Tim Pflederer, MD, the chief medical officer for Evergreen Nephrology, argues that pharmacists are critical for optimizing sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist therapy for patients with chronic kidney disease (CKD). In an interview, he discussed what it will take to get more eligible patients on guideline-directed care. Pflederer was direct about the necessity of these professionals, identifying three specific contributions they make to the treatment process.
Education, Cost, and Adjustment
The first contribution is education. Pharmacists ensure patients understand the benefits of the drug, its specific purpose, and the adverse events they need to watch for. The second is cost and access. These medications are expensive, and with multiple options available across both classes, a pharmacist is often the person who identifies the specific agent a patient can afford. They determine what insurance covers and what the patient will tolerate.
The third contribution is ongoing adjustment. Pharmacists recommend changes and work closely with the provider to modify therapy based on the patient’s response and symptoms. All three contributions serve one goal in his framing: making sure the patient gets the medication, takes it, and stays on it long enough to see reduced kidney disease progression, fewer cardiovascular events, and lower mortality.
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The Limits of a 15-Minute Visit
When asked about the biggest opportunity to improve uptake, Pflederer pointed to team infrastructure rather than prescriber behavior. He stated that these medications cannot be delivered by a provider in a 15-minute office visit. The simple act of a doctor writing a script and sending the patient out the door is insufficient.
Healthcare systems often struggle to reimburse for the time spent on non-face-to-face tasks like prior authorizations and complex medication counseling. This creates a structural barrier where the most effective care for chronic conditions demands resources that traditional fee-for-service models do not always support. Without a system that values this coordination, the burden falls entirely on the physician or the patient to handle the complexities.
Successful treatment requires patient education, prior authorization to secure coverage, and continuing communication to confirm the patient is taking the drug and not experiencing side effects. That level of supportive care demands a team. It requires a provider, a pharmacist, a nurse navigator, or a care manager. Pflederer reported growing success as those systems develop.
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A Team-Based Payment Model
Pflederer closed the interview by connecting this clinical approach to the payment model. He said value-based care is at its core team-based care. At Evergreen Nephrology, pharmacists, care managers, and dietitians work alongside nephrologists and primary care physicians.
This collaboration happens throughout the patient’s journey. It is not limited to the office visit. He emphasized that the team approach is essential for managing the long-term needs of patients with chronic kidney disease. By integrating these roles, the practice aims to keep patients on therapies that can significantly alter their disease trajectory.
