Welcome back to this week's edition of The Weekly Fill! We're bringing you the latest pharmacy trends with some fun updates about life at ShiftRx.
The Weekly Fill is your go-to for pharmacists, pharmacy techs, owners, operators, managers, you name it. If you’re in pharmacy, this newsletter is for you. 😇
💊The Big Fill this Week:
Medicaid Cuts Projected to Cause 16,500 Deaths Annually: Alarming Findings from New Study
A new study warns that proposed federal Medicaid cuts could result in 16,500 preventable deaths each year, making it one of the most consequential threats to public health in recent memory. The analysis models the impact of Medicaid funding reductions on access to care, particularly for low-income populations who rely heavily on the program for primary, chronic, and acute care services.
Key Takeaways:
Mortality Risk Tied to Coverage Loss:
Researchers estimate that every 300–800 Medicaid disenrollments could result in one additional death annually, due to delayed diagnoses, unmanaged chronic conditions, or unfilled prescriptions.
Hospitals Brace for Uncompensated Care Surge:
Cuts could lead to billions in lost Medicaid funding, shifting financial burden onto safety-net hospitals and further straining emergency departments and charity care resources.
Rural and Underserved Communities Hit Hardest:
Areas already struggling with provider shortages and limited transportation options are expected to experience disproportionate harm, exacerbating health disparities.
Pharmacy Impact:
Lower Medicaid enrollment could directly affect 340B pharmacies, FQHCs, and hospital-based systems that rely on Medicaid reimbursements to maintain service availability.
💬 What Public Health Experts Are Saying:
“This isn’t just a budgetary issue, it’s a life-or-death issue,” said one of the lead researchers. “When you cut Medicaid, you’re not trimming fat, you’re cutting into people’s ability to survive.”
For Patients:
Without Medicaid access, millions may forgo preventive services, medications, or follow-ups, resulting in worsened outcomes and higher downstream costs.
For Pharmacists:
Expect ripple effects on reimbursement, patient medication adherence, and care continuity, particularly in regions where Medicaid is the dominant payer.
Moving Forward:
As Congress debates funding allocations, pharmacy and healthcare leaders are urged to advocate for Medicaid stability, highlight real-world impacts on patients, and support data-driven policy reform that prioritizes equitable access and outcomes. Read more here.
📊Industry Trends:
The Future Is Now: Pharmacy Ramps Up for the Advanced Therapeutics Era
Cell and gene therapies are transforming treatment for rare diseases and cancer, but with price tags in the millions and workflows spanning lab to bedside, health systems are racing to develop infrastructure for access, safety, and sustainability. At ASHP’s Pharmacy Futures 2025 summit, pharmacy leaders called for urgent planning around operational readiness, payment strategy, and ethical deployment of these high-stakes, one-time treatments.
Key Takeaways:
The Scale of Change:
The FDA has approved 21 gene and cell therapy products, with many more in the pipeline. These therapies target complex conditions like blood cancers and genetic disorders, and can cost millions per patient.
Operational Overhaul Required:
From cell collection and shipping logistics to handling fragile, custom-made products, pharmacy teams need training, personnel, and interdisciplinary coordination. “We’re sharing ideas at an advanced pace,” said Kevin Zinchuk of Brigham and Women’s Hospital.
No Standardized Blueprint:
Hospitals are independently creating committees to vet patient eligibility, track outcomes, and coordinate logistics, highlighting the lack of national guidance or regulatory uniformity.
Payment Remains Fragmented:
At institutions like the University of Chicago, each therapy involves case-by-case insurer negotiations, even when patients are in-network. “Without coordination, it could bankrupt the system,” warned Chief Pharmacy Officer Denise Scarpelli.
💬 What Pharmacy Leaders Are Saying:
“There are a lot of questions because there is really no standardized guidance or regulations on how to do this,” Zinchuk explained. Scarpelli added, “I always think about how we can give patients access and make sure it’s affordable, for them and the system.”
