COVID-19 Guidance Documents

Dispensing

BCCSU issues information for alcohol use disorder and withdrawal management during COVID-19

The BC Centre for Substance Use has released a document for health-care providers serving patients who have alcohol use disorder or are withdrawing from alcohol.

The document contains information for prescribers, the types of medications involved in the treatment of alcohol withdrawal, considerations for medication delivery and more.

Download the document at the BCCSU website.

Updated: BCPhA resource on controlled substance delivery changes

The BC Pharmacy Association has put together a resource to help pharmacists understand the changes announced by the College of Pharmacists on March 26, 2020 to permit pharmacists to act in the best interests of patients who require controlled drugs and substances, including Opioid Agonist Treatment medications.

This resource was updated on April 7, 2020.

Note: Professional Practice Policy 58 (Adapting Prescriptions) does not include adapting (e.g. renewing) a prescription for narcotic, controlled drugs or targeted substances. If a change to a prescription for one of these categories of drugs is warranted, the pharmacist must contact the original prescriber to discuss modifying the original prescription.

Download Resource

BC Pharmacy Association writes College of Physicians and Surgeons to warn against prescribing hydroxychloroquine for COVID-19

The BC Pharmacy Association has written to the College of Physicians and Surgeons of B.C. to request that the College of Physicians direct physician prescribers against prescribing hydroxychloroquine for patients and themselves.

The BCPhA is taking the position that prescribing hydroxychloroquine is not appropriate as there is no proper evidence that the drug can be used as a prophylaxis for COVID-19.

The College of Physicians has been advised that our members are using their authority to refuse to fill prescriptions that they are concerned will represent a harm to the patient or are simply inappropriate.

BCPhA sends clarification to media on medication supplies from B.C. pharmacies

Over the past 24 hours, many BCPhA members have said a number of patients are visiting pharmacies requesting medications without a clear understanding of the regulations around renewals and emergency refills.

After yesterday’s press conference by Minister Adrian Dix and Public Health Officer Dr. Bonnie Henry, media reported that patients could get their prescriptions “without a doctor’s note” to help relieve the burden on doctors’ offices.

Unfortunately some patients have misinterpreted this information. The BCPhA will be issuing the following news release for distribution this afternoon.

BC Pharmacists message to patients on medication supplies during COVID-19 outbreak

MARCH 17, 2020 – British Columbia’s community pharmacists are committed to remaining available to patients in need during this COVID-19 outbreak, as we have been for other public health crisis in the past.

We remain steadfast in helping alleviate the burden on other parts of the health-care system and providing an adequate supply of medication for patients, who are being asked not to visit doctors’ offices for their prescription needs.

Over the past 24 hours, many patients have been directly visiting pharmacies, generally for one of two reasons:

  1. They require an adequate supply of their regular medications in order to self-isolate; or
  2. They have run out of their regular medications and need more.

While pharmacists are committed to ensuring every patient has an adequate supply of medication, they remain bound by existing regulations when providing medications without a new prescription. The following represent some of the criteria pharmacists must follow:

  • Patients must already be taking the medication or have an existing prescription for their medication. Pharmacists can not provide a new medication to a patient without a previous doctor’s prescription.
  • Generally this service is provided for medications used to treat chronic conditions.
  • Patients who have an expired prescription can have that filled by a pharmacist. The pharmacist will work with the patient to determine the appropriateness and the amount of supply to provide them.

Patients who have run out of their medication or need more, should call ahead to their regular pharmacy to determine whether a pharmacist can provide the additional supply.

Patients are encouraged not to stockpile medications. Pharmacists aim to make sure all patients have access to their medications, so they are generally not providing more than a 30-day supply to support those who are self isolating.

Canadian Pharmacists Association releases 30-day supply explainer video

We know that the current 30-day supply recommendations may be difficult for some patients to understand. CPhA has developed an explainer video to help pharmacists tell their patients why this recommendation has been made, and why it is so important that we all work together to protect the medication supply for all Canadians. The video is available in English and in French and can be shared on your website, in emails or on social media.

CEO Update: 30 and 90 day dispensing

Since the outbreak of the COVID-19 pandemic, British Columbia’s pharmacists have done all they can to balance the increased demand for medications from patients while ensuring drug supply remains stable.

As you are all well-aware, the early call for patients to “stockpile” medications enhanced the natural instinct patients had to be sure they had their prescriptions filled in the event they needed to self-isolate. In B.C. this led to an unprecedented spike in demand for early refills, emergency fills and other dispensing services. In some pharmacies the increased volume in dispensing in March was up between 50 to 200 per cent. Not surprisingly, this has stressed the distribution system to its breaking point.

Across the country most provinces moved to dispense only 30-days' supply of chronic medications in an effort to stabilize the distribution supply. Some provinces adopted official 30-day dispense policies, some national organizations such as CPhA also adopted official policies. But none of these policies were or are applicable in B.C.

What is important to remember is that the B.C. government did not adopt a 30-day dispense policy. PharmaCare did accommodate the ability to dispense only 30 days if the pharmacist believed that was the right thing to do. This ensured that pharmacists would not be penalized for dispensing less than the maximum supply.

The March 26, 2020 PharmaCare Newsletter clarified their position: “Pharmacies may also have encountered local, demand-driven shortages that require them to dispense smaller amounts than they would normally. PharmaCare policy is that fills should be up to the maximum days’ supply whenever possible. If this policy conflicts with what is feasible given the pharmacy’s on-hand supply, the pharmacy may fill an amount less that the maximum days’ supply”.

Some members have reached out to say that they need clarity about the B.C. position and/or that they believe they should follow the direction of various national organizations have issued. Again, I say, that each province is making the decisions they feel are right for their patients. PharmaCare has made no changes to the position noted above.

While many pharmacies in B.C. have not yet seen a total easing of the distribution supply problems that happened in early to mid-March, members tell us that the situation is balancing and that more “normal” orders are being received.

At this juncture I believe that each pharmacist must make a decision about whether or not they can provide their patients with the 90-day supply of medications they would traditionally receive. The decision not to dispense, and to dispense, a lesser amount needs to be made solely on the consideration of the impact to each pharmacy’s ongoing drug supply.

I know each pharmacist will continue to do their best to meet patient needs and protect the access to medications.

