FAQs for Pharmacists on Minor Ailments and Contraception Services

Eligibility must include ALL of the following: 

1. Be a resident of B.C. (Must have a permanent address in B.C., verified by a B.C. driver’s licence, BC Services Card or other ID) 
2. Have a BC Personal Health Number (PHN) (B.C. residents with a PHN are eligible, even if they are not covered by or registered with PharmaCare, such as beneficiaries of Non-Insured Health Benefits, Veterans Affairs Canada and Canadian Armed Forces 
3. Not be covered under PharmaCare Plan B (Long-Term Care) (Patient is under the care of another healthcare provider) 
4. Have a clinical need for service (Patient must self-identify as having a minor ailment listed under Schedule A of the Pharmacists Regulation or a contraception need, and initiate a request for MACS)
5. Active Medical Services Plan (MSP) coverage is not an eligibility requirement.

Pharmacists can charge fees for MAC services for patients who do not meet PharmaCare eligibility. Patients must be informed about the fee and reason for the charge prior to provision of service.  

Of note, pharmacies cannot opt-out of providing PharmaCare funded services in order to charge an eligible patient directly unless they are not registered with PharmaCare (i.e. have opted out of all PharmaCare services including drug billing).

PharmaNet claims for non-eligible MACS should use PIN: 98890089 (Non-benefit minor ailment). In the SIG enter the 10-digit pharmacy phone number first followed by the type of minor ailment or contraception assessment provided. 

Currently, consultations or assessments offered virtually (E.g. phone or online) are not covered by PharmaCare. However, this is being explored by the Ministry.  If Pharmacies provide virtual prescribing for minor ailments and contraception, the PharmaNet claim should use PIN: 98890090 (Virtual non-ben minor ailment). In the SIG enter the 10-digit pharmacy phone number first followed by the type of minor ailment or contraception assessment provided.  

Yes, if the following conditions are met.

• The prescribing pharmacist is an employee or independent contractor of a PharmaCare-enrolled pharmacy that has PharmaNet access
• The pharmacist checks PharmaNet while physically at the pharmacy before the offsite visit
  • If a pharmacist working offsite needs to re-check PharmaNet, they may call their pharmacy for someone onsite to check
  • No offsite (remote) access to PharmaNet is permitted
• The pharmacist submits the claim at the PharmaCare-enrolled pharmacy on the day of the MACS assessment

Pharmacists are not required to use CareConnect, but they are strongly encouraged to sign up, as it can provide important information to assist with the clinical assessment of a patient. 

CareConnect, the Provincial eHealth Viewer, is a secure, view-only Electronic Health Record that delivers patient-centric information to support care providers in the delivery of direct patient care. It provides access to an integrated, provincial view of clinical information (e.g. labs, imaging, clinical documents, and immunizations). 

Clinical service fees for MACS are not adjudicated in real-time on PharmaNet. Claims are adjudicated in monthly batches. Please call the PharmaNet Help Desk about specific claims. The PharmaNet Help Desk has access to payment and claim details and can fax or mail these details (with patient identifiers removed). 

PharmaCare will pay pharmacies $20 for each MACS provided to an eligible patient.

The maximum amount PharmaCare reimburses a pharmacy for either medication reviews or MACS, clinical services (E.g. prescription adaptation), and drug and vaccine administrations for the same patient, on the same day is $78.00. This does not include dispensing fees. 

PharmaCare will not reimburse a medication review service claim and MACS claim for the same patient if both are conducted on the same day. 

PharmaCare will not reimburse a medication review service claim and a MACS claim for the same patient if both are conducted on the same day. 

Yes. A pharmacist may assess and bill for multiple minor ailments for the same patient on the same day. (See minimum time interval between billing for same minor ailment or contraception for further details). 

The minimum time interval between assessments for the same minor ailment or for contraception for the same eligible patient is three days. For example, if a claim was submitted on Monday, the 3-day interval would be Tuesday to Thursday, and an assessment can be eligible for PharmaCare claim again for the same minor ailment or contraception for the same patient on Friday.  

Yes. Pharmacies will need to manually remove the dispensing fee to avoid having it be charged to PharmaCare (first payer). If the patient is already at their weekly/daily dispensing fee limit, dispense the MACS Rx last. This ensures that the fee would not inadvertently be counted towards the patient’s weekly/daily maximum and also allow the dispensing fee to be passed on to a third-party insurer if appropriate. 

