The use of GLP-1 receptor agonists has expanded far beyond diabetes, transforming care for patients with obesity, cardiovascular disease, and other chronic conditions. Prescriptions are rising rapidly — a 2024 British Medical Journal study reported a 700% increase over 4 years in US patients without diabetes starting GLP-1 therapy. At the same time, new potential applications are emerging in heart failure, metabolic liver disease, and neurodegenerative disorders.

But this rapid adoption also exposes major gaps in patient access, affordability, and medication management — areas where pharmacists are playing an increasingly critical role.

The Access Gap: When Prescriptions Don’t Equal Treatment

For many patients, a GLP-1 prescription doesn’t automatically translate to treatment. These drugs remain expensive, and the barriers to coverage are complex and inconsistent.

In practice, that means physicians write prescriptions that never get filled. Thomas So, PharmD, is senior manager of the Consumer Drug Information Group at First Databank (FDB). The company is known for its FDB MedKnowledge drug database, which is used in healthcare settings throughout the US and Canada. He said step therapy often forces patients to first try lower-cost or preferred alternatives like lifestyle changes or cheaper weight-loss drugs such as phentermine/topiramate. Even when a patient qualifies, coverage varies widely between insurers and brands.

These barriers translate into measurable care gaps. In one large claims-based analysis published in Journal of Managed Care & Specialty Pharmacy, only about one third of patients who started GLP-1 therapy remained on it after a year, and affordability was one of the strongest predictors of discontinuation.

As this study published on January 30 in JAMA Network Open reported, discontinuing and reinitiating GLP-1s limits the benefits of these agents on weight management and glucose control. For the increasing numbers of complex patients, the consequences can be more severe, So said.

“When patients walk away from the pharmacy counter, that’s a red flag for potential nonadherence, which can lead to uncontrolled diabetes and ultimately to hospital admissions and readmissions,” he said.

Pharmacists on the Front Line of Access

Pharmacists are often the first to see the real-world fallout of these access challenges.

“Pharmacists can readily ascertain when a patient may not be compliant with their GLP-1 prescriptions,” So said. “If the costs are prohibitive, we can see that immediately — whether it’s because the prescription was denied by insurance or because the out-of-pocket cost is simply too high.”

That direct visibility makes pharmacists critical to the early detection of medication-related risk. Working closely with primary care physicians, they can often prevent treatment failure before it becomes a clinical crisis — ensuring that therapeutic intent at the point of prescribing matches what patients can actually obtain and sustain.

In hospitals and outpatient networks that integrate pharmacists into care teams — often through embedded specialty pharmacy models or pharmacist-managed clinics — medication access and adherence outcomes improve. A study published in the March 31, 2024, edition of the Journal of Managed Care & Specialty Pharmacy showed that pharmacist interventions in specialty care settings significantly increased long-term adherence to high-cost therapies and reduced delays in treatment initiation.

Another analysis from the same journal found that patients whose prescriptions were managed through an integrated health-system pharmacy began therapy 6 days sooner on average than those using external pharmacies. Similarly, an American Journal of Health-System Pharmacy study found that embedding clinical pharmacy specialists in ambulatory clinics increased the proportion of prescriptions actually filled within the system from about 13% to 35%.

Collectively, these findings reinforce that when pharmacists are directly involved in coordinating access and managing prior authorization or formulary challenges, patients are more likely to start and stay on appropriate therapy.

Pharmacists as Clinical Equalizers

Access is only the first barrier. Once therapy begins, the pharmacist’s role extends into clinical management — monitoring side effects, evaluating drug-disease interactions, and counseling patients on what to expect.

“Pharmacists’ clinical expertise allows them to help manage patients on GLP-1 medications, especially with side-effects management and preventing complications,” So said. “Common side effects include nausea and vomiting. By making patients aware of these issues, pharmacist counseling can help prevent complications such as dehydration and electrolyte imbalances.”

For patients with comorbidities, these are serious concerns.

“If a patient also has heart failure, dehydration and electrolyte imbalances can worsen the condition,” So said. “Dehydration lowers blood volume, making it harder for the heart to pump. To compensate, the heart beats faster, increasing cardiac workload and risk of arrhythmias. Additionally, dehydration can lead to kidney injury, especially in patients with heart failure.”