Geraldine Vance

CEO

BC Pharmacy Association

Clarification to media and the public on emergency medication refills

After a press conference on March 16 by Minister Adrian Dix and Public Health Officer Dr. Bonnie Henry, media reported that patients could get their prescriptions “without a doctor’s note” to help relieve the burden on doctors’ offices.

Unfortunately some patients have misinterpreted this information. The BCPhA has issued a news release to provide some clarification, which has resulted in media coverage.

Last updated on March 18, 2020

Clarity on quantity of supply for medication refills

The COVID 19 pandemic is evolving quickly and the impact on community pharmacies is also evolving day to day. We are hearing from many members about the most pressing issues and communicating those to the Ministry and, as needed, the College of Pharmacists.

The Association is aware that the pressure on pharmacies is enormous and that efforts to meet increased demands is not easy. We know that patients are coming for early renewal of prescriptions, looking to have new prescriptions filled and that the volumes of prescriptions is unlike what pharmacies have seen before.

We also know that pharmacists are facing the same stress about the uncertainty of the situation that everyone is and this is particularly challenging in the face of such an increase on workload.

The Minister of Health and the Provincial Health Officer are being briefed each day on issues impacting pharmacy and we are assisting PharmaCare in understanding the changing landscape. Be assured that the Association is canvassing members to be sure we are in a position to clearly communicate the priority issues.

The two issues that we understand are of most importance now are security of medication supply and providing adequate protection for pharmacists who may come into contact with patients.

In terms of stability of supply, a number of other provinces have moved to limiting dispensing quantities to a maximum of 30 days for all medications. In our conversation with the Ministry today we explained the important contribution setting this limit in place in B.C. could have on maintaining access to all needed medications. 

Today's dispensing quantities remain as:

 

  • Emergency supplies – up to 30 days’ supply
  • Regular fills – Do not dispense more than the maximum days’ supply indicated on PharmaNet

PharmaCare asks pharmacists that:

  • Pharmacists should reduce visits to prescribers by providing up to 30-day emergency supplies to patients with expired prescriptions, using guidance from Professional Practice Policy 31. This may be repeated for another 30-day supply if necessary, and includes narcotics, psychiatric drugs and anti-psychotics for chronic conditions
  • Manage stock appropriately. Do not dispense more than the maximum days’ supply indicated in PharmaNet. Do not over-order.
  • Provide early fills so patients can self-isolate for a minimum of 14 days, and longer for seniors and patients who are at-risk
  • Use intervention code "UF". The combination of the amount of medication patient has on hand in addition to the amount dispensed must not exceed the maximum days' supply
  • All early fills, emergency supplies or other dispenses that are exceptional due to COVID-19 must be documented as "for COVID-19" or similar to avoid audit

College of Pharmacists approve amendments to bylaws of Pharmacy Operations and Drug Scheduling Act and Community Pharmacy Standards of Practice

Pharmacists may now provide emergency supplies of controlled drugs and substances, including Opioid Agonist Treatment medications, to patients with expired prescriptions. Some of the changes are described below. For the full list of changes, please visit the College of Pharmacists of BC's website.

1) Transferring prescriptions to other pharmacists
The College Board has amended Section 8(3)(a) of the Community Pharmacy Standards of Practice to allow for the transfer of a prescription for controlled drug substances to other pharmacies licenced in British Columbia. 

2) Permitting verbal orders for a new prescription or to extend or refill an existing prescription
The College Board has amended Section 19(6) of the Pharmacy Operations and Drug Scheduling Act (PODSA) Bylaws to permit pharmacists to dispense drugs included in the controlled prescription program upon receiving a verbal order from a practitioner, if doing so is permitted under a section 56 exemption to the Controlled Drugs and Substances Act.

It is important to note that when taking verbal prescriptions in community practice, a registrant must make a written record of the verbal authorization in accordance with Section 6(7) of the Community Pharmacy Standards of Practice, as well as applicable federal legislation.

This written record MUST include: 

  • The pharmacist’s signature or initial
  • The name of the practitioner providing the verbal order.
  • The practitioner’s college identification number 

3) Faxing of controlled prescription program forms

The College Board has also amended Section 7(3) of the Community Pharmacy Standards of Practice to allow pharmacists to dispense prescriptions received by facsimile transmission for drug referred to on the Controlled Prescription Drug List in exceptional circumstances.

College of Pharmacists calls for feedback on exemption for prescriptions of controlled substances

Below is an excerpt from the College website:

The College is asking for your feedback on proposed amendments to the Pharmacy Operations and Drug Scheduling Act Bylaws that would enable the temporary exemption made by Health Canada to permit practitioners to verbally prescribe prescriptions for controlled substances.

Please provide your feedback as soon as possible as a shortened public posting period has been requested from the Minister of Health to implement these bylaw changes as soon as possible to support patients during the COVID-19 pandemic.

Background

To support continuity of care to patients during the COVID-19 Pandemic, Health Canada has issued a temporary exemption for prescriptions of controlled substances, to maintain Canadians’ access to controlled substances as needed for medical treatments.

As part of the temporary exemption, made under the Controlled Drugs and Substances Act (CDSA), Health Canada will permit practitioners to verbally prescribe prescriptions for controlled substances.

To submit comments, please follow the below instructions:

Comments on proposed changes to regulatory college bylaws may be submitted by email, feedback form or regular mail. These submissions should be addressed to the attention of the Director of Policy & Legislation.

Download: Feedback Form
Email: legislation@bcpharmacists.org
Fax: 604-733-2493 or 800-377-8129


Mailing Address:
Bob Nakagawa, Registrar
200 - 1765 West 8th Avenue Vancouver, BC V6J 5C6

College issues reminder on importance of patient ID and counselling, including for deliveries

On April 21, the College of Pharmacists of BC communicated that its compliance officers have found patient identification verification and counselling to be two of the top areas of non-compliance.

The College is issuing a reminder that particularly during the COVID-19 pandemic, all medication deliveries require positive patient identification and counselling.

For patient identification:

The Pharmacy Operations and Drug Scheduling Act Bylaws require the identity of the patient is confirmed before providing pharmacy services. At the time of dispensing, every prescription must include written confirmation of the pharmacist or pharmacy technician who verified the patient's ID.

