ADA Standards of Care often remain theoretical until they intersect with daily pharmacy operations. As a third-year PharmD student working at a statewide chain, the gap between classroom learning and real-world application became clear while reviewing diabetes treatment protocols.
Identifying Overlapping Therapies
The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in treating type 2 diabetes has grown significantly. This prevalence creates a specific opportunity for pharmacists to identify patients receiving overlapping incretin-based therapies. One common example of potentially duplicative care is the concurrent use of dipeptidyl peptidase-4 (DPP-4) inhibitors alongside GLP-1 RAs. According to the 2026 American Diabetes Association (ADA) Standards of Care, concurrent use of DPP-4 inhibitors with GLP-1 RAs is not recommended. The guideline notes that this combination does not provide additional glucose-lowering benefit compared to GLP-1–based therapy alone. Additionally, discontinuing an unnecessary medication can reduce pill burden and potentially decrease out-of-pocket costs.
The student generated a list of patients currently taking a DPP-4 inhibitor and reviewed each individual profile to see if they were also receiving a GLP-1 RA. This process identified 7 patients receiving this potentially duplicative incretin therapy. After reviewing each patient’s medication regimen, the student contacted the prescribers, explained the rationale for the recommendation, and recommended discontinuing the DPP-4 inhibitor when appropriate while continuing the GLP-1 based therapy.
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During this process, the student learned that some prescribers preferred receiving therapeutic recommendations by fax rather than by telephone. Our pharmacy did not have a standardized form for communicating these recommendations, creating a barrier to efficient care. So, the student decided to create one.
Developing a Communication Tool
The student developed a form containing the patient and medication information, the identified therapeutic issue, clinical rationale, supporting guideline reference, recommendation, and a section for the prescriber to respond. The initial version was shared with a pharmacist, who helped refine the form and provided valuable feedback.
One of the recommendations faxed using the new form involved a patient receiving sitagliptin (Januvia; Merck) concurrently with semaglutide (Ozempic; Novo Nordisk). After reviewing the recommendation, the prescriber completed and returned the form, agreeing with the intervention and discontinuing the sitagliptin. The student subsequently spoke with the patient to explain the change in therapy, and they were pleased to see a medication being removed rather than added. Seeing the recommendation progress from identifying a potential medication therapy problem, to reviewing evidence, to communicating with the prescriber, and ultimately to a change in the patient’s medication regimen was meaningful. It demonstrated how knowledge gained in the classroom can translate into practical intervention and medication optimization.
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The student initially shared the form with the pharmacy leadership team hoping to receive feedback and suggestions for improvement, but the response was much more. The company’s Director of Pharmacy Operations took an interest in the project and recognized that this form could benefit all pharmacies. He subsequently shared the form across the entire company, making it available to all pharmacists throughout the organization.
While the immediate success of the intervention is rewarding, the logistical reality of the form highlights a broader systemic friction. Relying on a paper document that must be physically printed, filled out, and faxed manually introduces latency and potential for error into a process that requires speed. As automated prescribing and electronic health record integrations become more standard, the manual nature of this workflow could eventually become a bottleneck. The student hopes to eventually integrate this tool directly into the pharmacy management system, allowing for a more streamlined approach to pharmacist-initiated medication optimization.
This experience reinforced the importance of looking for opportunities to apply what is learned in the classroom to everyday pharmacy practice. What began as a question about duplicative therapy ultimately led to a patient-specific intervention, the development of a communication tool, and a resource now available to pharmacists throughout the community.