The PS intervention code should be entered on the first dispense and does not need to be entered again for refills. This is similar to using an intervention code for adaptation.

Yes.

Yes. See SA drug list and criteria. 

Pharmacists in British Columbia are permitted to prescribe LARC such as intrauterine devices (IUD) according to the Health Professions Act – Pharmacists Regulation. Unfortunately, the medSask guidelines do not include LARC as treatment options since it is beyond the scope of practice for pharmacists in Saskatchewan. BCPhA is working with medSask to update their guidance for B.C.  

When discussing birth control methods, SOGC recommends LARC as a strong consideration for reliable contraception, especially for individuals who are not planning pregnancy soon, within the next year, or never. Pharmacists are encouraged to discuss available contraception options with patients and collaborate with clinics and healthcare providers who provide LARC insertion to improve access to care and ensure appropriate follow-up.

UBC CPPD has developed free and accredited online course to support prescribing contraception:  

• MACS: Case-Based Learning – Contraception 
• MACS: Case-Based Learning – Emergency Contraception 
• Contraception Part I - Hormonal Contraception, LARC and Permanent Contraception  
• Contraception Part II – Emergency Contraception 

As described in the Pharmacists Regulations, a ‘minor ailment’ is defined as a disease, disorder or condition, in the form indicated by the individual's signs and symptoms that: 

(A) presents a low risk of masking an underlying disease, disorder or condition, and  

(B) can be readily diagnosed without the need for laboratory or imaging tests;  

And the individual's signs or symptoms can be reasonably expected to resolve with only short-term or episodic treatment. 

Please refer to the Pharmacists Regulations for permitted drug categories per minor ailment. Pharmacists can prescribe any schedule I drug for the purpose of contraception and emergency contraception.

BCPhA has developed a Product List for Minor Ailments and Contraception as a reference. 

If a drug falls under the approved drug categories listed in Schedule A of the Pharmacists Regulation for the specific disease, disorder or condition a pharmacist must ensure that the intended use is:  

•  An indication approved by Health Canada 
• A best practice or accepted clinical practice in peer-reviewed clinical literature, or  
• Part of an approved research protocol. 

Non-prescription drugs do not require a prescription. Pharmacists can recommend, non-prescription products. First Nations clients have have coverage of certain non-prescription products through PharmaCare Plan W.

Yes. Pharmacist-prescribed prescriptions can be transferred and adapted. 

Minor ailments are typically acute conditions that can be expected to resolve with short-term or episodic treatment. Renewals are typically for continuity of care for stable chronic conditions. Pharmacists must use their professional judgement to determine what service would be most appropriate to meet patient safety and needs, while ensuring their rationale is documented to align with regulatory requirements and policy. 

Minor ailments are generally for acute conditions requiring short-term or episodic treatments. Pharmacists must exercise their professional judgement in deciding whether it is appropriate to issue refills at the time of the initial prescription for a given ailment, while also ensuring that their rationale is documented. The follow-up plan should be designed to ensure that the patient adheres to the intended timeline for their therapy. In cases where the initial treatment fails to produce the desired outcome, or further evaluation is needed for ongoing care, advising a patient to see an alternative healthcare provider may be required. 

Yes. Establishing a follow-up and monitoring plan is mandatory.

According to Standard 16 of the HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions:

“Only a full pharmacist may perform the restricted activities of making a diagnosis or prescribing a Schedule I drug and may only do so for the purposes set out in the Pharmacists Regulation”.

A pharmacy student who is a registrant of the College of Pharmacists of BC may provide pharmacy services under the supervision of a full pharmacist. As such, a pharmacy student registrant may participate in aspects of PPMAC; however, this must always be done under the supervision of a full pharmacist who has completed the required training and has self-declared the completion of their training through eServices. The supervising full pharmacist always has sole responsibility for the diagnosis and prescribing decisions.

Yes. In Alberta, a prescription is valid if provided by a professional authorized to prescribe under Alberta legislation or federal legislation. Under federal legislation, a prescription is valid if provided by a person authorized to treat patients with a drug under the laws of the province within which that person is practicing his or her profession. 

Yes, BC pharmacists are able to prescribe for a patient presenting with symptoms consistent with an uncomplicated urinary tract infection (uUTI), whether it is the patient's first episode, or not. 

While other clinical resources (e.g. MedSask, UBC clinical education modules) suggest that a first episode of a uUTI is a reason to refer a patient to another healthcare provider, it is not a requirement for BC pharmacists to follow a specific resource when providing care to patients. Pharmacists should use their clinical judgement to determine if a referral to another healthcare provider is necessary.

