Adapting a Prescription

PPP-58: Adapting a Prescription


The College of Pharmacists of BC’s Professional Practice Policy 58 Adapting a Prescription (PPP-58) provides the framework to guide pharmacists in the safe and effective adaptation, including renewals, of existing prescriptions.  PPP-58 is applicable to pharmacists in all practice settings including; community, long-term care, hospital and other institutional pharmacy settings.

This policy, which provides the opportunity for pharmacists to maximize their full educational and professional competencies, also provides structure to, and refines the process of, exercising professional judgment in clinical practice.  This becomes increasingly important as pharmacists evolve their role as medication experts and assume accountability for their drug therapy decisions.

It is not mandatory that a pharmacist adapt a prescription and the decision to adapt a prescription or not is at the discretion of the individual pharmacist.  Should a pharmacist choose to adapt a prescription however, the intent must be to optimize therapeutic outcome of treatment and the adaptation must be done in accordance with PPP-58 and within the limits of the pharmacist’s own competencies.

The evolutionary change in pharmacy practice, through the implementation of PPP-58, is that it gives pharmacists independent authority and accountability for the adaptation of a prescription.  In doing this, the pharmacist is making the decision, based on their professional judgment, that the prescription is the ‘right’ drug therapy for their patient.

Although this additional authority comes with added responsibility it allows pharmacists to demonstrate their value, as medication experts, in an evolving patient-centered, clinical care environment.

PPP-58 says that a pharmacist must have appropriate knowledge and understanding of the condition and the drug being dispensed in order to adapt a prescription. What does it mean to have appropriate knowledge and understanding?
It is not possible to establish parameters to define what is meant by ‘appropriate knowledge and understanding’, as each situation would be unique. A pharmacist must use their professional judgement to determine if they have the ‘appropriate knowledge and information’ each time they consider adapting a prescription.
PPP-58 says that a pharmacist must have sufficient information about the specific patient’s health status to ensure that adapting the prescription will maintain or enhance the effectiveness of the drug therapy and will not put the patient at increased risk. What does it mean to have sufficient information?

It is not possible to establish parameters to define what is meant by ‘sufficient information’, as each situation would be unique. A pharmacist must use their professional judgement to determine if they have ‘sufficient information’ each time they consider adapting a prescription.

In doing this, a pharmacist must ensure they consider all relevant information that is available to them. This would include, but is not limited to, a review of the patient’s local and PharmaNet record, any patient specific information conveyed by the prescriber and any information obtained directly from the patient or their representative.

PPP-58 says a pharmacist must not adapt an expired prescription, nor adapt a prescription for a duration that exceeds the expiry date of the original prescription. What does this mean?

Effective October 14th, 2022, all prescriptions (new and existing) are valid for up to TWO years from the prescribing date, with exception of prescriptions for benzodiazepines or other targeted substances, in which case the prescription is valid for a period of up to ONE year from the prescribing date unless permitted by a section 56 exemption to the Controlled Drugs and Substances Act (CDSA).

For illustrative purposes, a prescription issued on January 5th, 2022 that is valid for two years would expire on January 4th, 2024. After January 4th, 2024, this prescription would no longer be valid, regardless of how many refills were initially authorized by the prescriber, and would not be eligible for adaptation.

Continuing with this example, if a pharmacist was considering performing an adaptation on this prescription before January 4th, 2024, they would need to ensure that the duration of the adaptation did not exceed the expiry date of the original prescription. In this case, the pharmacist would only be able to authorize a quantity that would supply the patient up to, and not beyond, January 4th,2024.

Do I have to use the adaptation documentation and notification template form on the College website, or can I use my own template?
Documentation and notification of adaptations must meet the requirements listed in part 3(f) and (g) of PPP-58. A pharmacist can choose to use their own templates but must ensure that all the required information is documented and retained as part of the patient’s record.
Why is it important to document an adaptation, and what are some tips for documentation?