For Health Systems:
Front-end investment in personnel, training, and infrastructure will be essential. Smaller hospitals may opt not to offer these therapies—but should still facilitate referrals to ensure equitable access.
For Pharmacists:
Roles are expanding across the therapeutic lifecycle, from apheresis to bedside delivery, pharmacists are key to managing safety, outcomes, and access for this new wave of personalized medicine.
Moving Forward:
Advanced therapies are here. To avoid last-minute chaos, pharmacy must lead the way in building coordinated systems that balance innovation, ethics, access, and financial sustainability. Read more here.
🗞 Quick Scripts: Other Industry News
Iowa Passes PBM Reform Bill, Joining National Push for Pharmacy Fairness
Iowa has passed SF 383, a new law that prohibits pharmacy benefit managers (PBMs) from excluding pharmacies from networks or reimbursing out-of-network providers at lower rates than in-network ones. The law aims to protect patient access to community pharmacies and prevent discriminatory contracting practices that have financially strained independent providers. This move follows Texas’s passage of SB 1236, a landmark bill that mandates PBM transparency, eliminates hidden fees, and bans retroactive claim recoupments. Iowa’s action shows growing momentum among states to rein in PBMs and support equitable access to pharmacy services. As more states follow Texas’s lead, this trend could signal a broader national shift toward PBM accountability and pharmacy sustainability.
Historic $7.5 Billion Purdue Pharma Settlement Aims to Address Opioid Crisis Fallout
All 50 states, D.C., and U.S. territories have agreed to a $7.5 billion settlement with Purdue Pharma over its role in fueling the opioid epidemic, marking one of the largest public health legal settlements in U.S. history. The deal includes $6.5 billion from the Sackler family and permits individuals who opted out to still pursue civil lawsuits. Purdue Pharma aggressively marketed OxyContin while falsely downplaying its addictive potential, encouraging high-dose prescriptions that contributed to widespread misuse and overdose deaths. The funds will be distributed over 15 years and follow the 2024 Supreme Court rejection of an earlier proposal that shielded the Sacklers from liability. Purdue will be dissolved and replaced by a public benefit company focused on opioid treatment and prevention. The epidemic has contributed to hundreds of thousands of deaths and devastated communities across the country. Read more here
CVS Under Investigation for Using Prescription Texts to Lobby Against PBM Reform
The Louisiana Attorney General is investigating CVS for allegedly using its prescription text messaging system to lobby patients against a state bill (HB 358) aimed at reforming PBM practices. The messages warned patients that changes to pharmacy regulations could lead to store closures or reduced access, a claim critics say was misleading and intended to sway public opinion using private health data. The AG's office is examining whether this violated patient privacy laws or constituted inappropriate political messaging under the guise of healthcare communication. CVS maintains it was simply informing patients about policies that could affect their care. However, lawmakers and advocacy groups argue this tactic erodes trust between patients and providers. The investigation raises broader questions about how pharmacy chains leverage digital tools and patient communications to influence legislation.
🫡 Drug Spotlight: Blujepa (gepotidacin)
What it is:
Blujepa is an innovative, first-in-class oral antibiotic approved in March 2025 for treating uncomplicated urinary tract infections (UTIs) in females aged 12 years and older.
Why it matters:
- Designed to combat antibiotic-resistant bacteria, gepotidacin targets essential bacterial enzymes differently from traditional antibiotics, offering a solution when common treatments fail
- In clinical trials, it matched or outperformed nitrofurantoin, with half of patients symptom-free post-treatment
Clinical implications:
- Offers non–nitrofurantoin/fluoroquinolone UTI coverage, ideal for patients with resistance or contraindications.
- **FDA flagged ongoing trials for gonorrhea, signaling **expanded future use .
Mechanism of Action
Gepotidacin inhibits bacterial DNA replication by targeting two essential bacterial enzymes:
- DNA gyrase (GyrA)
- Topoisomerase IV (ParC)
Unlike fluoroquinolones, which bind to the same targets but in a different way, gepotidacin binds at unique sites, making it effective even against fluoroquinolone-resistant bacteria. This unique binding disrupts the supercoiling and separation of bacterial DNA, processes essential for replication, leading to bacterial cell death.