This also applies to treatment recommendations, particularly antimicrobials. While some clinical resources recommend sulfamethoxazole-trimethoprim as a second line option for uUTI, it is not recommended as empiric therapy in BC as resistance rates exceed 20%.

Additional resources for antimicrobial treatment options:

• Bugs&Drugs
• BCCDC antimicrobial resistance dashboard

Pharmacists are accessible primary health care professionals who are well positioned to take on a larger role in the management of uncomplicated urinary tract infections.

BC pharmacists are not permitted to prescribe triptans for headache. Schedule A of the Pharmacists Regulations limit prescribing for headaches to NSAIDS only.  

Confusion may arise due to the medSask guidelines and PARs for headache that include prescribing triptans for mild-moderate migraine which is permitted in Saskatchewan, but not BC. This is one of the discrepancies in the MedSask materials previously highlighted and is also flagged within the MedSask BC headache guideline. BC does not mandate that pharmacists follow a specific clinical resource when providing care to their patients. MedSask resources are intended to be one of the possible clinical references that pharmacists can use to support their practice.

BC pharmacists are not permitted to prescribe antibiotics for insect bites such as for post-exposure prophylaxis of Lyme disease. Schedule A of the Pharmacists Regulations limits prescribing for urticaria (including insect bites) to topical drugs only.

Confusion may arise due to the UBC CPE Course which includes a section on prescribing antibiotics for Lyme disease post-exposure prophylaxis, which is permitted in Ontario, but not BC. When considering treatment options remember to refer to Schedule A of the Pharmacists Regulations, which defines what category of drug can be prescribed for each minor ailment.

BC pharmacists are not permitted to prescribe for folliculitis. Schedule A of the Pharmacists Regulation lists impetigo and does not include folliculitis.

Confusion may arise due to the medSask guidelines for “Superficial Bacterial Skin Infections” which includes treatment options for non-bullous impetigo and folliculitis. Prescribing for folliculitis is permitted in Saskatchewan, but not in BC. As medSask guidelines include some conditions that are out of scope in BC, refer to Schedule A of the Pharmacists Regulations which defines eligible minor ailments and the drug categories that can be prescribed by pharmacists in BC.

Minimum documentation requirements for PharmaCare payment are listed in the PharmaCare Policy. Claims for MACS will be subject to recovery if documentation does not meet the minimum requirements. 

Pharmacists can choose to use their own forms for documentation purposes. The Ministry of Health has provided a sample form. Ensure that you meet the minimum documentation requirements for PharmaCare payment.  

Pharmacists may use any evidence-based resources that enable them to provide safe and effective patient care. In B.C., MedSask should be considered one of the possible clinical decision support resources/tools, and it is not mandated that pharmacists follow their specific guidelines in applying care to their patients.

"Full Pharmacists” and “Pharmacy Technicians” must obtain and at all times maintain professional liability insurance coverage that meets the following 3 criteria as laid out in Section 81 of the Health Professions Act Bylaws and Professional Practice Policy-60: 

• Provides a minimum of $2 million coverage; 
• Provides occurrence based coverage or claims made coverage with extended reporting period of at least 3 years; and 
• If not issued in the pharmacists’ or pharmacy technicians’ name, the group policy covers the pharmacist or pharmacy technician as an individual 

BCPhA basic coverage offers liability insurance for $2 million per occurrence and $4 million annual aggregate, which meets the requirements to register with the College of Pharmacists of British Columbia. All registrants need this level of coverage to practice in B.C.  BCPhA insurance for B.C. pharmacists will cover you for what is in the scope of practice as defined by the College of Pharmacists of BC. 

To increase professional liability insurance coverage through our program, please contact us at info@bcpharmacy.ca. If you have any insurance related inquires, please contact our Insurance broker Westland Insurance at bcpharmacy@westlandinsurance.ca. 

Pharmacies accepting online bookings must use the provincial ImmsBC system MACS Appointment Scheduler. Pharmacies must not use their own appointment scheduler. The ImmsBC system supports pharmacies with MACS appointment scheduling only, and some limited report generation. It is not used for MACS record management or administration of payments. 

The public can book MACS appointments through the provincial system on the government webpage “See a pharmacist for minor ailments or contraception”. 

For instructions on ImmsBC MACS appointment scheduling, see https://www.bcpharmacy.ca/covidportal/immsbc