For counselling:

Pharmacists are required under the Health Professions Act Bylaws to consult with a patient or patient's representative at the time of dispensing, to ensure the patients know about the medication they are taking, and that they understand how to take the medication appropriately. Every prescription requires counselling by a pharmacist, and must include written confirmation of the pharmacist who performed the consultation. Simply having the pharmacy assistant or technician ask the patient “Do you have any questions for the pharmacist?” is not acceptable. For deliveries, a pharmacist must provide consultation by phone or in-person before the delivery is released.

For more information, please visit the College website

College weighs in on patients' concerns about emergency supplies dispensing fees

The BC Pharmacy Association is aware that some patients have put forward concerns that 30-day limits on emergency refills could result in patients paying more for their medications, due to dispensing fees incurred for multiple trips.

The College of Pharmacists of BC has put out some advice in response to this question. More information is available at the College's Frequently Asked Questions for COVID-19 page.

My pharmacist is insisting on dispensing only one month of my chronic medication which is resulting in me paying more. Is this allowed?

We are recommending no more than a one-month’s supply for most people in order to help reduce the potential strain on the drug supply chain. However, we would expect pharmacists to use their professional judgment based on each patient’s situation to determine what is appropriate. In particular, for patients with compromised immune systems or who have an increased risk of more severe outcomes from COVID-19 – they may require a longer supply to enable them to safely self-isolate at home.

Under ordinary circumstances, on a yearly prescription someone could, in theory, pay out-of-pocket for amounts over what either PharmaCare or a third-party insurer would reimburse. We are asking pharmacies to not accommodate these requests at this time to help reduce the risk of drugs shortages.

It would ultimately be a business decision with regards to dispensing fees and would be at the discretion of the individual pharmacy.

Update on Canada's drug supply

McKesson, speaking to Global News, March 17:
Full article

Andrew Forgione, a spokesperson for the drug wholesaler McKesson, said the company was working with pharmacies, hospitals and manufacturing partners to promote responsible ordering and distribution during the novel coronavirus pandemic and COVID-19 outbreak.

“In recent days, we’ve taken proactive steps to support responsible ordering, including temporarily adjusting daily customer ordering for some medications and certain daily essentials,” Forgione said via email.

“It is unnecessary for Canadian consumers or retailers to mass order products. We encourage patients and customers to refill maintenance medications and seek healthcare essentials in a responsible manner to avoid unnecessary strain on the system.” More information from the full article.

Statement from Innovative Medicines Canada, March 18:
Full statement

Ottawa, March 18, 2020—As Canada responds to the global COVID-19 pandemic, some Canadians have expressed concern that they may not have access to the medicines they need, when they need them.

Based on the information we have received from our membership, which includes the majority of Canada’s research-based pharmaceutical companies, there are no COVID-19 related shortages being reported, or current constraints on their ability to supply medicines to Canadians. More information from the full statement.

Last updated on March 18, 2020

Early Refills, Stockpiling and Emergency Supplies

Further to last week’s PharmaCare newsletter, we would encourage pharmacists to avoid “topping up” a patient’s medications supply in excess of PharmaCare’s 100 or 30-day maximum supply policies. That is, a patient’s on-hand quantity should not exceed these limits. Additional limits on refills, renewals and emergency supplies may be issued in the coming days. We will update you as the situation evolves.

The distribution supply chain remains in good order and pharmacies should not over-order or stockpile at the local level, but rather should maintain their routine ordering process in discussion with their distributors.

PROVINCIAL HEALTH OFFICER - LETTER FOR HEALTH CARE WORKERS

Pharmacists should use their professional judgment in allowing early refills for the best interest of patients, without promoting stockpiling.

When submitting early refills utilize the “UF” intervention code and document the rationale “early fill to accommodate self-isolation for COVID-19”.

BCPhA has also contacted most private payers about changes to their early refill policies on account of COVID-19. At this time, there are no changes to report to members at this time. Please consult the chart below for each payer’s existing early refill policy.

Emergency Supplies

Pharmacists are also strongly encouraged to provide emergency supplies in accordance with Professional Practice Policy 31 (Emergency Supply for Continuity of Care) particularly in the case of expired prescriptions that would otherwise require a prescriber visit.
 
Pharmacists are reminded that this policy provides broad latitude for pharmacist decisions on emergency supplies, provided it is in the patient’s best interest and all decisions are properly documented with rationale. 
 
When entering an emergency supply, pharmacists are reminded to: 

  • Enter “Emergency Supply” at the beginning of the Sig 
  • Enter your CPBC ID as the practitioner ID
  • Enter P1, for practitioner ID ref
  • Enter “NN” intervention code

Emergency supplies and adaptations for patients

The BC Pharmacy Association is aware of reports that some pharmacists have been told by prescribers not to provide emergency refills, and instead require patients to call or visit their doctors.

During the COVID-19 pandemic, pharmacists have been requested by the Ministry of Health and the College of Pharmacists to provide emergency refills to provide medications to patients as needed to avoid non-essential physician and pharmacy visits and free doctors to treat COVID-19 cases.

The BCPhA will continue to support pharmacists in providing these refills/adapt prescriptions as requested by the provincial government, especially if a patient has taken the time to call ahead to your pharmacy.  

Pharmacists can provide up to 30-day emergency supplies as per PPP-31 and adapt prescriptions as per PPP-58, if in the best interest of the patient.

Patient concerns on 30-day supply

The BCPhA has received feedback from members about patients who have concerns around the 30-day supply issue. We understand many patients are used to receiving a 90-day supply of their medications for chronic conditions. However, these are not ordinary times.

We know community pharmacists are working hard to ensure that all patients get a supply of their medication as concerns around drug shortages continue.

We are doing our best to get the message out to the public about the reason for 30-day supplies and will continue with public messaging to patients. We are discussing with the Ministry of Health about what options there are so a 30-day supply doesn’t create a financial hardships for some patients.

Green Shield Canada: early refill intervention code available when dispensing for COVID-19 self-isolation

With the growing COVID-19 pandemic, Green Shield Canada (GSC) has received numerous inquiries from both plan members and pharmacies around our policies concerning medication refills. To minimize the risk of drug shortages as a result of COVID-19, some officials and pharmacy organizations, including the Canadian Pharmacists Association, recommend dispensing no more than a 30-day supply of medication, unless clinically justified.