🌟Pharma Spotlight
Each week, we highlight pharmacy professionals and industry leaders who are making a real impact. This is our way of celebrating the work and dedication of professionals who drive pharmacy forward.
Pharmacy Career Spotlight: Brian Mabie
This week, I am honored to spotlight a pharmacist whose four-decade career has touched nearly every corner of the profession. With 43 years of experience, including 27 years in management, he has worked across clinical practice, pharmaceutical R&D at Parke-Davis/Pfizer, and managed care in both health plans and PBMs. Today, he serves as Pharmacy Director for the State of Delaware, where he oversees Medicaid pharmacy benefits and shapes drug policy affecting thousands of lives. His deep industry knowledge, leadership in government, and passion for the profession make him a powerful example of what a multifaceted pharmacy career can look like.
1) You've had a remarkable 43-year career in pharmacy, spanning clinical practice, industry, and government, what initially drew you to the field, and what has kept you engaged over the decades?
“I grew up in a small farm town in Michigan with one local drugstore. The pharmacist there always fascinated me, and a family friend who worked at the store really encouraged me. I thought it would be a good way to make a living and help people. What’s kept me engaged is how the profession continues to evolve. Right now, for example, I’m working on how to pay for cell and gene therapies, treatments that can cost $3.3 million for a single patient. It’s challenges like that, plus being able to shift roles throughout my career, that keep things interesting.”
2) You spent 8 years in R&D at Parke-Davis/Pfizer. What was one of the most exciting or challenging projects you worked on during that time, and how did it shape your approach to pharmacy today?
“During one of Pfizer’s mergers, I worked on centralizing chemical warehouse systems globally. We had to standardize pharmaceutical ingredient inventories across multiple countries and create a system that could track, source, and dispatch ingredients to labs within days. It was exciting to build that from scratch and work with colleagues around the world. Another highlight was working on investigational product labeling and packaging. Seeing a drug like Celebrex go from concept to market, especially after designing the first clinical gel batch, was incredibly rewarding.”
3) Your background includes a decade in managed care across both health plans and PBMs. How did that experience influence your perspective on pharmacy’s role in shaping healthcare policy and cost containment?
“In health plans, we mainly provided advice to employer groups, showing them utilization trends and strategies. But it was in the PBM space where I really got into formulary decisions and rebate negotiations. Now in Medicaid, it’s a different challenge. If a manufacturer pays a rebate, we’re required to cover the drug, even if it’s not the best option clinically. You can’t manage the formulary in the same way. That’s what makes my current role both difficult and exciting: we’re shaping policy while balancing cost, safety, and access.”
4) As Pharmacy Director for the State of Delaware, what are some of the initiatives or changes you’ve helped implement that you're particularly proud of?
“One initiative we launched this year focuses on proton pump inhibitors (PPIs). We noticed that patients often stay on high acute doses long-term, so we created a project to flag those cases and recommend dose adjustments. It may not save a ton of money directly, but it's about improving patient safety and reducing unnecessary exposure. These kinds of small, thoughtful interventions can have a big impact.”
5) Looking back, what advice would you give to pharmacists or pharmacy students who are interested in pursuing a multifaceted career like yours, spanning clinical work, industry, and government?
“Follow your heart and do what makes you happy, because you’ll be doing it for a long time. If you try something and it’s not for you, don’t be afraid to change paths. My grandfather always said it’s easier to go to a job you love than one you dread. That’s stuck with me throughout my career.”
Key Takeaways for Pharmacy Professionals
This interview reflects the power of professional versatility and lifelong adaptability. From innovating supply systems in global pharma to crafting public health policy at the state level, his career shows how pharmacists can lead at the intersection of science, policy, and patient care. His advice is clear: pursue fulfillment over comfort, and don't hesitate to reinvent your career to match your values and curiosity.
That’s it for today’s fill!
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