The Diabetes Care guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1RA) as second line therapy in the setting of established atherosclerotic cardiovascular disease (ASCVD) and sodium glucose cotransporter 2 inhibitors (SGLT2i) as second line in the presence of chronic kidney disease or heart failure (HF). Formularies are often restrictive of these classes of medications and most require prior authorization (PA), which is a barrier to initiation of therapy. A pharmacist (PharmD) in the ambulatory setting is in an optimal position to navigate insurance formulary and medication cost issues. In addition, with knowledge of evidence-based medicine, a PharmD can provide the justification needed for a medication that adheres to guideline recommendations regardless of formulary status. This retrospective review evaluates if the PharmD in Endocrinology (Endo) clinic improved HbA1c through resolution of medication access problems allowing for initiation of guideline-based therapies. The PharmD documented on 190 patients with T2DM from 11/2018 to 11/2019. Average time managed by Endo was 1.4 years (median 9.4 months) and 38% of patients were previously prescribed or established on SGLT2 or GLP-1RA therapy for an average of 1.4 years (median 11.5 months). The majority of patients had Medicare or Medicaid plans (73%). ASCVD or HF was present in 30% of patients. HbA1c was <7% in 17.8% of patients. The PharmD assisted with initiation of GLP-1RA or SGLT2 for 74% of the patients through test claims, education, prior authorizations and appeal letters. Of the patients with CV disease, 79% (45/57) were prescribed one of the agents with proven CV benefits with the help of the PharmD. Average HbA1c prior to PharmD was 8.9% and average most recent HbA1c was 8.05% (-0.85, p<0.05). Time between HbA1c values was an average of 5.4 months. Most recent HbA1c was <7% in 36% of patients. The PharmD contributed to a significant HbA1c change through navigation of formulary requirements combined with knowledge of clinical evidence.


M. Allison: None.

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