Information for Pharmacists: Minor Ailments and Contraception Service

For pharmacists using the medSask Pharmacist Assessment Records for documentation of MACS assessments, please use the most up-to-date BC version of the forms released on May 31, 2023. These forms have been updated to support compliance with PharmaCare documentation requirements.

You will notice that the current versions of the forms have confirmatory checkboxes for “Informed Consent”, “PharmaNet Check” and “Patient Eligible” at the top of the PARs.

To access the medSask guidelines please visit https://www.bcpharmacy.ca/medsask (ensure you are on the BC tab once you are on the medSask site).

Yesterday, BCPhA President Chris Chiew and I were pleased to join B.C.’s Minister of Health Adrian Dix for the formal announcement of pharmacist prescribing for minor ailments and contraception. And today, patients across the province will be able to access these services.

Yesterday was genuinely historic. B.C. pharmacists now have some of the broadest scopes of practice in the country. They have wide authority to renew, adapt and make therapeutic substitutions for many medications; they have injection authority for all publicly funded vaccines and various therapies; and now they add the ability to diagnose and treat 21 minor ailments and prescribe for them and contraception. And in all instances this work is compensated for.

The trust that was earned throughout the pandemic built the foundation upon which additional opportunities to provide timely access to patients is possible.

Like all other provinces, the stresses on the primary care system are great. Part of the solution is ensuring that each member of the patient care team is working to their maximum expertise and delivering the best care to patients in need. Community pharmacists are now far better positioned to do that than even a year ago.

The Minister also announced a provincial appointment booking system will be available on June 29. This system, similar to ImmsBC, will not only help patients find a pharmacy, but will also help pharmacy teams in managing their workflow. The BCPhA will be working to help your teams prepare for this launch.

No doubt, the launch of this major new service will bring with it some bumps in the road. But with the goal of increasing timely access to patients clearly in our collective path forward, I have no doubt of the significant contribution pharmacists will continue to make to the patients of B.C.

I would be remiss in not thanking our Minister of Health for his leadership and dedication in meeting the primary care challenges. His ministry team and the team at the College of Pharmacists pulled out all the stops to get us to where we are today.

And I appreciate all the organizations and pharmacists that have made time to provide input on how best to move forward with diagnosing and prescribing authority for minor ailments and contraception.

Over the years many have advocated for the new authority pharmacists now have, and there are many who contributed to this success. Thank you all who added your voices to the calls for patients needing this critical access.

Today is indeed a good day. 

Geraldine Vance
Chief Executive Officer
BC Pharmacy Association

Media Release

(Vancouver) May 31, 2023 —  Starting tomorrow, June 1, community pharmacists across British Columbia will be able to prescribe for contraception and many minor ailments, like indigestion, cold sores, mild acne, and uncomplicated urinary tract infections.

This expanded access means British Columbians can visit a local pharmacy to see their pharmacist for a prescription for any one of 21 minor ailments or contraception. This change helps relieve the burden on the B.C.’s primary care system and emergency rooms and allows patients convenient access to get treatment for common ailments. 

“Pharmacists are one of the most accessible health care providers in B.C., and we are here for patients when they need us,” says Pharmacist Chris Chiew, President of the BC Pharmacy Association. “We are here and ready to help British Columbians when they need us."

There are more than 1,400 community pharmacies across the province, in communities large and small. On June 1, more than 1,100 pharmacies will be available to provide this service. Over the coming weeks and months, more pharmacies will be adding the service for patients. 

“Pharmacists have the expertise and training to help provide greater access to primary care when patients need it,” Chiew says. “We are pleased to continue working with our primary care colleagues to help ensure British Columbians are cared for.” 

Last fall, in a move to help provide greater access to primary care, B.C. pharmacists were able to renew prescriptions for a wider range of medications, including mental health medications. This meant British Columbians needing timely access to their medication could ensure they’d be able to continue their treatment. Since these changes, B.C. saw a 120 per cent increase in the number of prescriptions renewed or adjusted by pharmacists, according to recently released data by the province.

Pharmacists were also given the ability to renew a prescription for up to two years for most medications. As before, pharmacists can provide an emergency supply of the majority of chronic medications for patients to ensure no patient goes without the medications they need. 

“We don’t want to see any British Columbian having to go to an emergency department for a simple skin rash, indigestion, a prescription for birth control, or to renew their prescription,” Chiew says. “Pharmacists are here to provide relief when people need it.”

For more information on what minor ailments pharmacists and contraception pharmacists can prescribe for and to find a pharmacy offering this service, visit seeyourpharmacists.ca.

May 17, 2023

As part of the on-going implementation process for minor ailment and contraception prescribing by pharmacists, the pieces are in place for pharmacists to begin to offer the service to their patients on June 1.  A central booking system will follow the launch. It is expected that by the end of June the central booking system will be operational.

In the early days and weeks of the new patient care support being implemented, pharmacies can manage patient demand as best suits them – walk-ins, their own booking system or a combination of the two. It is fully expected that capacity across the province to have access to pharmacist prescribing will build over time. 

