Expansion of Pharmacy Services – Common Questions from Townhall Information Sessions
On October 14th, practice changes were implemented to expand the range of services available at BC pharmacies in order to improve healthcare access for British Columbians who have been affected by the shortage of primary care providers.
These practice changes include the following:
- Removal of 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.
- Amendments to 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.
On October 18th and 20th, the College participated in two virtual townhall information sessions, hosted by the Ministry of Health, to discuss the implications of these changes on pharmacy practice in BC. This article provides clarity on some of the most common questions received from registrants during those sessions.
The College has implemented several temporary changes to practice in response to COVID. Has there been any consideration for making these changes permanent?
Many of the temporary exemptions implemented by the College are enabled by Health Canada’s subsection 56 exemptions to the Controlled Drug and Substances Act that has been in place since October 2020. At this point in time, Health Canada has stated that the exemptions will expire on September 30, 2026 or earlier if they are revoked or replaced by another exemption. As a result, the College is unable to make these changes permanent.
However, other temporary changes to PPP-58, that were not contingent on Health Canada’s subsection 56 exemptions, have become permanent with the recent updates, such as the expansion of therapeutic substitution and allowing transferred prescriptions to be adapted.
Any temporary changes will continue to be reviewed on an ongoing basis.
Are pharmacists now allowed to perform intramuscular and subcutaneous injections in sites other than the deltoid and tricep area?
Yes. However, the pharmacist would be responsible for ensuring that they have the knowledge, skills and abilities to ensure that they are able to safely administer the injection at the required site. The College encourages pharmacists who self-identify any learning needs to seek out additional training.
Does the extended 2-year validity period apply to all prescriptions?
Currently, all prescriptions are valid for 2 years. This includes prescriptions for controlled substances, narcotics and benzodiazepines or other targeted substances. Health Canada’s subsection 56 exemptions to the Controlled Drugs and Substances Act that is currently in place allow the College to apply the 2 year expiry date to benzodiazepines and other targeted substances. However, when the section 56 exemptions expire, the expiry of benzodiazepines and other targeted substances will revert back to 1 year, as stipulated in the Benzodiazepine and Other Targeted Substances Regulation.
With the amendments to PPP-58, have there been any changes to the documentation and notification requirements for adaptations?
Pharmacists are still required to document the details of their adaptation and notify other health professionals. The specific documentation and notification requirements can be found in PPP-58: Adapting a Prescription. The College considers documentation an important component in establishing accountability and responsibility for performing prescription adaptations.
If a pharmacist has already provided an emergency supply but the patient was unable to get a prescription during that time, can the pharmacist issue another emergency supply?
A pharmacist may issue an emergency supply after an initial emergency supply has been provided, if appropriate. It would be up to the professional judgement of the pharmacist to assess the appropriateness of each emergency supply to ensure they have sufficient information and that the quantity issued is reasonable in the given circumstances.
Can a pharmacist transfer a prescription that has no refills remaining to another pharmacy for subsequent renewal at the other pharmacy?
No. As per our bylaws, a “prescription transfer” means the transfer via direct communication from a registrant to another registrant of all remaining refill authorizations for a particular prescription to a requesting community pharmacy. A prescription must have remaining refills in order to be transferred. In these cases, the pharmacist who has the original prescription may adapt the prescription or a pharmacist at the other pharmacy may consider providing an emergency supply, if appropriate.
Can a pharmacist adapt an adapted prescription?
No. A pharmacist cannot adapt an adapted prescription. However, a pharmacist may choose to issue an adaptation with refills, if appropriate.
Can a pharmacist perform adaptations if they do not have an original prescription?
No. As per PPP-58, a pharmacist must have an original prescription that is current, authentic and valid. Under PPP-58, this includes transferred prescriptions.
Pharmacists are not allowed to adapt prescriptions for cancer chemotherapy agents. Does this include adjunct therapies such as antinauseants that are prescribed with chemotherapy drugs?
No, this limitation does not extend to cancer therapy adjunct treatments and a pharmacist may adapt these drugs, if appropriate.
With the changes to PPP-58, pharmacists can now perform renewals on narcotic drugs, while permitted by Health Canada’s subsection 56 exemptions. Does this include drugs for OAT?
Yes. When permitted under a section 56 exemption to the Controlled Drugs and Substances Act, a pharmacist may use their professional judgement to provide a renewal for a narcotic, controlled drug or targeted substance under PPP-58, including OAT drugs. The pharmacist must use their professional judgement to determine if they have the appropriate knowledge and understanding of the condition and the drug, as well as sufficient information about the patient’s health status to ensure the adaptation will maintain or enhance the effectiveness of drug therapy and will not put the patient at increased risk. Adapting a prescription must only be done if it is in the patient’s best interest to do so. The pharmacist must be able to justify their rationale, and would be limited to providing a renewal for a duration up to, but not exceeding, the duration originally prescribed.
As the subsection 56 exemptions only allow pharmacists in BC to renew controlled substances, adaptations of these drugs is limited to renewals only. 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.
Have any training requirements been established for pharmacists who would like to prescribe for minor ailments?
The College is now working with the Ministry of Health and other partners to develop and implement standards for pharmacist prescribing for minor ailments and contraception, to ensure that BC pharmacists are qualified and able to deliver these services in a way that ensures the health and safety of British Columbians.
The implementation of prescribing authority for minor ailments and contraception is planned for Spring of 2023. More information on this initiative will be provided as it becomes available.
Is there an age restriction on patients for who we can provide renewals for?
No. There is no age restriction and as always, the pharmacist must use their professional judgement to determine the appropriateness of the adaptation.
For additional questions about these changes, please contact the College’s Practice Support Team at [email protected].