Ontario pharmacists will soon prescribe some medications. But it's not clear who will pay for it

Soon a trip to the pharmacist might save you a trip to the doctor in Ontario. 

Pharmacists are getting new powers on Jan. 1, 2023, that will allow them to prescribe medications for 13 minor ailments including urinary tract infections, tick bites, pinkeye, cold sores and dermatitis.

But with the change just five weeks away, it is still not clear if Ontarians will have to pay out-of-pocket for the service. That's because pharmacists are still waiting on details from the Ministry of Health, said Jen Belcher, a vice president at the Ontario Pharmacists Association.

"Pharmacists are looking to be ready to do this for our patients in January because we know the need," she said. "Where it's been challenging is the absence of information on what the program will look like in terms of funding and how to plan for it."

The move is intended to reduce the load on primary care physicians and emergency rooms, said Nardine Nakhla, a Scarborough pharmacist and professor at the University of Waterloo School of Pharmacy, who was one of the architects of the new regulations.

"It's within our knowledge and clinical expertise; this is just adding tools to that toolbox," she said. "It's going to help us ensure patients have access to care outside of the typical nine to five medical model."

For its part, the Ministry of Health said it will soon have more to say, but did not respond to questions about funding.

Peterborough pharmacist Samier Kamar is ready to launch in the new year despite the lack of communication. In a community where nearly one in 10 people don't have a family doctor, Kamar said he spends his days triaging questions and making referrals for people who have few other options, even setting up a virtual telemedicine service to connect patients directly to doctors on site.

He said the new changes can't come soon enough.

"It's frustrating for me because I'm seeing all these patients," he explained. "I can do a lot, but also, I can't."

The new prescribing regulations — which require pharmacists to complete a mandatory one-hour online course — are part of Ontario's expanded scope of practice that began in 2019. Pharmacists can now administer injections and, since July of this year, offer point-of-care tests to help patients manage chronic conditions like diabetes and cardiovascular disease.

Ontario behind other provinces

Ontario lags other provinces like Alberta, where pharmacists have been allowed to prescribe all drugs except narcotics and controlled substances since 2007, says Alzeen Virji, who owns a pharmacy in Toronto and previously owned another in Calgary. Virji said one of the big challenges is Ontario's fragmented information systems.

"We don't have good systems here to support collaborative team-based care," he said, making it harder to share information with family doctors and notify them if a drug is prescribed.

"You need the tools to be able to create a good care plan."

Belcher is concerned this lack of integration will create additional administrative challenges at a time when pharmacists are already struggling with workload and staffing.

"From all of the conversations that we've had, if there is not a funding model in place, there would be a paid model" to offset the pharmacists' costs to ramp up, she said.

Nakhla said that new services won't be available overnight, but she still sees big opportunities over time, pointing to similar steps taken in other provinces.

A 2019 University of Waterloo study estimated that almost one third of non-urgent emergency room visits were for conditions that could potentially by managed by pharmacists if they had the scope of practice available in other parts of the country.

Time is short, warned Belcher.

"All of the policy and programmatic elements that go into what is required, all of that still needs to be set."