This is a very exciting time for pharmacists and their patients. Having the opportunity to fill gaps in care will make a meaningful difference in the lives of British Columbians.

A wide range of support tools is available to assist pharmacists in moving forward with implementing this new prescribing authority. More is on its way.

• The College of Pharmacists of BC has issued its Standards, Limits and Conditions for the new prescribing authority.
• The College has released a mandatory Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC): Regulatory Education Module. Pharmacists must complete this module prior to prescribing for minor ailments and contraception.  
• The Prescribing Minor Ailments (PMA) – The Fundamentals continuing education program is available through UBC CPPD at no cost to pharmacists. Additional courses on Contraception, Smoking Cessation, and other Minor Ailment topics will be released in the coming months.  
• MedSask Minor Ailments and Self-Care Guidelines are available to all B.C. pharmacists and students at no charge through the BCPhA website.  
• A BCPhA MACS Orientation module will be released over the next few weeks to provide some practical insights on conducting the minor ailment and contraception service. 

B.C. pharmacists have asked for training and resources for B.C.’s Minor Ailments and Contraception Service (MACS) to be made available prior to the June 1, 2023, launch date.

The BC Pharmacy Association (BCPhA) is pleased to announce that medSask’s resource “Minor ailment and self-care guidelines” for pharmacists in B.C. is now available at no cost to all pharmacists and pharmacy students in British Columbia. You can log on now to access this resource.

This resource, funded by the B.C. Ministry of Health, provides treatment algorithms as well as patient assessment and treatment templates for each condition. The resource is meant to serve as a tool to aid decision-making when assessing for minor ailments. Pharmacists are expected to exercise their professional judgment in their recommendations and prescribing practices. Please also note that medSask materials may not reflect the standards, limits and conditions set out by the College of Pharmacists of BC, or requirements for funding as determined by the B.C. Ministry of Health.  

Who’s eligible for complimentary access: 

All licensed pharmacists and pharmacy students registered with the College of Pharmacists of BC can access this free resource.  

How to access medSask:

Visit https://bcpharmacy.ca/medsask to learn more and to login.

Other educational materials:

Free accredited clinical education modules on several minor ailment conditions are now available to licensed B.C. pharmacists through UBC’s Continuing Pharmacy Professional Development program (CPPD). To access these resources, visit the UBC MACS on Canvas course catalog. 

Additional training and resources that will be made available prior to the June 1 launch: 

• An educational module to support pharmacists’ understanding of the regulatory changes and requirements by the College of Pharmacists of BC 
• A BCPhA orientation training module on prescribing for minor ailments and contraception that focuses on B.C.-specific requirements around PharmaCare and practice requirements.
• Accredited content on contraception and smoking cessation available from CPPD in summer 2023.

This afternoon, March 16, 2023, regulations that will allow for pharmacists to prescribe for minor ailments and contraceptives were posted on the Government of British Columbia’s web site.

As you may be aware, changes are to be made to B.C.’s Health Professions Act under the Pharmacists Regulation section. These proposed amendments are the first -- but an essential step to allow pharmacists to prescribe for minor ailments and contraceptives coming later this spring. Following the adoption of these amendments, the College of Pharmacists of BC will then work on changes to the Standards, Limits and Conditions.

Included in these proposed amendments are the types of minor ailments B.C.’s pharmacists will be able to prescribe for as well as the schedule of drug types, if adopted:

The BC Pharmacy Association welcomes these proposed amendments and looks forward to continuing to work with the Ministry of Health and College of Pharmacists of B.C. to support pharmacists in these exciting scope changes.

Updated: Oct. 31, 2022

Effective Oct. 14, 2022, changes came into effect to the College of Pharmacists of British Columbia's Professional Practice Policy 58-Adapting a Prescription.

These changes mean that community pharmacists in British Columbia are now able to renew and adapt prescriptions for a wider range of medications. Restrictions have also been lifted on which medications can be administered by injection and intranasally. Pharmacists can administer B12 shots, anti-psychotics and other medications through injection if there is a prescription. Excluded from this are cosmetic drugs and substances or allergy serums. Pharmacists can not inject these.

Additionally, the expiry date of a valid prescription has changed from 12 months to 24 months effective Oct. 14, 2022, according to changes in the Health Professions Act Bylaws. 

Highlights of the changes include:

• Renewals and adaptations: They can now be provided on prescriptions for any condition, with the exception of cancer chemotherapy, for patients who have been on the same dosage of their medications for a minimum of 6 months. This includes mental health medications. There are limits to narcotics and controlled substances.
   
• Narcotics and controlled substances: Pharmacists will be able to provide a one-time only renewal for narcotic and controlled substances, including Opioid Agonist Treatment, for the length of the original prescription. 
   
• Limits on making changes to a prescription’s dosage, formulation or regimen and therapeutic substitutions have also been lifted – with the exception of prescriptions for narcotic and controlled substances and cancer chemotherapy.
   