To ensure patient access to care and medication supply is not compromised during this critical time, GSC supports the recommendation from the Canadian Pharmacists Association to limit dispensing to a 30-day supply and is relying on pharmacists, as front-line healthcare providers, to use their professional discretion when deciding on the most appropriate days’ supply to dispense to any given patient. To that end, and until further notice, we are temporarily lifting the requirement to dispense maintenance medications in a 90-day supply during the COVID-19 pandemic.

Where dispensing of an early refill is necessary to enable self-isolation, but the claim is rejected by the adjudication system as an early refill, use of the intervention code MK = good faith emergency coverage established will enable the claim to be processed. In all cases where MK is used to enable claim adjudication, pharmacies are expected to clearly document the rationale for use to avoid subsequent audit. 

To read the full statement from GSC, click here.

Health Canada concerned patients may be directly buying and using chloroquine and hydroxychloroquine for COVID-19

Health Canada has issued an alert warning of the potential fatal consequences of patients directly purchasing and using chloroquine and hydroxychloroquine for COVID-19. In its April 25 statement, Health Canada said the drugs are known to potentially cause kidney or liver problems, low blood sugar, nervous system problems such as dizziness, fainting or seizures, and can potentially affect heart rhythm fatally.

Health Canada has authorized clinical trials with chloroquine and hydroxychloroquine for COVID-19, but says data from the clinical trials has been limited and the drugs have not conclusively shown effectiveness.

Health providers are asked to monitor patients closely if they are taking chloroquine or hydroxychloroquine, especially when there are:

  • Pre-existing heart conditions
  • when using higher doses
  • if prescribed in combination with other medications such as azithromycin that may prolong the QT interval

Health Canada issues exemptions for prescriptions of controlled substances

Health Canada has issued a statement on March 19 providing exemptions to, as long as permitted within provincial/territorial scopes of practice, allow pharmacists to:

  • Extend prescriptions
  • Transfer prescriptions to other pharmacists
  • Receive verbal orders from prescribers to extend or refill a prescription
  • Deliver prescriptions of controlled substances to patient's homes or other locations where they may be self-isolating

These exemptions will be in place until Sept. 30, 2020 or until they are replaced by another exemption, or revoked entirely.

British Columbian pharmacists must comply with the scope of practice set out by the College of Pharmacists of BC. The College made changes effective March 17 to permit pharmacists to deliver Opioid Agonist Treatment medications to patients without prescribers' authorization, though prescribers are still asked to indicate if they have decided not to permit delivery to a patient; and pharmacists must still document and notify prescribers of decisions to initiate or stop OAT delivery.

Ibuprofen and COVID-19: World Health Organization provides information

The World Health Organization has issued the following statement on social media regarding ibuprofen and COVID-19. On March, 18, in response to the question Could ibuprofen worsen disease for people with COVID19? the WHO said:

Based on currently available information, WHO does not recommend against the use of of ibuprofen. WHO is aware of concerns on the use of #ibuprofen for the treatment of fever for people with COVID19. We are consulting with physicians treating the patients & are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations.

The Canadian Pharmacists Association (CPhA) has also issued some detailed information on this (March 17, 2020). Ibuprofen was noted as a concern following media reports from France that anti-inflammatory medications could be a factor in aggravating COVID-19.

Here are a few key points to keep in mind from the CPhA:

  • Health Canada continues to recommend both ibuprofen and acetaminophen for treatment of fever due to COVID-19.
  • Evidence to date suggests that older people (>60 years of age) and those with underlying medical conditions are at higher risk of severe COVID-19 disease. As NSAIDs should also be used with caution in these populations, it is reasonable to avoid NSAIDs in the elderly and in those with comorbid conditions (e.g., cardiovascular disease, renal disease, chronic respiratory disease). If the use of an NSAID is unavoidable in these patients, it should be at the lowest effective dose and for the shortest duration.

The CPhA monograph Nonsteroidal Anti-inflammatory Drugs (NSAIDs) contains detailed information on the contraindications, warning and precautions to consider when recommending or prescribing NSAIDs.

Information from private insurers: three resources available

The BC Pharmacy Association recognizes that there is a need for an informational resource for pharmacy teams to, at a glance, access information about coverage from private insurers during the COVID-19 pandemic.

Three documents have been made available.

Information from private insurers on 30-day supply and emergency fills

The BC Pharmacy Association is aware that there is inconsistent coverage provided by private insurers who do not yet support 30-day limits on dispensing being adopted by pharmacies across Canada, and those that do support 30-day limits in their coverage.

Over the recent days, the Association has collected information from a number of private insurers to present information on each insurer's policy on providing coverage for 30-day supplies, rather than the patients' maximum fill limit. The document, which will be updated as needed, contains information from the following insurers:

  • Pacific Blue Cross
  • TELUS Health
  • Green Shield
  • Express Scripts
  • Claim Secure

30-Day Supply and Private Insurer Coverage

The following insurers have also provided verification that they will pay for emergency supply claims submitted by pharmacists during the COVID-19 pandemic. Pharmacists may provide emergency supplies in accordance with Professional Practice Policy 31.

  • Pacific Blue Cross
  • TELUS Health
  • Green Shield
  • Express Scripts

Private Insurers Coverage of Emergency Supplies

Insufficient evidence for treatment of COVID-19 with chloroquine or hydroxychloroquine

The Canadian Pharmacists Association has released a statement warning against the prescribing and dispensing of chloroquine or hydroxychloroquine to otherwise healthy patients for the prevention of COVID-19. While there is a study on the topic, the CPhA is recommending that the use of chloroquine or hydroxychloroquine for COVID-19 should be restricted only to hospital settings.

For the CPhA's full statement, see here.

Joint Statement from Colleges on unproven therapies for COVID-19

On March 25, the College of Pharmacists of BC, the BC College of Nursing Professions and the College of Physicians and Surgeons of BC issued a joint statement to warn against the use of anti-malarial, antibiotic and antiviral therapies to treat COVID-19 patients.

