Adapting prescriptions: An increase in therapeutic substitutions by community pharmacists

March 4, 2018 The Tablet

Pharmacists identify opportunities to conduct prescription adaptations to optimize safe and effective drug therapy outcomes for patients

Since 2009, pharmacists have had the ability to adapt a prescription by renewing it, changing a dose or regimen or making a therapeutic substitution. Therapeutic substitutions allow a pharmacist to substitute the prescribed drug with a different drug that is designed to have a similar therapeutic effect, as long as that drug is from within the same therapeutic class. Therapeutic substitutions were originally limited to five classes of drugs.

In June 2016, B.C. announced changes to its Reference Drug Program (RDP), adding in three new categories of drugs: Angiotensin Receptor Blockers (ARB), Statins and Proton Pump Inhibitors (PPI).

The College’s professional practice policy (PPP)-58 Medication Management (Adapting a Prescription) was updated to reflect this change. This allowed community pharmacists to therapeutically substitute in the expanded number of drug categories.  

In response to changes, the BC Pharmacy Association launched a training program to help community pharmacists overcome barriers to therapeutic substitutions.

Recent published data from PharmaCare show that the number of therapeutic substitutions has increased by almost 70 per cent from fiscal year 2015/2016 to 2016/2017, which demonstrates pharmacists' utilizing their full professional competency to make drug therapy decisions through therapeutic substitutions. Therapeutic substitution adaptations spiked for the months of December 2016 and January 2017 indicating higher use of therapeutic substitutions compared to past years.

The BC Pharmacy Association has been supporting community pharmacists across B.C. in the modifications to the RDP via pharmacist town hall meetings, webinar training, in-person practice support and online resources. Pharmacists can access online training webinars on the BCPhA website, including two new training programs: Modernizing Practice to meet a Modernized RDP and Adapting Prescriptions – A Guide to Maximizing Clinical Services in Your Practice (free for BCPhA members and CCCEP-accredited for 3.0 CEUs).


Figure 1: Number of Pharmacy-Initiated Therapeutic Substitutions 2015/01-2017/3, as presented by Mitch Moneo, Acting Assistant Deputy Minister (Pharmaceutical Services), at the 2017 BCPhA conference.

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