Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC)

Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC)

[Updated - June 22, 2023]

New regulatory standards providing pharmacists in BC with the authority to diagnose and prescribe medications to clients in British Columbia for minor ailments and contraception are now in effect.

What this means for British Columbians

These changes, along with the changes to expand the range of services available from community pharmacies announced in September, will help to expand the capacity of BC’s primary care providers and improve patient access to care for minor ailments and contraception.

As a result of these changes, patients in BC can expect:

• Improved timely access to medications
• An improved patient experience when accessing a primary care provider
• Improved access to healthcare services for those living in rural and remote communities
• Better health outcomes

What Conditions Will Pharmacists Be Able to Prescribe For?  

Pharmacists can make a diagnosis and prescribe drugs for the conditions listed in Schedule A of the Pharmacists Regulation.

Pharmacists may only prescribe Schedule I drugs for these conditions, if they are in a drug category shown opposite the condition listed in Schedule A of the Pharmacists Regulation.

For the purposes of contraception or emergency contraception, pharmacists may prescribe a Schedule I drug.

A pharmacist may only make a diagnosis or prescribe for one of these conditions if the patient’s symptoms indicate that the condition:

• Presents a low risk of masking an underlying disease, disorder or condition;
• Can be readily diagnosed without the need for laboratory or imaging tests; and
• Can be reasonably expected to resolve with only short-term or episodic treatment.

The following training and resources will be made available prior to the June 1 launch:

• A BCPhA orientation training module on prescribing for minor ailments and contraception that focuses on B.C.-specific requirements around PharmaCare and practice requirements.
• Accredited content on contraception and smoking cessation available from CPPD in summer 2023.

Standards, Limits and Conditions and Professional Practice Policy

Making a Diagnosis and Prescribing Standards, Limits, and Conditions

The Health Professions Act Bylaws, Schedule F, Part 8: Making a Diagnosis and Prescribing Standards, Limits, and Conditions set the standards, limits, and conditions for PPMAC.

(View PDF)

Professional Practice Policy-70: Making a Diagnosis and Prescribing - Regulatory Education Module

The Professional Practice Policy-70: Making a Diagnosis and Prescribing - Regulatory Education Module (PPP-70) has been developed to outline the education and self-declaration requirements for pharmacists who choose to provide PPMAC services. Completion of the Regulatory Education Module and submission of self-declaration through eServices must be done before providing PPMAC services.

(View PDF)

EDUCATION AND TRAINING

PRESCRIBING FOR MINOR AILMENTS AND CONTRACEPTION REGULATORY EDUCATION – NOW AVAILABLE

The College, in collaboration with UBC CPPD, has developed a regulatory education module for pharmacists.

This module introduces the new regulatory framework which enables pharmacists in British Columbia to prescribe for minor ailments and contraception in a safe, effective, and ethical manner. This regulatory framework has been established collaboratively by the College of Pharmacists of BC and the Ministry of Health.

Upon completion of this Regulatory Education module, you will be able to:

1. List the pharmacist’s professional responsibilities when making a diagnosis or prescribing for minor ailments and contraception
2. Describe the Pharmacists Regulation and the authority that enables pharmacists to make a diagnosis and prescribe for minor ailments and contraception
3. Describe the Standards, Limits and Conditions that govern pharmacists making a diagnosis and prescribing for minor ailments and contraception
4. Apply your knowledge of what is authorized in the Pharmacists Regulation and the College of Pharmacists of B.C.’s Standards, Limits and Conditions to provide safe, effective, and ethical care
5. Identify and locate applicable resources available to support pharmacists when making a diagnosis or prescribing for minor ailments and contraception

Prior to making a diagnosis or prescribing for minor ailments or contraception, pharmacists must complete the College’s regulatory education module and self-declare completion of this training through their eServices account. 

The College’s Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC): Regulatory Education Module is available on UBC’s Canvas Catalogue Learning Management System:

Do I have to complete the regulatory education module before I can prescribe for minor ailments and contraception? 

Yes. Prior to making a diagnosis or prescribing for minor ailments or contraception, pharmacists must complete the College’s regulatory education module and self-declare completion of this training through their eServices account. The module and self-declaration must be completed prior to providing services under PPMAC.  

The College’s PPMAC Regulatory Education Module is the only mandatory training module that must be completed prior to providing PPMAC services. This requirement is found in Professional Practice Policy -70 Making a Diagnosis and Prescribing – Regulatory Education Module.  

Where can I access the College’s mandatory regulatory education module for PPMAC? 

The College’s Pharmacist Prescribing for Minor Ailments and Contraception (PPMAC): Regulatory Education Module is available on UBC’s Canvas Catalogue Learning Management System.  

Where do I declare that I have completed the module?

Declarations of module completion must be recorded in the registrant’s eServices account. Declarations can be submitted by selecting “My Profile” > “My Declarations” > “PPMAC”. 

If I am a pharmacist who received authorization to prescribe in another province, do I still need to complete the College of Pharmacists of BC’s regulatory education module? 

Yes. Prior to making a diagnosis and prescribing for minor ailments or contraception in BC, all pharmacists registered in BC who choose to provide services under PPMAC must complete the College’s regulatory education module and self-declare completion of this training through their eServices account.  

The regulatory education module includes content specific to prescribing for minor ailments and contraception in BC. 

Will completion of the module count towards my required accredited learning activities? 

The College’s PPMAC regulatory education module is not an accredited learning program and therefore, cannot be used as an accredited learning activity for professional development. However, registrants may use the regulatory education module as a non-accredited learning activity.  

