Bulletin Today
APhA staff
CDC: Gabapentin use skyrocketing despite risks
Buoyed by increased usage among women and older adults, gabapentin—an anticonvulsant indicated for seizures but widely used off-label—has grown exponentially popular in the United States in recent years.
According to the latest CDC analysis, community pharmacies filled 177.6 gabapentin prescriptions per 1,000 people in 2024 versus just 79.5 per 1,000 people in 2010. Gabapentin is now the fifth most prescribed medication in the country up from the 10th in 2017, said the authors from CDC’s National Center for Injury Prevention and Control report said.
Writing in the Annals of Internal Medicine, authors noted that while primary care physicians are the leading prescribers of gabapentin, advanced practitioners are a close second, possibly due to expanded prescribing authority in certain states. They said that health care providers need to be vigilant regarding common adverse effects, including drowsiness, dizziness, blurry or double vision, inability to concentrate, and coordination issues as well as serious breathing problems in patients with respiratory risk factors. ■
Higher out-of-pocket costs rose for GLP-1s under Part D
A provision in the Inflation Reduction Act (IRA) that took effect this year adds another layer of complexity to efforts to ensure accessibility and affordability of the popular GLP-1 receptor agonists.
IRA now limits out-of-pocket spending to $2,000 under Medicare Part D—a change that may have prompted some health plans to tighten coverage of high-cost drugs, including GLP-1s, and increase cost-sharing for them, said a September 24, 2025, research letter published in JAMA.
Investigators compared metrics between 39.5 million beneficiaries of 4,528 Part D plans in 2020 and 45.6 million beneficiaries of 5,146 plans in 2025.
Their analysis revealed that while prior authorization was required for no more than 5% of GLP-1 prescriptions through 2023, by 2025, it was applicable to 99.9% to 100.0%. Out-of-pocket costs held fairly steady all the way through 2024, according to researchers, but climbed from $75–$138 in 2024, then to $122–$167 in 2025—particularly among stand-alone Part D plans.
While the trend toward more prior authorizations could be tied to the desire to deter off-label use of GLP-1s, the study authors agreed that the uptick in out-of-pocket costs is likely due to increased use of coinsurance on high-cost medications.
“Part D beneficiaries increasingly face prior authorization and higher [out-of-pocket] costs to access GLP-1RAs,” wrote the authors. “Although beneficiaries can avert cost increases by shopping for plans, most do not compare coverage options. Given the budgetary impact of GLP-1RAs for Medicare, ensuring beneficiary access and affordability will remain challenging.”
Study limitations included cost estimates that did not account for deductibles or out-of-pocket maximums. ■
ACOG recommends universal screening for cannabis use during pregnancy and lactation
In updated guidance from the American College of Obstetricians and Gynecologists (ACOG), the organization now recommends universal screening for cannabis use during pre-pregnancy, pregnancy, and postpartum periods.
The guidance document, “Clinical Consensus: Cannabis Use in Pregnancy and Lactation,” provides evidence-based guidelines for counseling, screening, and strategies to reduce the use of cannabis in pre-pregnancy and pregnancy and during lactation, ACOG noted.
Growing social acceptance and legal access to cannabis have created a false public perception of its safety during pregnancy, even though it has been linked to adverse outcomes such as preterm birth, low birth weight, and postnatal neurocognitive and behavioral dysfunction.
“The largest consumers of cannabis are reproductive-aged people, so we need to have these conversations with our patients and make sure that we educate them on the risks of cannabis use,” said Melissa Russo, MD, coauthor of the guidance. “While people do use cannabis for medicinal purposes, there is a lack of data on its safety and efficacy in pregnant and lactating people, and research now shows there are potential adverse effects on the pregnancy from cannabis use.”
No medical indication exists for using cannabis during pregnancy and the postpartum period, according to ACOG. They recommend that clinicians work with patients to determine alternative methods to address health concerns.
ACOG said that universal screening—using interviews, self-reporting, or validated screening tools—is recommended because it helps to eliminate bias, as it is required for all patients, and ACOG cautions against using biologic testing as a screening assessment for cannabis use. ■
OTC naloxone sales prove disappointing
Even though naloxone has been available without a prescription since September 2023, there has only been limited uptake, says new research from the Rand Corp.
Researchers looked at OTC sales of the drug over 12 months and included rates for August 2022 and August 2024 program-distributed and 2023 pharmacy-dispensed naloxone from published research. Biweekly sales of OTC naloxone peaked in the first month after it was approved for OTC sales, reaching about 22.5 units per million, the researchers found. Sales then dropped to about 15 units per million in early December 2023, and they remained between 11 and 15 units per million through September 2014.
“Data on the first year of OTC availability suggest retail OTC sales are limited and do not support that OTC options are filling gaps in naloxone distribution via pharmacies or distribution programs,” said researchers.
States averaged 396 OTC units per million residents during the 12-month study period, compared with an average of 7,063 state pharmacy-dispensed units per million residents in 2023 and 12,015 state program-distributed units per million residents from August 2022 through August 2024.
According to the researchers, among 136,239 OTC naloxone units sold, the unweighted mean price was $43.74 for counties with at least 75 units sold per million residents. ■
NC pharmacists allowed to test and treat for flu
Standing orders announced by North Carolina’s health director permit pharmacists to test and treat for influenza beginning October 1, 2025.
As authorized under HB 67, pharmacists throughout the state can test for influenza and then immediately treat patients with appropriate medications.
The standing orders authorize pharmacists to assess influenza symptoms in patients 5 years and older, perform point-of-care tests, and begin treatment when indicated. Additionally, pharmacists will be allowed to offer preventive treatment to high-risk individuals who have had a significant influenza exposure in the past 48 hours.
“This action reduces barriers for people who are feeling sick or have been exposed to someone with the influenza virus,” said Dev Sangvai, MD, North Carolina’s Health and Human Services secretary, in a news release. “Being able to get tested and immediately treated at a pharmacy increases access for people who do not have a regular provider and will help make communities healthier during the respiratory virus season.” ■