Overview

Change is the only constant, they say—and by Jove it tends to be fickle as well.

Provincial pharmacy associations lobby for years to have a seat at government tables, pharmacy regulators watch their recommendations for expanded scopes of practice gather dust while awaiting the legislative green light—then in a relative blink of an eye the lawmakers decree, “Pharmacists will prescribe! Pharmacists will conduct medication reviews! Pharmacists (and physicians and nurse practitioners and other providers) will collaborate!”

What took years to communicate, receives mere months to implement. Welcome to the unpredictable and confusing nature of healthcare reform, focusing on the pharmacy stage.

No two provinces alike

Complicating matters is the fact that, like all things Canadian, each province is unique in its approach. Provincial governments and pharmacy regulators alike have their own interpretations and requirements for expanded scopes of practice. Over time, one hopes that the differences translate into shared best practices, but meanwhile the onus is on the individual to know what is, or is not, allowed in his or her own province—and not be confused by the variations reported from across Canada. The chart below gives a snapshot of where the provinces currently stand; for details, go to Provincial Summaries.

Pharmacists’ Expanded Scopes of Practice: At-A-Glance Review

Province

Description of legislation & other key points

Key dates
B.C.
  • Pharmacists may adapt prescriptions to renew, substitute and adjust dose/formulation/directions of use (latter two restricted to certain conditions or classes of drug)
  • In B.C., the correct terminology is “adapting a prescription” (as part of medication management), not “prescribing”
  • So far, B.C. is the only government to pay pharmacists for adapting prescriptions

Effective January 2009
Alberta
  • Three options for prescribing: to adapt prescriptions (renew, substitute and adjust dose/regimen/formulation); in an emergency; to initiate a prescription or manage ongoing therapy (for those with additional authorization only)
  • Pharmacists in Alberta may also administer injections upon completion of training
  • So far, Alberta is the only province to offer additional prescribing authority for pharmacists wishing to initiate prescriptions and manage ongoing therapy

Effective April 2007
Saskatchewan
  • Two levels of prescribing proposed: level one is available to all pharmacists and includes renewals and refills, emergency prescribing, medication reconciliation and other activities; level two requires additional training and credentials (e.g., to prescribe oral contraception)

Implementation of level one prescribing anticipated in October 2009
Manitoba
  • Prescribing authority is part of an expanded scope of practice for pharmacists under the new Regulated Health Professions Act, recently introduced by government; details to come upon completion of supporting regulations

Government has appointed a mediator to hasten completion of supporting regulations
Ontario
  • Proposed amendments to the Pharmacy Act include prescribing authority, administering substances by injection or inhalation and ordering lab tests; details to come upon completion of supporting regulations

Passage of new Act anticipated in fall 2009; however, supporting regulations need to be drafted and approved
Quebec
  • Quebec is currently not pursuing independent prescribing authority for pharmacists
  • Existing legislation enables physicians to delegate authority to pharmacists to initiate or adjust medication therapy, according to direction from the physician and to make use, where applicable, of lab results

Legislation for delegated authority in effect since January 2003
New Brunswick
  • New legislation enables pharmacists to adapt prescriptions (e.g., renewals), prescribe in emergency situations, prescribe nonprescription drugs, treatments and devices, and prescribe within a collaborative practice setting.

Effective October 2008
Nova Scotia
  • The regulatory bodies for pharmacists and physicians are able to enter into direct agreements regarding expanded scope of practice
  • The first agreement, The Continued Care Prescriptions Agreement, enables pharmacists to extend prescriptions
  • Additional agreements, enabling pharmacists to administer injections and adjust dosages, are underway

The Continued Care Prescriptions Agreement took effect in 2006
P.E.I.
  • Prescribing authority is part of an expanded scope of practice for pharmacists under the amended Pharmacy Act; details to come upon completion of supporting regulations

Supporting regulations underway since May 2008
Newfoundland & Labrador
  • The regulatory bodies for pharmacists and physicians are in discussion to amend the Pharmacy Act to include an expanded scope of practice

Timeline indeterminate

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