Changes to Optimize Services Available at Community Pharmacies Now in Effect

Changes to Optimize Services Available at Community Pharmacies Now in Effect

On Thursday, September 29th, 2022, British Columbia’s Minister of Health, the Honourable Adrian Dix announced the expansion of pharmacy services available in BC in order to improve healthcare access for British Columbians who have been affected by the shortage of primary care providers. 

As part of this expansion of services, the College worked collaboratively with the Ministry of Health to introduce the following practice changes for BC pharmacists:

• Removing restrictions on Drug Administration allowing pharmacists to administer most Schedule I, IA, and II drugs, including controlled drugs by injection and intranasal route, with the exception of cosmetic drugs and substances, and allergy serums.
• Amending Professional Practice Policy 58: Medication Management (PPP-58), removing most restrictions on the drugs and conditions pharmacists can adapt prescriptions for.
• Extending the period of time a prescription is valid for from one year to up to two years.

These changes are now in effect.

Providing an Emergency Supply of Medications for Continuity of Care as Needed

Professional Practice Policy 31 Emergency Supply for Continuity of Care (PPP-31) allows pharmacists to provide an emergency supply of medications to patients without a valid prescription for an extended period of time, to ensure that no patient goes without the medications they need. 

Although the changes to Professional Practice Policy – 58: Adapting a Prescription (PPP-58) provide pharmacists with more opportunities to perform adaptations, pharmacists may still consider providing emergency supplies under PPP-31 in situations where a prescription is not eligible for a renewal or the pharmacist determines an emergency supply is more appropriate.

Adaptations & Renewals vs Emergency Supplies

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 date 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. 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. At the pharmacist’s discretion, the total quantity authorized for the renewal may be issued as a single dispense or with refills, as appropriate, taking into consideration any patient specific needs. 

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. However, as there are no strict limitations with respect to the quantity authorized for an emergency supply, a pharmacist may use their professional judgement to determine a quantity that is reasonable in the given circumstances, taking into consideration all patient-specific factors and the drug involved.

There may be many reasons a pharmacist chooses to provide an emergency supply rather than a 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.

The following scenarios illustrate how pharmacists can utilize both their ability to perform adaptations and their ability to provide emergency supplies of medication to ensure continuity of care for their patients.

1. Prescriber is no longer practicing
   If a prescriber is no longer a licensed practitioner (i.e. they have retired or have otherwise decided to stop practicing), any prescriptions they wrote while licensed are no longer valid. As one of the requirements for performing an adaptation is to have a current, authentic, and valid prescription (note: in PPP-58, an original prescription may include a transferred prescription), a pharmacist would not be able to adapt a prescription written by a prescriber who is no longer licensed to practice. In these cases, a pharmacist may consider providing an emergency supply to the patient, if they determine it to be appropriate.
    
2. Prescription has expired
   If a prescription has expired, a pharmacist may provide an emergency supply, if appropriate, in compliance with PPP-31.
    
3. Prescription has already been adapted 

   As per the limits in PPP-58, a pharmacist must not adapt a previously adapted prescription. This means that after a prescription has been adapted or renewed (which can be issued with refills), it can’t be adapted or renewed again. If a patient runs out of medication, and their prescription has already been renewed or adapted, a pharmacist may consider providing an emergency supply, if appropriate.

4. Prescription has been transferred 
   Under PPP-58, an original prescription may include a transferred prescription. If a pharmacist has received a transfer from another registrant, they may adapt this prescription. However, as a prescription must have remaining refills in order to be transferred, if a prescription has run out of refills, it cannot be transferred to another pharmacy for subsequent adaptation. In these cases, the pharmacist who has the original prescription may adapt the prescription or another pharmacist at another pharmacy may consider providing an emergency supply, if appropriate.