Options for Dispensing Mifegymiso in BC

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Resources available here:
BCPharmacists.org/Mifegymiso

Options for Dispensing Mifegymiso in BC

Earlier this year, Health Canada approved the drug Mifegymiso®, a two-drug combination product that provides a non-surgical option for early abortion. In BC, when the drug becomes available in early 2017, there will be options for how Mifegymiso® can be provided to patients. How the drug is dispensed and when the drug is taken will be a decision made between the patient and physician. 

“Ensuring safe, accessible dispensing of mifepristone for women in communities throughout BC will assist women and their families to receive high quality care closer to home." 
– Dr. Wendy Norman, MD, MHSc

“Pharmacists are uniquely positioned as medication experts within the health care system, able to provide a clinical check including allergies and drug interactions, and identify and resolve potential problems during the dispensing process of Mifegymiso.”    
– Dr. Judith Soon, RPh, PhD

As part of the approval process, Health Canada recommended strict conditions of use for this drug, including the requirement that physicians provide the first dose of Mifegymiso® directly to the patient – these conditions are reflected in the product monograph.

Both the College of Pharmacists of BC and the College of Physicians and Surgeons of BC expressed concerns that these conditions would be challenging to operationalize since most BC physicians are not legally authorized to sell and dispense medication, making it impossible for them to dispense Mifegymiso® to their patients, and therefore creating a barrier to access. 

“Pharmacists are the experts in drug therapy and drug distribution. Pharmacist involvement in distributing this drug and providing patient counselling contributes to its safe and effective use.” 
– Bob Nakagawa, Registrar, College of Pharmacists of BC

After corresponding with Health Canada, the two colleges were advised that it is within the purview of a practitioner and pharmacist to prescribe and dispense a drug in a manner that falls outside the recommended uses and conditions of use set out in the product’s label that is approved by Health Canada. 

How can Mifegymiso® be provided to patients?

There will be three possible ways Mifegymiso® can be provided to patients who are prescribed the drug. Options include: 

  • Patients can take the prescription to a pharmacist of their choice and have the drug delivered to the physician’s office to take, which is consistent with the product monograph, or
  • Patients can take the prescription to a pharmacist of their choice and take the drug at home as directed by the physician, with no requirement to have the ingestion witnessed.
  • If the prescribing physician is authorized to dispense in accordance with the College of Physicians and Surgeons standard on Sale and Dispensing of Drugs by Registrants, the drug can be sold, dispensed and taken by the patient in the physician’s office.

Patients will need to have informed consent discussions with their physician about how and where they intend to take Mifegymiso®. Physicians will clearly indicate which option the patient has selected on the prescription, and what the directions are for consumption, so that both the patient and the pharmacist are aware, and no confusion exists.

Although the product monograph may reference the patient receiving the medication directly from their physician, pharmacists in BC are able to dispense Mifegymiso® directly to the patient, which aligns with provincial legislation, and the College of Physicians and Surgeons professional standard, Sale and Dispensing of Drugs by Registrants. 

See our Dispensing Mifegymiso in BC Resource Page for more information and update on related educational resources as they become available.
 

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Jan 12, 2017