IPM Take
Cardiometabolic care is being redesigned in theory, but not yet in workforce policy. Hypertension, diabetes, obesity, kidney disease and cardiovascular risk are increasingly understood as one connected system. Yet many health systems still expect patients to navigate fragmented clinics, long waits and under-resourced primary care before prevention begins. Pharmacists sit in the gap. They can screen, counsel, monitor medicines, support adherence and identify social barriers earlier than many traditional pathways. But without payment, data access, referral loops and clear scope of practice, pharmacy-based prevention risks becoming another unpaid promise dressed up as innovation.
Executive Summary
A June 2026 Drug Topics article highlights the role pharmacists can play in reducing cardiometabolic health disparities, particularly through screening, prevention, medication management, chronic disease counselling and support for patients facing barriers such as cost, transport, health literacy and food insecurity.
The issue is bigger than the United States. The International Pharmaceutical Federation has called for pharmacists to be integrated into national noncommunicable disease strategies, with expanded scope of practice, fair remuneration, digital data-sharing and workforce development. WHO’s approach to noncommunicable disease management also emphasises integrated primary care, early detection and total cardiovascular risk management rather than single-condition silos.
Some countries are already moving. England’s community pharmacy blood pressure service supports cardiovascular risk identification and hypertension case-finding. The NHS 10-year plan also points toward a larger role for pharmacists in obesity, high blood pressure, high cholesterol, cardiovascular disease screening and diabetes screening. Canada has expanded pharmacist prescribing authority across jurisdictions, although the rules vary by province and territory. In Australia, Queensland’s chronic conditions pharmacy pilot includes structured prescribing for type 2 diabetes, hypertension and dyslipidaemia.
The policy risk is obvious. Health systems may ask pharmacists to absorb more prevention work without giving them the infrastructure, reimbursement or clinical authority to do it safely and equitably.
Why it matters
- Policymakers and public authorities: Need to decide whether pharmacists are part of the formal cardiometabolic workforce or just a convenient pressure valve for overloaded primary care.
- Payers: Must move beyond paying only for products and start reimbursing pharmacist-led prevention, screening, monitoring and adherence support where evidence supports value.
- Clinicians and providers: Need clear referral pathways, shared records and collaborative protocols so pharmacy-based screening leads to diagnosis, treatment and follow-up rather than isolated checks.
- Patients and advocates: Community pharmacy can reduce access barriers, especially for underserved groups, but only if services are affordable, culturally competent and connected to wider care.
- Industry / innovation partners: The rise of GLP-1s, SGLT2 inhibitors, lipid-lowering therapies and digital diabetes tools makes medication navigation more complex. Pharmacists can support safe, personalised use, but commercial expansion must not replace public accountability.
Cardiometabolic disease is no longer a specialist problem. It is a system problem. Diabetes, obesity, hypertension, dyslipidaemia, chronic kidney disease and cardiovascular disease now overlap so heavily that treating them as separate conditions looks increasingly outdated.
The American Heart Association’s cardiovascular-kidney-metabolic framework made that point explicit. Recent US estimates suggest that almost 90% of adults meet criteria for at least stage 1 CKM syndrome. That does not mean almost every adult is severely ill. It means cardiometabolic risk is now so widespread that waiting for disease to become advanced is policy negligence, not clinical prudence.
This is where pharmacists become politically important.
A June 2026 Drug Topics article argues that pharmacists are well placed to address cardiometabolic health disparities because they are accessible, embedded in communities and already involved in medicines, counselling, prevention and chronic disease management. The article highlights a brutal truth: many patients facing the highest cardiometabolic risk also face the most barriers to traditional care. Lower income, lower educational attainment, transport barriers, food insecurity, medication affordability, fragmented insurance and limited primary care access all shape who gets screened, who gets treated and who falls through the cracks.
Pharmacies are not a magic solution. But they are already open doors in places where the rest of the health system often feels closed.
Globally, the policy conversation is moving in the same direction. The International Pharmaceutical Federation has called for pharmacists to be fully integrated into national strategies on noncommunicable diseases. Its recommendations include expanding pharmacists’ scope of practice, ensuring fair remuneration for pharmacist-provided services, strengthening digital tools and data-sharing, and investing in workforce development.