• Emergency supply of medication: While pharmacists have been able to do this, expanding the length of these refills -- when appropriate -- is important to patients who don’t have a prescriber or have difficulty in accessing a prescriber. Depending on a patient’s specific situation, dispensing up to a 90-day supply is appropriate, assuming they have been on the same dosage of their medications for a minimum of 6 months.
   
• Restrictions on which medications can be administered by injection and intranasally have been lifted.Pharmacists can administer B12 shots, anti-psychotics, and other medications through injection if there is a prescription. Excluded from this are cosmetic drugs and substances or allergy serums. Pharmacists cannot inject these.

B.C.'s Minister of Health announced on Sept. 29, 2022 that work will start immediately to enable community pharmacists to have prescribing authority for minor ailments and contraceptives to go into effect by spring 2023. The BC Pharmacy Association is fully committed to working with the Ministry of Health and the College to move this component forward quickly.

Resources: 

• Adapting a prescription - 1-page information sheet
• Adapting Prescriptions - BCPhA e-training course FREE (worth 2.0 CEUs)*

*If you already have a BCPhA account, you have automatically been enrolled in the course. This course should appear in your eTraining portal.

Does the extended 24-month expiry apply to prescriptions written before October 14, 2022?

Yes. The 2-year expiry extension also applies to prescriptions written before October 14, 2022. Pharmacists may adapt and renew prescriptions up to two years from the original prescription date, if appropriate.

Does the 2-year expiry date apply to all prescriptions?

As per PODSA bylaw Section 10(5), the 2-year expiry date applies to all prescriptions. Prescriptions for benzodiazepines or other targeted substances have a 1 year-expiry date, however, the province has permitted such prescriptions a 2 year expiry date under Health Canada subsection 56 exemption to the CDSA. This exemption is set to expire September 30, 2026 or unless otherwise notified by Health Canada.

Do we need a copy of the original prescription when adapting transferred prescription?

No. A copy of the original prescription is not required as the transfer report should have all the relevant information. The original pharmacy is to ensure all relevant notes on the prescription that may not be on the transfer report is to be sent to the receiving pharmacy.

I have a prescription from a physician that has retired. Can I adapt this prescription?

No, the prescription must be current, valid, and not expired. If the physician has retired, the prescription is no longer is valid and therefore cannot be adapted. Using professional judgment, a pharmacist may dispense an emergency supply of prescription drugs to a patient.

Do pharmacists require additional professional liability insurance with the expanded scope?

No. This is covered under the same professional liability insurance as outlined by HPA Bylaw Section 81. See CPBC Professional Liability Insurance.

I have just received a prescription with the following statement “Do Not Renew and/or Adapt” (or something similar) hand-written on it. Does this mean that I cannot adapt or renew this prescription?

As per CPBC FAQ, pharmacists are expected to honour hand-written “Do Not Renew and/or Adapt” instructions on prescriptions. If this is pre-printed on a prescription or a physician electronically produces their prescription, they must sign or initial beside the notation.

Can we adapt off PharmaNet?

No, an original valid prescription is required.

If we are adapting and renewing prescriptions for patients without a family doctor, who do we notify?

The pharmacist must notify the prescriber who issued the original prescription that is being adapted/renewed.

How many times can you provide an emergency supply on a prescription drug?

There are no limits. During this primary care shortage crisis, pharmacists may use their professional judgement as per PPP-31 to provide an emergency supply of medications to patients for an extended period for time to ensure that no patient goes without the medications they need. Depending on the patient's unique situation, pharmacists may provide up to 90 days in an emergency supply.

Can pharmacists adapt prescriptions for non-B.C. residents and get reimbursed the clinical service fee?

To qualify for adaptation fee reimbursement, the patient must be a B.C. resident, but they do not need to be covered by Pharmacare.

Is the maximum clinical service fee per patient per day still capped at $78?

Yes. The maximum PharmaCare reimburses for a combination of clinical services (i.e., prescription adaptations and renewals, medication review services, vaccine administrations and drug administration) is still $78 per patient/same day. The Ministry is currently reviewing this fee limit.

Is there a cap on the number of adaptations we can do on a prescription?

Yes. As per Pharmacare Policy section 8.4 Clinical Service Fees, Pharmacare pays a maximum of two clinical service fees per drug, per person, during a six-month period. This means, currently, pharmacists can adapt the same drug (issued on different prescriptions) for the same patient no more than twice in a six-month period. The BCPhA are working with the Ministry to increase this clinical service fee limitation.

Also to note that a pharmacy can claim fees for any combination of clinical services – prescription renewals, vaccine administrations, drug administrations, drug adaptations and medication reviews – to a daily maximum of $78 per patient.

It is expected there will be an increased number of clients without GPs requesting for renewals or adaptations. In some cases, it may be inappropriate to adapt.  Is there a consultation fee when we cannot adapt?

In some cases, patients may need to be referred to practitioner. A mechanism to support more complex clients requiring a prescription is being established by the Ministry, so pharmacies can refer them to a virtual prescriber to get a prescription in a timely way.