The Colleges jointly urged health professions to resist pressure around unproven and potentially dangerous uses of existing medications. The Colleges also specifically warned against the use of hydroxychloroquine for COVID-19, as its demand for COVID-19 treatment could result in dangerous consequences for patients who need hydroxychloroquine for the treatment of conditions such as lupus and rheumatoid arthritis.

To read the full joint-statement, please visit the College of Pharmacists website.

Maintaining certification for drug administration by injection and intranasal route during COVID-19 pandemic: College

The College of Pharmacists of BC has provided instructions for drug administration-certified pharmacists who have had their first aid and CPR certification expire during the COVID-19 pandemic.

Pharmacists whose first aid and CPR certificates have expired and have not been able to obtain written proof that the certification has been extended, are not permitted to administer drugs by injection or intranasal route.

The College asks pharmacists whose first aid and CPR certificates will expire soon to contact their first aid and CPR certification body for an extension during the pandemic. Proof of extensions should be retained, and can include:

  • printed guidance from a provider's website
  • email correspondence from a provider or instructor
  • a reissued certificate with a new expiry date

There is no requirement to submit documentation to the College, however, practising pharmacists should retain supporting documentation in a readily retrievable manner.

For pharmacists who have expired first aid and CPR certificates and are unable to get a certificate extension, re-certification is required. Once re-certification has been completed, contact the College's Registration Department at registration@bcpharmacists.org before beginning to administer drugs by injection or intranasal route.

More information is available from the College's website.

Minister of Health Adrian Dix explains why B.C. didn't have "absolute rule" for 30-day dispensing limits

As our members know, the BC Pharmacy Association supported 30-day dispensing limits to help safeguard the Canadian drug supply during the initial stages of the COVID-19 pandemic. The BCPhA had, during this time, advocated for the provincial government to make 30-day supply limits mandatory for all prescriptions.

On April 29, B.C. Minister of Health Adrian Dix explained during his daily press briefing why he decided not to pursue an "absolute rule" restricting medication refills to 30 days.

"One of the reasons why it was a challenge to go to 30 day refills that people thought about and why we didn’t do it as an absolute rule in B.C. was because obviously people struggle going back and forth to the pharmacy more often, and this was a balance, and I want to thank everyone involved in pharmacy in B.C. for the ongoing work they’ve been doing in the province over the last period.

Just to put it in context, over the last month, the number of refills of over 70 days, so the long-term refills, dropped by about 6.7 per cent in that time.

To put it into context, we do about 700,000 of them, and about 50,000 or so of those, we did about 50,000 less than we usually do. So, there was still a lot of refills of 70 days or above, but I do think the ongoing work of pharmacy and the ongoing work of PharmaCare is really important, but that gives you a sense of how many people had their prescriptions filled for more than 70 days during the first month of the really intense period of the pandemic." - Adrian Dix, Minister of Health

To access the full press conference, click here.

President's Message: Addressing 30-day supply of medications

The COVID-19 pandemic has put considerable stress on all parts of the health-care system, including pharmacy.

Many patients on regular medications typically get a three-month supply when they go to the pharmacy. Over the last few weeks, many patients have been receiving only 30 days of their medicine. Some patients have raised questions about this temporary measure.

The decision by most pharmacists in B.C. and across Canada to do this is driven by the need to ensure that there is a reliable supply of medications over the next few months for as many patients as possible.

The demand for medications in communities and in hospitals in the last few weeks has risen dramatically. This rapid increase has made it difficult for pharmacies to get the amount of medications they need. 

Adding to the uncertainty, it remains unclear whether there will be more than the usual amount of drug shortages in the days and weeks ahead due to supply disruptions overseas.

Dispensing 30 days’ supply of medication is an action pharmacists are taking to ensure as many people as possible can access the medications they need now and in the next few, likely unpredictable, months.

On April 3, British Columbia’s Provincial Health Officer Dr. Bonnie Henry said she and Minister of Health Adrian Dix were aware that some people are concerned about dispensing fees and government is looking at ways to address the issue for those who need support.

B.C.’s community pharmacists continue to work hard to respond appropriately to the extraordinary challenges the COVID-19 pandemic has presented.

Keith%20Shaw-01.jpg

Keith Shaw, PharmD, MBA
President, BC Pharmacy Association

Shortage of salbutamol inhalers in Canada

An increased demand for salbutamol inhalers during the COVID-19 pandemic has resulted in shortages and limited supply for the product in Canada, according to Health Canada.

Salbutamol is used in the treatment of conditions such as asthma, chronic obstructive pulmonary disease (COPD). Health Canada is advising that patients should keep taking their regular medication to maintain their respiratory conditions, to reduce the need for salbutamol.

More information is available on Health Canada's website.

Watch out for fraudulent prescriptions

As an increasing number of practitioners and pharmacies rely on verbal or faxed prescriptions during the COVID-19 pandemic, it is increasingly important for pharmacy teams to be vigilant for illegitimate prescriptions.

Pharmacy teams should ensure:

  • the prescription was faxed from the physician's office and not by a patient
  • all requires aspects of a prescription (date, signature) are included
  • that the patient's identification is confirmed
  • that the prescription has not already been filled elsewhere through the patient's PharmaNet profile

More information is available on the College's website to help pharmacies guard against prescription fraud.

COVID Testing for Pharmacists

Essential health worker status for pharmacists

Pharmacists are considered essential workers during the COVID-19 pandemic in British Columbia. The Emergency Management BC office and the Provincial Health Officer has determined that pharmacists are a direct-to-public health service, and that pharmacies themselves are considered essential health service providers.

The B.C. government has declared that as pharmacies are an essential service, they should and are encouraged to remain open, while following the orders and guidance provided by B.C. Public Health Officer Dr. Bonnie Henry to protect the safety and health of their staff and patients.

The following additional information may impact pharmacists and their teams during the COVID-19 pandemic:

  • Health workers during the COVID-19 pandemic receive priority testing
  • Licensees of long-term care facilities, along with workers and contractors, will be reporting their staff and contractors' names, contact informations, Social Insurance Numbers and additional information using instructions as directed by the Provincial Health Officer, by midnight, March 28, 2020
  • Employees, contracted workers and volunteers are ordered to only work in one long-term care facility, unless given an exemption by the Medical Health Officer. This order was put into effect on March 26, 2020

COVID-19 testing for pharmacy staff: more info now available from Provincial Health Services Authority and Ministry of Health

The BC Pharmacy Association has discussed with the B.C. Ministry of Health to confirm that pharmacy professionals are designated as health-care workers and are eligible for priority testing. The Ministry asks pharmacy team members to refer to the provincial government's list of essential services to confirm their status as essential health-care workers.