Documentation establishes accountability and responsibility for performing prescription adaptations. It is an important component in demonstrating how the pharmacist exercised their professional judgement through documentation of their rationale and case-specific details that support the pharmacist’s decision to adapt.

Some tips for documentation include:

  • Complete your documentation as soon as possible (preferably immediately) after the activity
  • Ensure all required information is documented as per part 3(f) of PPP-58
  • Include all relevant information deemed necessary to support the decision to perform an adaptation
  • Ensure all documentation is legible and non-erasable
  • Do not delete, remove or rewrite any part of the adaptation record. If you make an error, cross out the error with a single line and initial it


How is providing an emergency supply for continuity of care under PPP-31 different than providing a renewal under PPP-58?

Under PPP-58, pharmacists can utilize their professional judgement to adapt (renew) a prescription, for whatever period of time they feel is appropriate, as long as the duration does not exceed the expiry of the prescription. When adapting, the pharmacist must ensure they have sufficient knowledge, understanding and patient-specific information to determine if the adaptation and subsequent continuation of therapy is in the best interest of the patient. Adapted renewals are generally performed when a pharmacist decides that they have enough information to determine a longer-term supply may be in the best interest of the patient.

PPP-31 allows pharmacists to provide patients with an emergency supply of prescription drugs for continuity of care in exceptional circumstances. Although this policy gives broad latitude for pharmacists to exercise their professional judgement, generally, emergency supplies are utilized to provide short term supplies when a longer term renewal may not be appropriate under PPP-58.

There may be many reasons a pharmacist chooses to provide an emergency supply rather than an adapted renewal, including but not limited to, the pharmacist does not feel comfortable providing a longer term supply after considering the patient’s health status, the prescription is not eligible for adaptation under PPP-58, the patient has an upcoming appointment with their prescriber for a new prescription or it is not in the patient’s best interest to provide an adapted renewal.

What is NOT considered a prescription adaptation?
  • When the pharmacist calls the original prescriber to make a change to a prescription

    If a pharmacist identifies a drug-therapy problem and decides the best course of action to address their concerns is to contact the prescriber, any changes authorized by the prescriber as an outcome of that conversation is not considered adapting. Any time a pharmacist contacts a prescriber for prior authorization to change  a prescription is not adapting.

  • When the pharmacist dispenses and interchangeable drug product

    If a pharmacist determines that two drugs meet the definition of “interchangeable drug” per the Drug Interchangeability Update, the decision to dispense an interchangeable drug is not adapting.

  • When an approved protocol exists

    In practice environments where a governing body of a hospital or College Board has approved a protocol, any prescription changes made in accordance with the approved protocol would not be adapting.

  • When the pharmacist is continuing therapy by supplying a few doses

    PPP-31 authorizes pharmacists to provide emergency supplies to ensure continuity of care. When only a few doses are required because an appointment with the prescriber is imminent, this does not align with the intent of PPP-58 and would not be considered adapting.

What is a primary health care provider?
Primary health care providers are usually the first people you see when you have a health concern or question. They may include health professionals like family doctors, nurse practitioners, and naturopathic doctors.
Do I always need to obtain consent to adapt a prescription? Do I need to document consent?

In BC, the obligation to obtain informed consent to healthcare from an adult patient, the criteria for consent and how to obtain consent, is defined in the Health Care (Consent) and Care Facility (Admission) Act.

The act states that every adult patient has the right to give, refuse or withdraw consent to treatment. Providing treatment by adapting a prescription in accordance with PPP-58 requires the pharmacist to obtain consent from the particular patient.

In BC, the age of majority is 19 years. Normally, a parent or guardian provides consent to healthcare on behalf of the minor. However, this is not always the case. The Infants Act provides that a minor may consent to treatment (adaptation of a prescription) if the pharmacist has explained to and is satisfied that the minor understands the nature, consequences and can reasonably foresee risks and benefits of the treatment; and has decided that in the circumstances the treatment is in the infant’s best interest. A parent or guardian cannot overrule the decision made by the minor and is not entitled to disclosure of the information.

