As Told By a Pharmacist

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  • “New year, New Me!” – Wegovy 

    “New year, New Me!” – Wegovy 

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    On December 22, 2025, Novo Nordisk shocked the world with breaking news: Wegovy (semaglutide) was FDA-approved in an oral formulation at a dosage of 25mg for weight loss management. Indeed, semaglutide has long existed in an oral formulation as Rybelsus (an FDA approved medication for Type 2 Diabetes and Cardiovascular Risk Reduction dose in 7mg or 14mg). The important distinction is that the approval for the higher dosage, oral formulation is for weight management and to reduce the risk of cardiovascular events in obese individuals with heart disease.

    Who isn’t it for?

    As with all medications, there are some exemptions to therapy that include: individuals with Multiple Endocrine Neoplasia Type 2 (MEN2), or a personal or family history of Medullary Thyroid Cancer (MTC) or any allergies to the ingredients of Wegovy. Importantly, oral Wegovy should not be used concomitantly with any other GLP-1 agonists.

    OASIS Trials

    The OASIS trial was a 72 week trial used to determine the efficacy of oral Semaglutide 25mg for weight management. Week 1 was used to screen the participants, 64 weeks consisted of treatment, and the remaining 7 weeks were used for observation and follow up. Participants were randomly assigned either oral semaglutide or a placebo at a 2:1 ratio. The medications were dosed once a day in addition to lifestyle modifications.[1] The 64-week treatment for the Semaglutide group was conducted in a titrated fashion: 3mg once a day for 4 weeks; 7mg daily for 3 weeks; 14 mg for the next 4 weeks; then the target dose of 25mg once a day for the remaining 51 weeks of treatment.[2] The placebo group also received matching tablets for the same duration.  

    The estimated average change in body weight for the semaglutide group was 13.6%, and just 2.2% in the placebo group.[3] The change of Impact of Weight on Quality of life (IWQOL) is a self-reported questionnaire used to assess the impact of one’s weight on their functionality and quality of life. The IWQOL Physical function score was significantly higher in the semaglutide group (55.3.% versus the placebo group 34.8%). These findings are associated with a clinically significant improvement in quality of life and physical function.

    How Will This Affect Consumers?

    Novo Nordisk plans on rolling out the oral pill in January 5, 2026. That’s right, within days! This new formulation of such a highly sought out drug will provide consumers with a more convenient option to reach their weight loss goals and may potentially alleviate some demand for the injectable version. With commercial insurance plans, the projected cost would be $25 per one (1) month supply.[4] The Wegovy website offers self-pay plans for the initial, 1.5mg and 4mg dosages starting at $149 per month until April 15, 2026, then increasing to $199 per month. The self-pay offer for a 1-month supply of 9mg and 25mg (target/maintenance dose) would cost $299.

    [1] https://www.nejm.org/doi/full/10.1056/NEJMoa2500969

    [2] https://clinicaltrials.gov/study/NCT05564117

    [3] https://www.nejm.org/doi/full/10.1056/NEJMoa2500969

    [4] https://www.wegovy.com/about-wegovy/the-wegovy-pill.html

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  • Hypertension Guidelines Updated–Key Takeaways!

    Hypertension Guidelines Updated–Key Takeaways!

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    The American Heart Association (AHA) has spent the last eight years revamping the 2017 Hypertension Guidelines, and it shows. There have been a notable number of new recommendations and improvements with an emphasis on prevention and lifestyle modifications. The AHA has also shifted to a more collaborative treatment approach, including nuanced guidance to navigate this multifaceted disease state that burdens nearly half of adult Americans.[1]

    A New Method to Predicting the Probability of a Cardiovascular Event 

    Predicting risk of Cardiovascular (CVD) Events (PREVENT) replaces the Pooled Cohort Equations, a tool formerly used to calculate the 10-year risk of having a CVD event. PREVENT is the first of its kind that utilizes kidney, metabolic and socioeconomic factors to determine a more inclusive score. PREVENT predicts the 10- and 30-year risk for CVD events, including heart failure and Atherosclerotic CVD.[2]  Studies have shown underestimation among certain demographics, which have led to missed opportunities to intervene and begin treatment. Although in need of more fine tuning, by shifting to a more inclusive approach, PREVENT can provide a more complete baseline and improve patient outcomes. 