New information has been issued by the Public Health Services Authority (PHSA) so all health-care workers who meet the symptomatic requirements are able to be tested for COVID-19. The PHSA has also made available their list of COVID-19 Community Collection Centres along with contact information for health-care workers to use, which can be accessed through the PHSA website.

The BCPhA has posted the testing criteria below.

1) Testing will NOT be done for asymptomatic individuals.

2) Testing criteria includes:

  • Fever and cough or shortness of breath (new/worsening – not pre-existing),
  • OR two of the following symptoms: fever, cough, shortness of breath, diarrhea, fatigue/malaise, rhinorrhea.

3) If testing is required, see contact information for the list of testing centres in your health authority (COVID-19 Community Collection Centre – updated frequently).

4) Immediately after testing, return home and self-isolate. You will receive a phone call with your results.

5) Further instructions will be provided by the public health officer.

Some testing centres may yet to have been notified that pharmacy staff are eligible to be tested for COVID-19. Please submit reports to info@bcpharmacy.ca if you meet the criteria, but have been turned away from testing.

Pharmacists considered as health-care workers for COVID-19 priority testing

The BC Pharmacy Association has received clarification from the B.C. Ministry of Health that pharmacists are considered health-care workers for priority COVID-19 testing.

  1. Pharmacists who have COVID-19 symptoms are asked to call 811
  2. Identify yourself as a pharmacist with symptoms who is seeking to be tested for COVID-19

If you are a pharmacist with symptoms who has called 811 and was NOT directed to a testing site, please contact info@bcpharmacy.ca so the report may be shared with the Ministry of Health.

Updated guidance on self-isolation: pharmacists should self-isolate for 10 days following onset of symptoms

Self-isolation guidelines were recently updated. If a pharmacy staff member believes they have symptoms of COVID-19, new guidelines are asking for a self-isolation period of 10 days following the initial start of symptoms.

Following 10 days, if temperature is normal and other symptoms have resolved, the affected person may return to their normal routine. More information is available in this Interim Guidance document (March 23, 2020) from the B.C. Centre for Disease Control.

The BC Pharmacy Association has also confirmed with Vancouver Coastal Health that its employees are also following these new guidelines to self isolate for 10 days, rather than 14, after initial start of symptoms.

Opioid Agonist Treatment

BCCSU issues COVID-19 information for pharmacists delivering Opioid Agonist Treatment

Immunocompromised patients and those who exhibit symptoms or are under quarantine or self-isolation may not be able to attend the pharmacy for their witnessed dose or to pick up their carries.

The BC Centre on Substance Use has released opioid agonist treatment guidance for pharmacists. See the full document here.

  • Pharmacists are asked to consider delivery of OAT medication to patients where appropriate
  • Communicate stable and predictable hours of operation and delivery options to OAT patients
  • Methadose, Metadol-D, and Sandoz Methadone (Sterinova) are all commercially available methadone 10mg/mL products that meet the Health Professions Act definition (section 25.91) of an interchangeable drug. For more information and key considerations when deciding on a formulation, please see the BCCSU Methadone Formulations Options Bulletin.
  • In the context of the pandemic, Health Canada is preparing to issue additional exemptions under the Controlled Drugs and Substances Act (CDSA) for prescriptions of controlled medications, including OAT, as early as this week (week of March 16, 2020). The exemptions under consideration would permit pharmacists to extend prescriptions, transfer prescriptions to other pharmacists, and permit prescribers to issue verbal orders (i.e., over the phone) to extend or refill a prescription.

Last updated on March 18, 2020

Updated: BCPhA resource on controlled substance delivery changes

The BC Pharmacy Association has put together a resource to help pharmacists understand the changes announced by the College of Pharmacists on March 26, 2020 to permit pharmacists to act in the best interests of patients who require controlled drugs and substances, including Opioid Agonist Treatment medications.

This resource was updated on April 7, 2020.

Note: Professional Practice Policy 58 (Adapting Prescriptions) does not include adapting (e.g. renewing) a prescription for narcotic, controlled drugs or targeted substances. If a change to a prescription for one of these categories of drugs is warranted, the pharmacist must contact the original prescriber to discuss modifying the original prescription.

Download Resource

A summary of the changes are described below. For full details, please visit the College of Pharmacists of BC's website.

  1. Transferring prescriptions to other pharmacists
  2. Permitting verbal orders for a new prescription or refill an existing prescription
  3. Faxing of controlled prescription program forms
  4. Delivery by pharmacy employees. (This does not include OAT)

College of Pharmacists calls for feedback on exemption for prescriptions of controlled substances

Below is an excerpt from the College website:

The College is asking for your feedback on proposed amendments to the Pharmacy Operations and Drug Scheduling Act Bylaws that would enable the temporary exemption made by Health Canada to permit practitioners to verbally prescribe prescriptions for controlled substances.

Please provide your feedback as soon as possible as a shortened public posting period has been requested from the Minister of Health to implement these bylaw changes as soon as possible to support patients during the COVID-19 pandemic.

Background

To support continuity of care to patients during the COVID-19 Pandemic, Health Canada has issued a temporary exemption for prescriptions of controlled substances, to maintain Canadians’ access to controlled substances as needed for medical treatments.

As part of the temporary exemption, made under the Controlled Drugs and Substances Act (CDSA), Health Canada will permit practitioners to verbally prescribe prescriptions for controlled substances.

To submit comments, please follow the below instructions:

Comments on proposed changes to regulatory college bylaws may be submitted by email, feedback form or regular mail. These submissions should be addressed to the attention of the Director of Policy & Legislation.