These are subtle but potentially dangerous downstream effects — the kind of interactions pharmacists are uniquely positioned to help primary care teams anticipate and manage. GLP-1s have a complex pharmacokinetic profile and interact differently with each patient’s physiology, particularly in those with multiple chronic diseases.

A 2023 Lancet Diabetes & Endocrinology meta-analysis confirmed that GLP-1s confer significant cardiovascular and renal benefits, reducing the risk for major adverse cardiovascular events and kidney disease progression even in patients who are nondiabetic. But those benefits depend heavily on continuity of therapy and careful management of side effects. When adherence falters, so do outcomes.

So said pharmacists can tailor patient education to mitigate this risk — adjusting timing, suggesting anti-nausea strategies, or coordinating with prescribers to titrate doses more gradually. Their interventions can be the difference between sustained therapy and premature discontinuation.

The Transition Trap: Medication Risks After Discharge

The period following hospital discharge is one of the most vulnerable points in a patient’s care journey. Medication reconciliation errors, incomplete communication between inpatient and outpatient providers, and coverage interruptions all contribute to readmissions.

Multiple systematic reviews including the 2022 study in the September-October issue of the Journal of the American Pharmacists Association reported that pharmacist-led medication reconciliation during transitions of care is associated with lower 30-day readmissions, including a meta-analysis from The British Medical Journal showing significant reductions in postdischarge healthcare utilization.

Working alongside primary care physicians, hospitalists, and other clinicians, pharmacists help ensure more seamless handoff between inpatient and outpatient care, confirming prior authorizations, ensuring proper dosing, and preventing gaps in therapy.

“Pharmacists, as part of the healthcare team, help manage complex patients such as those with cardiovascular-kidney-metabolic syndrome, and can conduct comprehensive medication reviews that consider all of a patient’s conditions — heart disease, kidney disease, diabetes — and collaborate with providers to optimize regimens,” So said.

In patients with multiple comorbidities, such as those with type 2 diabetes, chronic kidney disease, and obesity, the pharmacist’s review can also prevent adverse drug events that might otherwise lead to readmission. Because these GLP-1s improve glycemic control, weight, and cardiometabolic stability, even brief lapses can reverse progress — leading to hyperglycemia, dehydration, and cardiovascular stress. So said pharmacists are often the first to detect those lapses, and by tracking refill delays, spotting coverage denials, or flagging early nonadherence, they can step in before those interruptions turn into readmissions.

Expanding Indications, Expanding Challenges

While pharmacists manage these daily realities, the research pipeline for GLP-1s keeps growing.

Recent trials have demonstrated promising applications in conditions well beyond glycemic control. In the STEP-HFpEF trial, semaglutide improved symptoms and exercise capacity in patients with heart failure with normal pumping function who also had obesity. A separate trial published in The New England Journal of Medicine on April 30 showed semaglutide induced histologic resolution in metabolic-associated steatohepatitis.

Additionally, emerging preclinical and clinical data, as in this study, suggest GLP-1 receptor agonists may provide neuroprotective benefits in Alzheimer’s disease and Parkinson’s disease, helping reduce neuroinflammation, oxidative stress, and neuronal loss. Every new patient population introduces clinical value, but also new risks, comorbidities, and potential interactions between drug and disease that must be managed at the point of care.

“Pharmacists can help with comprehensive medication reviews that take all of these factors into account,” So said. “They can also translate complex medical information into language patients can understand, which improves adherence and outcomes.”

From Promise to Practice: The Pharmacist’s Expanding Role

The GLP-1 story is emblematic of a bigger shift in healthcare: the move from drug-centric to system-centric medicine. These medications don’t just test the limits of what pharmacology can do; they test how well healthcare systems can adapt.

For now, pharmacists are the connective tissue holding that adaptation together. They troubleshoot insurance denials, educate patients, prevent medication-related complications, and flag early signs of nonadherence. Their expertise complements that of physicians and nurses, extending the reach of the care team into the moments between office visits — where most adherence failures and adverse events occur. While reimbursement models and staffing constraints still limit how widely these roles can be implemented, pharmacist-led interventions have been linked to better medication adherence, fewer hospitalizations, and stronger chronic disease control.

So reported no conflicts of interest.