    Categorization of Hypertension Stages

    Historically, Prehypertension was defined as a systolic reading between 120-129 mm Hg and a diastolic reading of less than 80 mm Hg.[3] The new guidelines reclassified this simply as Hypertension or high blood pressure (BP), removing pre-hypertension all together, and prompting drug therapy initiation if the 10-year cardiovascular risk (defined by PREVENT score) is greater than, or equal to 7.5%. Hypertensive urgency is now a dated term, and is simply “hypertensive emergency”, a reading greater than180/120 mm Hg. 

    What About the Drug Therapy options?

    Same drug classes—different execution. In 2025, the AHA shifted from race-based therapy recommendations to an individualized approach. Previously, for African Americans, initial treatment options were either thiazide diuretics, or calcium channel blockers not an angiotension Enzyme Inhibitors or angiotension Receptor Blockers. Comparatively, in other demographics, all four drug classes were considered. Despite the AHA’s previous recommendations, it did not yield favorable outcomes; for example, from 2017-2020, the control rate of high blood pressure in African Americans was 18% worse than their counterparts.[4] The riddance of race-based blood pressure recommendations will hopefully encourage practitioners to create more individualized treatment plans.

    How Have the Therapy Recommendations Evolved?

    The new guidelines have introduced initiating two drugs when the patient has systolic 2 consecutive systolic readings of 130mm Hg instead of 140mm Hg (per 2017 guidelines). Fifty-percent of patients are non-adherent to their blood pressure medications one year after therapy initiation, so introducing two drugs may exacerbate this problem. What’s more, from a provider perspective, it would be difficult to pinpoint which side effect profile corresponds to which medication, thus further complicating dosage titrations. A solution to reducing pill burden would be combination products, which the guidelines encourage. However, due to the ever-changing healthcare landscape of prior authorizations and insurance formulary changes, combination medications may not be accessible for many.

    The Correlation Between High BP and Dementia: How in the World is Dementia Related to BP?

    Midlife high blood pressure is the leading risk factor for white matter abnormalities in the brain, which are markers related to cognitive decline and dementia. In the previous 2017 guidelines, there were hypotheses that controlling systolic BP may reduce the occurrence of certain types of dementia. Since then, those theories have been confirmed with various studies, and current guidance is that reaching a target goal of 130mm Hg/80mm Hg can prevent cognitive impairment. 

    More Stringent Blood Pressure Goals in Pregnancy

    Due to growing evidence that elevated BP can complicate pregnancy pre- and post-delivery, the new guidelines lowered the BP goal to 130mm Hg over 80mm Hg. The guidelines further recommend individuals that already have high blood pressure and are planning to become pregnant should be counseled on the use of aspirin to prevent preeclampsia. 

    [1] https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/index.html

    [2] https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

    [3] https://www.ahajournals.org/doi/10.1161/cir.0000000000000678

    [4] https://minorityhealth.hhs.gov/heart-disease-and-blackafrican-americans

    2 responses to “Hypertension Guidelines Updated–Key Takeaways!”

    1. Walt Avatar
      Walt

      very important article! Thanks for the info!

      Liked by 1 person

      Reply
      1. Delphine Adams Avatar
        Delphine Adams

        Thank you for reading!

        Like

        Reply

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  • The True Cost of Vaccine Hesitancy

    The True Cost of Vaccine Hesitancy

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    One of the greatest threats to public health is not another virus—it’s doubt. Vaccine hesitancy is quickly becoming a threat to global health. Pre-pandemic levels, for childhood vaccinations for Measles Mumps Rubella (MMR), Polio, DTaP (diphtheria and whooping cough), were 95% which is high enough to generate Herd Immunity (a.k.a. community immunity). This is when a significant percentage of a population is immune to a disease, making it very difficult to spread. This is the only surefire way to eradicate diseases (e.g Smallpox, which was globally eradicated in 1980).  

    Herd immunity is especially important when it comes to young children. Because it takes roughly 7-8 years for a child’s immune system to fully develop, young children are vulnerable to contracting illnesses and succumbing to them as they do not yet have strong enough immunological defenses to fight them. Vaccines also aid in strengthening young immune systems by teaching them how to recognize and defend against germs and antigens. More importantly, children that are immunocompromised, have chronic illnesses, or have allergies to specific components of vaccines are relying on Herd Immunity from their classmates to live healthy lives since they may not be able to get vaccinated. 