Download: Feedback Form
Email: legislation@bcpharmacists.org
Fax: 604-733-2493 or 800-377-8129


Mailing Address:
Bob Nakagawa, Registrar
200 - 1765 West 8th Avenue Vancouver, BC V6J 5C6

College of Pharmacists of BC: PPP-71 changes to delivery requirements for Opioid Agonist Treatment now in effect

Effective immediately, pharmacists are permitted to use their professional judgement to deliver Opioid Agonist Treatment medications to patients if they feel it is safe, appropriate and in the best interests of the patients.

The changes, which effect Professional Practice Policy 71, were intended to take effect on April 1, 2020. Due to recent developments of COVID-19, the College decided to accelerate the implementation of these changes to March 17.

Prior to the changes, PPP-71 permitted pharmacists to deliver methadone to a patient's home only if authorized by a prescribing physician. With the change that is now in effect, the restriction that delivery must be authorized by a prescriber is removed. In addition, PPP-71 now also permits pharmacists to authorize delivery of OAT by buprenorphine/naloxone and slow release oral morphine, in addition to methadone.

Prescribers have been asked to indicate “Do Not Deliver” on the Controlled Prescription Program Form, or to contact patients' pharmacies directly, for patients where prescribers have decided to prevent delivery to a patient.

Pharmacists must still notify prescribers of decisions to initiate or stop OAT delivery. For complete information on the change, please visit the College of Pharmacists' website.

Last updated on March 18, 2020

College issues statement on patient signatures for Opioid Agonist Treatment

The College of Pharmacists has posted this response in their Frequently Asked Questions, on the topic of whether pharmacy teams can forgo patient signatures for their OAT accountability log, in order to maintain social distancing.

Below is an excerpt from the College:

Please take all precautions you can, including disinfection, restricting contact, etc. If you are making procedural changes in the best interest of your patients and your staff's health, please ensure you document your temporary policy and that it is understood by all staff.

There are many changes that the College are reviewing, in coordination with the Ministry of Health and Health Canada. Please continue to monitor our website and email communications for updates regarding this issue.

Health Canada issues exemptions for prescriptions of controlled substances

Health Canada has issued a statement on March 19 providing exemptions to, as long as permitted within provincial/territorial scopes of practice, allow pharmacists to:

  • Extend prescriptions
  • Transfer prescriptions to other pharmacists
  • Receive verbal orders from prescribers to extend or refill a prescription
  • Deliver prescriptions of controlled substances to patient's homes or other locations where they may be self-isolating

These exemptions will be in place until Sept. 30, 2020 or until they are replaced by another exemption, or revoked entirely.

British Columbian pharmacists must comply with the scope of practice set out by the College of Pharmacists of BC. The College made changes effective March 17 to permit pharmacists to deliver Opioid Agonist Treatment medications to patients without prescribers' authorization, though prescribers are still asked to indicate if they have decided not to permit delivery to a patient; and pharmacists must still document and notify prescribers of decisions to initiate or stop OAT delivery.

OAT and Injections Training Postponed

Pharmacists and pharmacies across the province have been occupied with the COVID-19 pandemic. As a result, the Ministry of Health has confirmed that OAT training occurring after March 14 will be suspended until further notice.

The Ministry of Health will provide direction regarding when training sessions will resume, when they deem it reasonable in the context of general guidance from the Provincial Health Officer.

If you have already registered for one of the upcoming sessions, a representative from the BC Pharmacy Association will reach out to you. There will be no cancellation fees for participants.

Last Updated: March 13, 2020 8:00 PM

Recording available: What pharmacists should know about COVID-19, substance use, and safer supply

On April 9, 2020, BC Pharmacy Association (BCPhA) partnered with the BC Centre for Substance Use (BCCSU) on a webinar with information specific to pharmacists who are serving substance users during the COVID-19 pandemic, including information about the new provincial clinical guidance.

Speakers included:

  • Dr. Mona Kwong, Pharmacy Advisor and Director, Addiction Pharmacy Fellowship, BCCSU
  • Ann Johnston, Manager, Pharmacy Practice Support, BCPhA
  • Guy Felicella, Speaker, Guy Felicella Consulting

The recording is now available on the BC Pharmacy eTraining portal.

Start eTraining

Survey: Identifying pharmacies offering Opioid Agonist Treatment delivery

The BC Centre on Substance Use (BCCSU), in partnership with BCPhA, are calling out to compile a list of community pharmacies in all health authority regions of the province to determine services that could support patients on opioid agonist therapy. The list of community pharmacies will be continually updated and information will be posted online on the BCCSU page.

This survey will take only 5 minutes to complete.

Some of the responses (clearly identified in the question description sections) will not be made publicly available for privacy reasons. If you have any question or would like to have your information updated, please email us at lisa.parvin@bccsu.ubc.ca.​

To access the survey, please select the link below:

Take the Survey

Temporary authorizations of opioid agonist treatment deliveries by non-pharmacists

The College of Pharmacists have made additional amendments to Professional Practice Policy 71 to temporarily permit non-pharmacists to deliver opioid agonist treatment during the COVID-19 pandemic.

Regulated health professionals who are not pharmacists may now deliver opioid agonist treatment (OAT), as long as they are:

  • authorized by a pharmacist to do so
  • possessing the scope and competence to assess the patient, and where required, witness the ingestion of OAT

In exceptional circumstances where neither a pharmacist nor a regulated health professional is available to deliver OAT, a pharmacist may authorize a pharmacy employee to deliver OAT to a patient, as long as they have:

  • the knowledge and competence to recognize situations where it is unsafe to provide OAT to a patient
  • the appropriate knowledge and competence to provide witnessed ingestion (where applicable)
  • the knowledge and competence necessary to identify the patient

Regulated health professionals and pharmacy staff should refer to:

Additionally, OAT delivery on behalf of a pharmacist must meet Health Canada's requirements:

  • Deliver the controlled substance to the individual identified in the prescription or to a person responsible for that individuals care (Despite this, the College has determined that OAT cannot be delivered to any other person but the patient)
  • Obtain in writing a note from the pharmacist identifying the name of the individual providing the delivery, the name and quantity of the controlled substance to be delivered, and the place of delivery; and,
  • Have the above note as well as a copy of this exemption while providing the delivery.

PharmaCare Newsletters

Clarification on pharmacists' exemption from self-isolation

On March 18, 2020, Dr. Bonnie Henry clarified that pharmacists and other health-care workers are only conditionally exempt from self-isolation in certain situations while at work. Please see the following additional clarification from PharmaCare.

