By Janice Harvey, RPh, CDE
The BC government has a current ad campaign that says, “Make Your Pharmacist Part of Your Healthcare Team,” which then promotes some of the services that pharmacists can provide:
- Assess and treat 21 minor ailments
- Prescribe free contraceptives
- Administer vaccines and medical injections
- Renew prescriptions and provide emergency refills
Can a pharmacist prescribe for a urinary tract infection? Yes, if it’s considered uncomplicated. What about an ear infection? No, not at all. How about injection of vitamin B12? In some cases, yes. How about renewing a prescription? Yes, but not for all medications. How can anyone make sense of it all?
Let’s start with minor ailments
A minor ailment is one where the condition can’t easily be mistaken for something more serious. During a minor ailment assessment, your pharmacist will ask questions that help to ensure the correct diagnosis and rule out other possibilities, because what seems minor could be more complicated.
Let’s consider urinary tract infections (UTIs) as our example of a minor ailment. Symptoms typically include frequent urination, pain when urinating, and cloudy or foul-smelling urine. If you’ve previously had a UTI, you know what it feels like — and if you think you have a UTI, you’re probably right. In most cases, pharmacists will be able to prescribe an antibiotic and make additional recommendations. However, there are some individuals for whom we can’t prescribe: individuals living in long-term care, youth under 16 years of age, men, and pregnant women. And sometimes it is necessary to refer, such as when an individual experiences recurrent UTIs, or if a patient is at increased risk for a complicated infection. In those cases, the antibiotics that pharmacists can prescribe may not be the best choice.
If a pharmacist chooses to refer you to another prescriber, it doesn’t mean that they are not capable of understanding your condition or don’t want to help. In fact, we want you to have the best care possible. The limitations are in place for your health and safety. For more information, please read our previous article about pharmacist prescribing or visit the government website at gov.bc.ca/SeeAPharmacist.
Not all contraceptives are free
Pharmacists may also prescribe hormonal contraceptives. Whether prescribed by a pharmacist, a physician, or a nurse practitioner, there are some contraceptives that are fully covered by PharmaCare, some that are only partially covered (e.g., brand-name options), and some that are not covered at all (e.g., Lolo). An up-to-date list of contraceptives that are partially or fully covered is available online.
Some injections, not others
Pharmacists can give most vaccines and administer many drugs by injection. Vaccines are not limited to those for flu and COVID-19, but also include vaccines for shingles, pneumonia, RSV, tetanus, measles, and more.
Unlike vaccines, injectable medications can only be administered by a pharmacist if they have been prescribed by a physician or nurse practitioner. Thus, if you purchase a vial of vitamin B12 directly (without it being prescribed), then you will also be responsible for doing your own injection. Pharmacists can do the injection only if it has been purchased as a prescription medication.
To make it more confusing, some medications that come in prefilled syringes are intended for patient self-injection, while others are meant to be injected by a healthcare provider. Pharmacists can inject the latter. Please ask us if you need assistance with an injection and are not sure if it is something that our pharmacists can do.
Renewals vs. emergency fills
When a pharmacist renews a prescription or provides an emergency supply of any medication, they are not actually “prescribing” a medication; rather, they are “dispensing” it. And there are limitations.
A pharmacist can renew a prescription to ensure you won’t have a disruption in your treatment, but there must have been no clinical change to your prescription for 3 to 6 months and the health condition being treated has to be stable. It’s important to understand that the pharmacist is not obligated to provide you with a renewal. The pharmacist must have enough knowledge of the health condition and your health status to be able to make the decision to renew or not to renew. By getting your prescriptions at one pharmacy, you develop a relationship with the pharmacists, and they will have access to all your health information, so they can be confident in making decisions that affect your health.
Wherever possible, pharmacists should be renewing a prescription, rather than providing an emergency supply. The renewal can be for a longer duration, as long as it doesn’t exceed the expiry date of the prescription. An as example, if your doctor has provided a prescription for 3 months of your blood pressure medication, with no refills, your pharmacist will likely want to extend the prescription rather than provide an emergency supply, unless you have an appointment scheduled and simply need a small supply to last until the appointment. When renewing the prescription, the pharmacist may ask you to have your BP taken in the pharmacy to make sure the medication is providing adequate BP control.
What if the prescription is for a new medication and the doctor prescribed it for just one month, as they wanted to be able to reassess how well the treatment was working at the end of that month? In this situation, a pharmacist cannot renew the prescription. But what if something comes up and you can’t get to the appointment for reassessment? Your pharmacist may decide to provide an emergency supply for a short period of time (a week, perhaps) so you can continue to maintain treatment until a reassessment can be done. An emergency supply is usually provided for a week to 10 days, though it could be for longer, if appropriate. Another example of this could be when you’re vacationing and forget your medications at home. Or you’re moving and can’t find the box that your medications are in.
Still confused?
We wouldn’t be surprised! If you need help with anything to do with your medications, please ask. We will always do what we can to help, within our limitations.
As of August 1, there have been additional changes to the policy on adaptations, which includes not only renewal of prescriptions, but also changes to dose, directions for use, and even the drug itself. And as of August 30, some pharmacists in BC will be able to order certain lab tests, though there will be limitations to that, too. We will look at the changes in more detail over the next couple months.