    In the previous school year (2024-2025), vaccine rates for DtaP, MMR and Polio dropped to 92.1%, and 92.5% respectively.1 Though these figures do not seem like a huge decrease from the previous ~95%, this trend is notable because herd immunity may be a thing of the past as we continue to move forward. By way of example, approximately 286,000 kindergartners were present at school without having documentation showing they were vaccinated against MMR. 

    In the 2023-2024 school year, the rate of exemptions from vaccines was 3.3%;2 however, last year, we saw a national increase in the percentage of exemptions to 3.6%, and 17 states reported exemptions over 5%!

    What does this actually mean? According to the CDC, as of September 23, 2025, there have been 1,514 confirmed measles cases, and 40 total outbreaks thus far. The largest demographic accounting for those cases at 39% were (you guessed it), those aged 5-19 years old. 

    Is measles really that bad? Measles is a highly contagious, airborne disease that presents as cough, fever, runny nose and a characteristic rash. In the wake of COVID, flu, and several bugs, it may be difficult for someone to deduce measles as the culprit, especially without the triage of a healthcare provider. It can also lead to several complications such as pneumonia, other infections, permanent brain damage which in turn can lead to fatal brain disease, long-term and permanent damages, or death.3 Before a measles vaccine was introduced in 1963, the majority of children were exposed and infected, and unfortunately around 400 of the annual, measles-related deaths were children.4

    In short, if we do not address vaccine hesitancy, we are putting some of our most vulnerable populations at risk, and taking a dangerous step backwards as a society. 

    Healthcare providers: this is your opportunity to combat the ever-growing misinformation that has been infiltrating our media outlets. This is a call to action to provide evidence-based recommendations, and advocate for public health by educating your patients. 

    Parents and caregivers: I urge you to consider the source of your health care information, and gather insights from reputable sources before making impactful decisions.

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    1. Centers for Disease Control and Prevention. (2025, July 31). Vaccination Coverage and Exemptions among Kindergartners — SchoolVaxView. https://www.cdc.gov/schoolvaxview/data/index.html ↩︎
    2. Centers for Disease Control and Prevention. (2025, July 31). Vaccination Coverage and Exemptions among Kindergartners — SchoolVaxView. https://www.cdc.gov/schoolvaxview/data/index.html ↩︎
    3. World Health Organization. (2024, November 14). Measles [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/measles (who.int) ↩︎
    4. Buechner, M. (2025, September 8). Americans Who Never Forget: Life Without Vaccines. UNICEF USA. https://www.unicefusa.org/stories/americans-who-never-forget-life-without-vaccines (unicefusa.org) ↩︎
  • Omeprazole + clopidogrel

    Omeprazole + clopidogrel

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    A lot of my customers are on Omeprazole (commonly used for heartburn) and Clopidogrel (for stroke and heart attack prevention), this combination gives me heartburn every time I see it (no pun intended). Clopidogrel is often prescribed without respect to Omeprazole because “the patient has been on Omeprazole for ages” and providers often leave staple drugs on.

    I’m sure you’re thinking “one stops the blood from clotting while the other treats heartburn, what’s the connection here?” Well, Clopidogrel is used for heart attack and stroke prevention. It is also a prodrug that is mainly metabolized by CYP2C19 into an active metabolite that allows the drug to stop blood from clotting together. Omeprazole stops this enzyme from working and can greatly reduce well Clopidogrel can do its job. 1This means that it may be unable to prevent another stroke or heart attack from occurring when used with Omeprazole!2

    So What Do you Do with this Informaiton?

    Speak to your doctor about alternative heart burn drugs for safe use in clopidogrel. Make sure they substitute Omeprazole with an alternative therapy right away. Just removing Omeprazole with no other alternative can result in rebound GERD, which often comes with worse symptoms than before.


    Share your story in the comments below or reach out to your local healthcare advocate.

