmD, CDCES, associate professor at the University of Washington School of Pharmacy, noted that oral GLP-1s are not typically her first recommendation, but she will offer them to patients who prefer an oral tablet. “I feel like I always held that way far back in my arsenal. It didn’t even come up until we tried an injection because I think they get their hopes up. They have the expectation [that weight loss effects are] going to be the same as they see in the media and like their friend had, and it’s not.”¹

Although semaglutide injectables may be health care providers’ first choice, Charles Gregor Derupe, PharmD, clinical pharmacist with Virginia Mason Medical Center, shared that oral semaglutide will help silence “food noise” and limit weight gain without worrying about a weekly injection, noting that it depends on what the patients’ priorities and values are.¹

Navigating Access

Pharmacists also play an essential role in identifying subpopulations and screening for patients who benefit from GLP-1s the most, including those with high insulin resistance or type 1 diabetes with significant insulin resistance, or those in assisted living with caregiver support.

“There is a time and a place for these medicines where they can be incredibly beneficial, and I think there’s also a possibility for them to cause a lot of potential harm in certain cases,” Winter said.¹

Ramsbacher has a similar outlook. “I’ve had so many people come to me, and they’re like, ‘I’ve seen this medication advertised for weight loss, and I’m interested,’ and they’re appearing not to be overweight,” he said.¹

Once an individual is identified as a proper candidate for treatment with a GLP-1 RA, pharmacists are crucial in assisting with coverage and navigating the prior authorization (PA) process, specifically by leveraging knowledge of formularies and specific payer requirements. Alibhai noted that the University of Washington provides access to the retail pharmacy system, allowing the pharmacists to run test claims to determine coverage and patients’ out-of-pocket costs. There are also teams that assist with PA paperwork, which is known to be burdensome for many practices.¹

However, the pharmacist’s role is not complete after a PA is approved for a GLP-1 and a patient begins treatment. Often, pharmacists can offer personalized titration by adjusting dosing schedules and titration rates based on individual patient tolerability, even if it means staying on a lower dose longer than standard guidelines. Pharmacists can also counsel patients whose dosage was changed, informing them that symptoms might temporarily return when the dosage is adjusted.¹

“I always say if you have [AEs], as long as it’s tolerable and it’s not completely disrupting your lifestyle, push through it at least for a week or two, and then usually it will dissipate on its own,” Derupe shared.¹

Conclusion

As GLP-1 RAs evolve, semaglutide stands out as a highly effective and increasingly prominent option, demonstrating its tolerability across glycemic control, weight loss, organ protection, and practical use. Pharmacists are indispensable in managing GLP-1 therapies, contributing to direct patient care and education, enhancing adherence, and facilitating access while integrating a multidisciplinary approach.¹

REFERENCES

1. Neumiller J, Cheng V, Winter A, et al. Diabetes clinical forum. Presented at: Pharmacy Times Clinical Forum; June 30, 2025; Seattle, WA.

2. GLP-1 agonists. Cleveland Clinic. Updated July 3, 2023. Accessed August 13, 2025. https://my.clevelandclinic.org/health/treatments/13901-glp-1agonists