Consent may be expressed orally, in writing or may be inferred from the patient’s conduct. PPP-58 requires the pharmacist to document the acknowledgement of informed consent.


Can I provide a renewal for narcotic, controlled drug or targeted substance under PPP-58?

Yes, but only if permitted under a section 56 exemption to the Controlled Drugs and Substances Act. The pharmacist may use their professional judgement to determine if they have the appropriate knowledge and if it is in the patient’s best interest to do so. If they are comfortable with their assessment, they can make the decision to provide an adapted renewal of a narcotic, controlled drug or targeted substance for a duration up to, but not exceeding, the duration originally prescribed.

This only applies to adapted renewals. A pharmacist must not perform other adaptations on narcotic, controlled drug or targeted substances which include changing the dose, formulation or regimen, and making a therapeutic substitution.


Practical Examples
Changing the Dose

You receive a new prescription for alendronate 10mg once weekly for an elderly female patient. The PharmaNet record indicates the patient was previously taking alendronate 10mg once daily for the past year. You have a discussion with the patient and determine the following:

  • The patient has been having difficulty with compliance of the once daily regimen.
  • The physician discussed with her that she was changing the prescription to the once weekly formulation to make it easier for her to remember her dose.

Incomplete Information

You receive a new prescription for an adult female patient for Betaderm 0.1% Cream; Apply TID. The patient indicated that her skin is really dry and scaly and that she would prefer a product with more of a moisturizing effect.

You have a discussion with the patient and determine the following:

  • She had used Betaderm 0.1% Cream for one month and was getting results with the cream.
  • You visually confirm that her skin is dry and scaly.

Incomplete Information

You receive a new prescription for Ramipril – take one tablet daily. No strength is indicated on the prescription. The PharmaNet record indicates the patient has been getting the 10mg strength for the past 6 months.

You have a discussion with the patient and determine the following:

  • The patient confirms that the prescription was intended for the same dose (10mg) as before and that the medication is being used for blood pressure control.

Renew a Prescription

A long standing patient of your pharmacy takes a thyroid supplement and diuretic every day. She comes to the pharmacy and requests a renewal of her prescriptions. You notice in your records that 3 months ago she received the same prescriptions but no refills were authorized. You review the PharmaNet record and determine she has been on the same dose of the same medications for 2 years.

You have a discussion with the patient and determine the following:

  • She confirms that her TSH levels are being regularly monitored as well as her blood pressure.
  • She confirms that she sees her physician every 6 months and that she is due for her follow-up in 3 months.

Therapeutic Substitution

Patient arrives at your pharmacy with a prescription for Prevacid 30mg once daily x 3 months for GERD. You notice the prescription is from the local walk-in clinic physician. You check the PharmaNet profile and determine that the patient has previously been on Rabeprazole 20mg once daily x 6 months and has had Pharmacare coverage through special authorization for the Rabeprazole. You process the prescription for Prevacid 30mg once daily and notice that the patient does not have special authorization for the Prevacid.

You have a discussion with the patient and determine the following:

  • The patient receives social assistance and cannot afford the prescription cost for the Prevacid.
  • The patient had run out of the Rabeprazole prescription last week and couldn’t get to her regular doctor, so went to the walk-in clinic.
  • The patient wanted a renewal of the prescription she was previously on for her heartburn, but she couldn’t remember the name of it when she went to the clinic and she didn’t have her empty vial with her.
  • Her previous prescription had been controlling her symptoms very well and she had not had any side effects.
  • Patient is anxious to get her Rabeprazole medication as her symptoms have increased over the past week since she has been out of her medication.

Note: In the ‘Notification’ section of the form you would indicate that both physicians were notified of this adaptation.