Additional clarification from PharmaCare:

Pharmacists may be exempt from self-isolation requirements after travel if they are critical to the operation of their organization/pharmacy. Pharmacists who have recently returned from outside Canada should self-isolate if they are not critical staff. If a pharmacist must work after travelling, they should self-monitor carefully and use a mask and gloves to protect others if they have any respiratory symptoms. PharmaCare Newsletter, March 18, 2020

Additional information from PharmaCare on dispenses during COVID-19 pandemic

The below are excerpts from the March 26, 2020 PharmaCare Newsletter.

Pharmacists may have received conflicting information regarding the days supply permitted for any dispense. Different policies have been implemented across Canada, and across different public and private payers to manage perceived or real supply issues. Pharmacies may also have encountered local, demand-driven shortages that require them to dispense smaller amounts than they would normally.

PharmaCare policy is that fills should be up to the maximum days’ supply wherever possible. If this policy conflicts with what is feasible given the pharmacy’s on-hand supply, the pharmacy may fill an amount less than the maximum days’ supply indicated in PharmaNet or on the written prescription. 

As noted in the PharmaCare audit section below, at this time, PharmaCare audit will not scrutinize dispenses that are less than the written prescription, and if smaller dispenses are required for supply management, additional dispensing fees may be claimed for subsequent dispenses to complete the fill.

PharmaCare: Special Authority Adjustments during COVID-19

Effective March 26, 2020, PharmaCare has implemented the following changes to ensure efficient access to medications and promote patient safety during the COVID-19 pandemic:

  • More staff are available on the Special Authority (SA) phone lines, to help resolve issues with faxing requests because the prescriber is not in the office.
  • Temporary manual extensions are available over the phone for select drugs where infusion dates are already planned, and the prescriber is not available for completion of renewal request.
  • Automatic uploads in PharmaNet to extend SAs for many limited coverage drugs that are expiring between now and July 1, 2020. 

More information on the March 26, 2020 PharmaCare Newsletter.

PharmaCare: Frequent Dispensing Authorization form and Smoking Cessation Program Declaration and Notification form

The requirement for a patient signature on the Frequent Dispensing Authorization form (HLTH 5378) is temporarily suspended effective April 17. Pharmacists are asked to indicate patients' verbal assent on the form by writing the word "COVID" where the patient's signature would go.

For blister packs, PharmaCare asks pharmacists to accommodate four weeks' supply as opposed to one.

For the Smoking Cessation Program Declaration and Notification form (HLTH 5464), signatures are also suspended if there is verbal assent from a patient. Pharmacists are also asked to indicate "COVID" in the area where patients sign.

  • Forms must be retained
  • Patients should be asked to sign the forms where it is feasible
  • Alternatively, pharmacists may contact the prescriber to request a new prescription, which has weekly or daily dispense indicated on the prescription

For both forms, pharmacists should ensure that patients are aware of the contents of the declaration to which they are verbally assenting.

For more information, please see the April 17 PharmaCare newsletter.

COVID-19 pharmacy procedures from PharmaCare

Download the PharmaCare Newsletter here.

Pharmacies are being asked to help maintain the viability of our health care system by reducing the load on prescribers and helping to manage the drug supply. 

Pharmacies should make every effort to:

  • Reduce prescriber visits by providing up to 30-day emergency supplies to patients with expired prescriptions (see PPP-31). This may be repeated for another 30-day supply if necessary. This includes narcotics, psychiatric drugs and anti-psychotics for chronic conditions.
  • Manage stock appropriately. Do not dispense more than the maximum days’ supply indicated in PharmaNet. Do not over-order.
  • Provide early fills to people so they can self-isolate for a minimum of 14 days – longer for seniors and other more vulnerable people. Use intervention code “UF”. Please note the combination of the amount the patient has on hand, plus the amount the pharmacy dispenses, may not exceed the maximum days’ supply

Process for Early Refills and Documentation

All early fills, emergency supplies, or other dispenses outside the norm due to COVID-19 MUST be documented as “for COVID-19” or similar, to avoid audit.

In all cases where a pharmacist submits a PharmaNet claim for an emergency or early fill, the pharmacist MUST document it appropriately (e.g. “early fill for self-isolation for COVID-19”) to avoid subsequent audit.

Last updated on March 18, 2020

Updates from PharmaCare

Highlights from the April 1, 2020 PharmaCare Newsletter

Urgent coverage needs for First National Health Authority clients

The First Nations Health Authority (FNHA) will reimburse pharmacists a $10 service fee for FNHA clients experiencing coverage issues, using the Transitional Coverage Request (TCR) manual claim process form. The TCR form is updated with a checkbox to indicate whether the coverage issue is related to COVID-19.

PIN 3642005 - TCR Payment - this PIN will show on payment statements from Pacific Blue Cross where a patient is on Plan W but can’t get immediate coverage for a medication, including medical supplies and equipment, so pharmacy can provide item and get coverage by FNHA/PBC. The $10 payment for this PIN is in addition to the drug cost and dispensing fee.

PIN 3642006 - MSP Enrolment - this PIN will show on payment statements from Pacific Blue Cross where a patient does not have Plan W as their primary drug plan. The pharmacist can submit a TCR with the client’s PHN, status number, date of birth and address, indicating that the client requires Plan W enrolment, and be reimbursed $10 from FNHA.

 

Direct-acting oral anticoagulants now covered for new patients

PharmaCare is covering direct-acting oral anticoagulants (DOACs) for all patients newly starting anticoagulation during the COVID-19 pandemic. Previously, DOACs were a Limited Coverage Benefit under PharmaCare. New patients starting anticoagulation will be covered indefinitely.

PharmaCare notes DOACs are as effective as warfarin for anticoagulation treatment for the following conditions:

  • prevention of ischemic strokes in patients with atrial fibrillation
  • prophylaxis of venous thromboembolism
  • treatment of deep vein thrombosis
  • treatment of pulmonary embolism

As a result, PharmaCare is making this coverage available in case regular lab testing (which is required for warfarin, and not required for DOACs) is not safe or accessible for patients who would otherwise be prescribed warfarin during the COVID-19 pandemic.