B.C. pharmacists given power to renew prescriptions

Pharmacists in B.C. will have the ability to renew prescriptions, alter dosages and dispense substitute drugs without the oversight of a doctor beginning in January.

The province is following Alberta's lead, which started the practice last year as a way to increase access to medication despite the shortage of doctors.

Soon afterward, the B.C. Pharmacy Association began lobbying the provincial government to institute a similar system in B.C. The change takes effect Jan. 1, 2009.

Health Minister George Abbott stressed that in B.C. the pharmacists' new power applies to routine renewal of prescriptions for conditions such as high blood pressure that don't require people to see a doctor each time.

He said the province is trying to work out a fee structure for the service with the B.C. Pharmacy Association. The association had proposed charging patients, but Abbott said that won't happen.

'To keep going [to a pharmacist] when there's no clinical monitoring, I think is dangerous.' — Dr. Shelley Ross, family physician

"I advised the pharmacy association [Thursday] morning, and I'm trying to do it in the clearest terms possible, that we will either have routine renewal of prescriptions by pharmacists on the basis of a fee negotiated between the province and its pharmacy association, or there will be no prescription renewal by pharmacists," he said in an interview.

"There will not be any renewal with fees out of the pockets of the public for routine renewal of prescriptions."

Abbott said the Medicare Protection Act already allows patients to renew routine prescriptions without charge so it wouldn't make sense for pharmacists to charge clients for the same service.

Dr. Shelley Ross, a family physician for the last 30 years, said that while she regularly consults with pharmacists about interactions between various drugs and appreciates their expertise, she doesn't agree with the new policy.

'Pharmacists are given … very strict criteria on how they can make the adaptation to a prescription.' — Marshall Moleschi, College of Pharmacists of B.C.,

Ross said giving pharmacists the power to deal with chronically ill patients to the point that they can substitute drugs and alter dosages isn't right because they don't have the patient's medical history and don't do the clinical follow-up.

"To keep going [to a pharmacist] when there's no clinical monitoring, I think is dangerous," Ross said.

"I have no problem with somebody adjusting a dose of medicine or exchanging one for another if they're equal. But who's going to take the responsibility? This is why you need a doctor because when things go wrong, who are you going to blame? Because the buck stops here."

Marshall Moleschi, registrar for the College of Pharmacists of B.C., said pharmacists are the experts when it comes to knowledge about prescription medications.

He said the college has developed a policy to ensure patient safety and that the change will make for a more comprehensive health-care system.

"It's adding capacity to the system," Moleschi said. "Pharmacists are given, through the policy and the guidelines, very strict criteria on how they can make the adaptation to a prescription, and there has to be good communication with the original prescriber."

Moleschi said that in Alberta, pharmacists have applied the policy change to about one per cent of prescriptions. In B.C., a total of 43 million prescriptions are dispensed every year.