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    1. Howden CW. Clinical pharmacology of omeprazole. Clin Pharmacokinet. 1991 Jan;20(1):38-49. doi: 10.2165/00003088-199120010-00003. PMID: 2029801 ↩︎
    2. McTavish, D., Buckley, M. M., & Heel, R. C. (1991). Omeprazole. An updated review of its pharmacology and therapeutic use in acid-related disorders. Drugs, 42(1), 138–170. https://doi.org/10.2165/00003495-199142010-00008 ↩︎

  • Major Medicare Changes in 2025: Progress and Pitfalls

    Major Medicare Changes in 2025: Progress and Pitfalls

    Delphine Adams's avatar

    Written by:

    Delphine Adams

    Several significant changes to Medicare have reshaped how millions of Americans access and afford healthcare—especially when it comes to prescription drugs. While many of these changes aimed to improve affordability and access, they’ve, instead, presented a new set of challenges, particularly in rural and underserved communities. Here’s a closer look at key impactful updates we’ve seen so far.

    A New Cap on Out-of-Pocket Costs for Medicare Part D

    Perhaps the most widely celebrated changes this year is the reduction of the annual out-of-pocket maximum for Medicare Part D to $2,000, a significant decrease from the previous cap of $8,000. This shift has been a game changer for Medicare beneficiaries—especially those on high-cost medications who do not qualify for the Extra Help Program. Though the cap is set to rise steadily in the coming years, for now it is certainly a relief for many.

    Monthly Payment Options Through Medicare Advantage: A Double-Edged Sword

    Medicare Advantage plans have also introduced new flexibility for prescription drug payments, allowing enrollees to split their annual out-of-pocket costs into monthly payments. This can greatly improve budgeting and financial planning for patients, especially those managing multiple chronic conditions.

    But this simplification has come with unintended consequences. In rural communities, where provider options are already limited, patients are finding that their trusted doctors or specialists are no longer in-network. Take Ms. Betty, for example—a patient who has seen the same neurosurgeon for five years. Under her new plan, that doctor is no longer covered.

    What happens next?

    • The search for a new provider begins, often hours away from home
    • Access issues arise if the patient is without reliable transportation or caregiver support.
    • Delays in time-sensitive care can occur due to new referral requirements or extended wait times.

    This raises a critical concern: while payment flexibility is helpful, network limitations are leaving many patients in limbo, especially when specialist care is urgently needed.

    The Growing Burden of Prior Authorizations and Formulary Changes

    Another trend gaining attention in 2025 is the increase in prior authorization (PA) requirements, which has become a significant hurdle for both patients and healthcare providers.

    These increased PA demands have led to:

    • Interruptions in therapy for patients with complex or chronic conditions.
    • Delays in access to routine medications, sometimes taking up to two weeks for approvals.
    • Increased administrative workloads for providers and their staff, diverting time and resources away from patient care.

    Even more concerning are the frequent changes to drug formularies—especially for essential medications like insulin.

    While the Inflation Reduction Act of 2022 capped insulin copays at $35 per month, that protection doesn’t help if the insulin a patient relies on is no longer on the plan’s formulary.

    Consider Mr. J, a patient who finally stabilized his A1C levels using Humalog KwikPen after years of trial and error. When he arrives to pick up his refill, he’s told it’s no longer covered. He’s left in shock and uncertainty—with no immediate alternative in place.

    In some cases, routine medications now require a new prior authorization every month. These delays create dangerous gaps in care, eroding patient trust and undermining treatment success.

    Final Thoughts: Navigating Progress with Caution

    While the changes to Medicare in 2025 aim to improve affordability and accessibility, they have also exposed serious gaps in continuity of care, provider access, and administrative burden.

    The lowered out-of-pocket cap is a significant win, and monthly payment options may help patients better manage costs. But as provider networks shrink and drug coverage becomes more volatile, many Americans—especially those in rural or low-income communities—are finding it harder to get the care they need, when they need it.

    Moving forward, policymakers, providers, and patient advocates must work together to ensure that cost-saving reforms do not come at the expense of access or quality of care. Simplifying authorizations, expanding networks, and stabilizing formularies must be the next steps in creating a Medicare system that works for everyone.

    *The patient names and scenarios mentioned in this article are completely fictious, but are used to illustrate potential customer experiences that I have personally observed as a pharmacist of the years and those shared by my colleagues in the industry

    Have you experienced challenges or benefits from the new Medicare changes in 2025?
    Share your story in the comments below or reach out to your local healthcare advocate.

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