Pharmacy Agreement in BC
As of January 1, 2009, pharmacists in British Columbia have an expanded role that allows them to: 1) renew prescriptions up to six months without requiring a doctor's prescription; 2) change the prescribed dose, formulation or regimen of a prescription; and 3) make a therapeutic drug substitution within the same class1.
Under this interim agreement, pharmacists are remunerated (paid) for renewing or adapting prescriptions and therapeutic substitution2.
| Dispensing Fee | Maximum Adaptation Fee | Maximum Payment | |
| Adaptation/renewal | $8.60 | $8.60 | $17.20 |
| Therapeutic substitution | $8.60 | $17.20 | $25.80 |
Pharmacies are able to submit two clinical service fees (as above) within a six month period for each patient.
Better Pharmacare Coalition Concerns:
A Core Value of the Better Pharmacare Coalition is "strengthening and preserving the patient-physician-pharmacist relationship." We believe that pharmacists are an important part of a patient's health care team. However, the Better Pharmacare Coalition has some serious concerns about these changes:
- The Better Pharmacare Coalition feels that the Interim Agreement was negotiated behind "closed doors" with no consultation or participation by patients.
- While pharmacists are an important member of a patient's health care team, they are not physicians and do not have enough clinical knowledge about an individual patient's detailed health history to determine whether a prescription should be changed (e.g. dosage or frequency of administration).
- There are no province-wide electronic health records that would allow pharmacists to gain access to critical information, such as blood tests and other diseases, which would assist in making decisions about treatment changes.
- The Better Pharmacare Coalition is concerned that a perceived or actual conflict of interest exists when remuneration is based solely on adapting prescriptions or making a therapeutic substitution. Therefore, rather than making treatment decisions based strictly on physicians' assessments and the individual needs of patients, pharmacists may have an added incentive to switch or adapt patients' medications so they can be financially remunerated.
- The Better Pharmacare Coalition opposes giving pharmacists the power to therapeutically substitute one drug for another without a doctor's approval. Allowing pharmacists to do so is "therapeutic substitution," which has already proved to be potentially injurious to patients (e.g. therapeutic substitution of proton pump inhibitors caused patient harm in BC).
- The Better Pharmacare Coalition recommends that in order to protect the principle of "therapeutic options for patients," the Government must revise the Interim Agreement such that a pharmacist and/or pharmacy cannot switch the medication prescribed by a physician unless deemed medically necessary (e.g. drug—to—drug interaction unknown to the prescribing physician) and provide compensation to the pharmacist and/or pharmacy for this service.
- The Better Pharmacare Coalition recommends that relevant patient organizations be included in the consultations related to the "formalization" of a permanent agreement by September 2009 between the Government, generic drug manufacturers and the BC Pharmacists Association aimed at reducing the price of all generic medications (old and new) and establishing ethical, cost effective reimbursement practices for pharmacists and pharmacies.
- The Better Pharmacare Coalition recommends, except in safety related incidences (e.g. drug—to—drug interactions not known by the prescribing physician), to eliminate the practice of therapeutic substitution, both in existing BC PharmaCare policy and in the Interim Agreement and in future agreements Government may contemplate negotiating with the BC Pharmacists Association or any other professional body or organization.
- BC Ministry of Health, Pharmacare website: http://www.health.gov.bc.ca/pharme/newsletter/08-012news.pdf
- Ibid