That is not professional lobbying dressed up as health equity. It is a workforce reality. Cardiometabolic disease requires prevention, monitoring, medication optimisation, adherence support and long-term follow-up. These are exactly the points where many health systems are weakest.
England shows one route forward. The NHS Community Pharmacy Blood Pressure Check Service uses pharmacies to identify people over 40 who may have undiagnosed hypertension, provide ambulatory blood pressure monitoring where needed, promote healthy behaviours and send readings back to general practice. The NHS 10-year plan also points toward a larger clinical role for community pharmacy, including screening for cardiovascular disease and diabetes, and supporting management of obesity, high blood pressure and high cholesterol.
Australia is testing another model. Queensland’s Community Pharmacy Chronic Conditions Management Pilot allows participating pharmacists to undertake protocol-based prescribing within chronic disease programmes, including cardiovascular risk reduction for type 2 diabetes, hypertension and dyslipidaemia. The pilot is scheduled to run until June 2027 and will be evaluated across access, continuity, effectiveness, efficiency, sustainability, appropriateness and safety.
Canada shows both progress and fragmentation. Pharmacists across Canada now have some level of prescribing authority, but the scope varies by jurisdiction. That variation matters. A patient’s access to pharmacist-supported chronic disease care can depend less on clinical need and more on postcode, province or regulatory history.
The same issue is even sharper in low- and middle-income countries. A 2025 systematic review found that community pharmacists in LMICs already provide primary healthcare functions, including health education, referrals, medication review, point-of-care testing, screening and support for chronic illness. But the review also identified barriers such as unfriendly government policies, lack of time, weak collaboration, physical constraints and limited training. In other words, pharmacists are already doing the work, but many systems have not formally recognised them as primary healthcare providers.
This is the policy fault line.
If governments want pharmacists to help close cardiometabolic gaps, they cannot build the model on goodwill. They need to answer five uncomfortable questions.
First, who pays? Screening without reimbursement is not a sustainable prevention strategy. If pharmacists are expected to detect risk, counsel patients and support long-term disease management, payment models need to reward clinical service, not just dispensing volume.
Second, who has access to the record? Pharmacy-based cardiometabolic care cannot work if pharmacists are locked out of patient data. Blood pressure checks, diabetes risk screening, medication changes and adherence interventions need to flow into shared records and back to primary care.
Third, who is responsible for follow-up? A high blood pressure reading in a pharmacy is useful only if it triggers confirmation, treatment and monitoring. Without closed-loop referral pathways, screening becomes theatre.
Fourth, who is allowed to prescribe or adjust therapy? In some systems, pharmacists can already prescribe under protocols or adapt medicines. In others, they remain trapped in a narrow dispensing role despite being asked to support complex chronic care.
Fifth, who protects equity? Pharmacy access is not equally distributed. Rural areas, deprived urban neighbourhoods and fragile health systems may have fewer pharmacies, fewer staff and less digital infrastructure. If pharmacy-based prevention is introduced without equity planning, it could widen gaps rather than close them.
There is also a political tension that cannot be ignored. Expanding pharmacists’ role often triggers resistance from parts of the medical profession, especially around prescribing. Some concerns are legitimate: diagnosis, safety, liability and conflicts between prescribing and dispensing need clear governance. But using safety as an excuse to preserve outdated professional boundaries is not a patient-centred policy.
The answer is not pharmacist substitution. It is pharmacist integration.
Cardiometabolic care needs team-based models where pharmacists, physicians, nurses, dietitians, social workers and digital health systems work from the same patient record, under shared protocols, with clear escalation rules. Pharmacists should not be left to compensate for broken primary care. They should be commissioned as part of the primary care response.
The stakes are rising. GLP-1s, SGLT2 inhibitors, mineralocorticoid receptor antagonists, lipid-lowering therapies, blood pressure medicines and digital diabetes tools are making cardiometabolic care more effective, but also more complex and expensive. Patients need help navigating eligibility, side effects, adherence, affordability and long-term use. Pharmacists are already doing much of this work informally.
The policy choice is whether to formalise it.
If health systems are serious about prevention, they cannot keep pretending that cardiometabolic care begins in the specialist clinic. For many patients, it begins at the pharmacy counter.
The question is whether policy will finally catch up.
