Amendments to PPP-58: Medication Management (Adapting a Prescription)

Amendments to Professional Practice Policy-58 Medication Management (Adapting a Prescription)

The Board approved amendments to the adaptation of transferred prescriptions and the limitation on drug categories for therapeutic substitution as part of Professional Practice Policy-58: Medication Management (Adapting a Prescription) to support patient care during the COVID-19 public health emergency. 

These amendments are now in effect. 

PPP-58 and the accompanying Orientation Guide provide the framework to guide pharmacists in the safe and effective adaptation of existing prescriptions through the following primary activities: 

1. Change – Changing the dose, formulation, or regimen of a prescription to enhance patient outcomes. 
2. Renew – Renewing a prescription for continuity of care
3. Substitution – Making a therapeutic drug substitution within the same therapeutic class for a prescription to best suit the needs of the patient. 

In light of the COVID-19 pandemic, the College reviewed PPP-58 for opportunities to support patient care during the ongoing public health emergency. Based on the review, temporary amendments were made to: 

• Permit the adaptation of transferred prescriptions; and 
• Remove the limitation on drug categories for therapeutic substitution where there is a drug shortage. 

These amendments will remain effective for the duration of the COVID-19 public health emergency in British Columbia. 

Minor updates to the Orientation Guide were also made to align with the recent changes to Professional Practice Policy 31 – Emergency Supply for Continuity of Care.

Permitting Adaptation of Transferred Prescriptions 

The Board approved amendments to PPP-58 permitting transferred prescriptions to be adapted during the COVID-19 public health emergency in BC. 

Under PPP-58, in order to adapt a prescription a pharmacist must have an original prescription that is current, authentic, and appropriate. Further, as stipulated in the Amendments to the Orientation Guide, original prescriptions do not include: 

• Transferred prescriptions 
• Previously adapted prescriptions 
• Emergency refills 

While adapting a transferred prescription was previously not permitted under PPP-58 requirements, the Board recognized that in light of the COVID-19 pandemic, it may be beneficial for a pharmacist to adapt transferred prescriptions due to physical distancing measures and travel restrictions or drug shortages, which may make these prescriptions more common. 

Permitting the adaptation of transferred prescriptions will also help to minimize delays in initiating or changing drug therapy and allow pharmacists to use their professional judgement to determine whether to adapt a transferred prescription. 

Removing the Limitation on Drug Categories for Therapeutic Substitution 

The Board approved removing the limitation on drug categories for therapeutic substitution where there is a drug shortage, for the duration of the COVID-19 public health emergency in BC.

This will allow pharmacists to adapt prescriptions for drugs not included under the Ministry of Health’s Reference Drug Program (RDP) by therapeutic substitution under the following conditions: 

• There is an actual shortage for a prescribed drug*; and
• No interchangeable drug is available 
• For the duration of the COVID-19 public health emergency in BC 

* Pharmacists must include evidence of the drug shortage with the adaptation documentation. Examples of acceptable evidence include: 

• Report from Drug Shortages Canada 
• A “no alternative available” listing on PharmaCare’s Current Drug Shortages List. 

When making a therapeutic drug substitution, pharmacists must be satisfied that the dose and the dosing regimen of the new drug you select will have an equivalent therapeutic effect, and that the substituted drug is within the same therapeutic class as the prescribed drug. 

Therapeutic substitution is not permitted for controlled drug substances and cancer chemotherapy agents. 

Previously, under PPP-58, therapeutic substitutions were limited to those categories under the RDP, unless in practice settings such as hospital, long-term care facilities or multi-disciplinary environments where collaborative relationships or appropriate protocols are established. 

While drug shortages have been increasing in recent years, additional drug shortages are occurring, or are expected to occur, as a result of COVID-19. In recent years, drug shortages of drugs within RDP classes have occurred, however the ability of pharmacists to provide therapeutic substitutions with other drugs in the same class has mitigated some of the impacts of these shortages. 

The expected and actual drug shortages due to COVID-19 will extend beyond the therapeutic categories of the RDP, requiring pharmacists to be able to ensure timely continuity of care for patients impacted by these shortages.