Do I have to complete the module all in one sitting or can I complete part of it and then pick up later where I left off? 

The regulatory module does not need to be completed in one sitting. Registrants may revisit the module as many times as required to pick up where they left off, until completed. Self-declaration through eServices must not be submitted until the module has been completed. 

CLINICAL RESOURCES

While most pharmacists in BC already have the knowledge, skills and abilities to prescribe medication for minor ailments and contraception, additional optional education, training and resources will be made available to registrants at no additional cost.

MedSask Minor Ailments and Self Care Guidelines
The British Columbia Pharmacy Association (BCPhA) is providing access to MedSask’s “Minor ailment and self-care guidelines” at no cost to all BC registrants. These guidelines serve as a tool to aid decision-making by providing treatment algorithms and patient assessment and treatment checklists for each condition.

• BCPhA: Free Access to MedSask’s Minor Ailments and Self Care Guidelines Now Available

UBC Continuing Pharmacy Professional Development Program (CPPD)
The University of British Columbia’s Continuing Pharmacy Professional Development Program (CPPD) is also providing free accredited clinical education modules on several minor ailment conditions to registered pharmacists in BC.

• UBC CPPD: Minor Ailments and Contraception Service (MACS) on Canvas Catalog

Additional Resources

• BC Gov: Minor Ailments and Contraception Service (MACS)
• BC Gov News: New health workforce strategy improves access to health care, puts people first
• BC PharmaCare Newsletter: Special Edition, April 18, 2023
• BC Pharmacy Association: MedSask Minor Ailment Guidelines Now Available
• BC Pharmacy Association: British Columbia Gets New Pharmacy Services

Can a pharmacist’s prescription be transferred?

Yes. A pharmacist can transfer a prescription issued by a pharmacist, if the transfer is done in accordance with the Community Standards of Practice bylaws on prescription transfers.

Can a pharmacist adapt another pharmacist’s prescription?

Yes. A pharmacist can adapt another pharmacist’s prescription if the pharmacist determines that the adaptation meets the criteria in Professional Practice Policy – 58.

Can a pharmacist prescribe Schedule II drugs for minor ailments?

No. The Regulation amendments do not give pharmacists authority to prescribe Schedule II drugs; however, Schedule II drugs can continue to be sold without a prescription, if the pharmacist determines it is appropriate for the patient.

If I decide to advise a patient to seek treatment from another health professional rather than prescribe for the patient myself, do I still need to document and if so, what do I need to document?

According to Standard 14 of the HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions:

“A pharmacist who prescribes a drug for a patient must document…”

As stated, the documentation requirements only apply when a pharmacist prescribes a drug. However, the Ministry of Health may have its own PharmaCare policies regarding documentation when a patient assessment does not lead to a prescription being issued. Review of the Ministry of Health’s Pharmacare Policy Guide is recommended.

Can I diagnose and prescribe through phone or virtual consultation, or do I need to see the patient in person?

The HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions do not limit pharmacists to making diagnoses or prescribing for minor ailments or contraception in person.

A pharmacist may make a diagnosis and prescribe for a patient over the phone or through a virtual platform if the pharmacist is able to perform a patient assessment that is appropriate for the condition being treated and conducted in a manner that the patient confirms is suitably private for them. The pharmacist is responsible for ensuring that the patient’s identification is appropriately verified before providing any pharmacy service that requires accessing, collecting, using, or disclosing personal health information.

As always, when making a diagnosis or prescribing for a patient over the phone or through a virtual platform, pharmacists must continue to act in accordance with the:

• HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions;
• Conflict of Interest Standards;
• Code of Ethics; and
• Other relevant legislation, bylaws, and policies.

Note: The Ministry of Health may maintain its own requirements regarding the provision of PPMAC services to PharmaCare eligible patients. Review of the Ministry of Health’s Pharmacare Policy Guide is recommended.

Can pharmacists assess patients and prescribe in different practice settings other than licensed pharmacies?

The HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions do not prevent pharmacists from making a diagnosis or prescribing for minor ailments and contraception in settings outside of licensed pharmacies. However, when prescribing for patients in settings other than licensed pharmacies, pharmacists must continue to act in accordance with those standards and other relevant legislation, bylaws, and policies referred to in the Application section of the standards. Regardless of practice setting, pharmacists must confirm with the patient that the setting is suitably private for the patient.

In its recommendations to the College Board, the Prescribing and Drug Administration Committee (PDAC) of the College identified virtual care as an area that may require further regulation to ensure consistency in patient care. The standards, limits and conditions for virtual PPMAC services may be subject to change in the future.

Must PPMAC services be provided in a private consultation room?

According to Standard 11 of the College’s HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions: “When making a diagnosis or prescribing a drug, the pharmacist must take the appropriate steps to ensure the assessment is conducted in a manner that the patient confirms as suitably private.”

PPMAC services may be provided to patients in various practice settings and environments including community pharmacies, hospitals, or residential care facilities. It is the pharmacist’s responsibility to ensure that the patient’s privacy needs are addressed in any of these settings. As part of the process, it is important for the pharmacist to confirm with the patient that the space where the consultation will take place is suitably private for them before proceeding with the provision of any service, particularly if a private consultation room is not available.

Will all pharmacists provide PPMAC services?

Having the legislated authority to prescribe for minor ailments does not mean all pharmacists will offer or provide this service. Patients are encouraged to speak to their pharmacist to find out what healthcare services they offer and whether they are right for their needs.

The decision to incorporate prescribing for minor ailments into pharmacist practice, and to what extent, is based on the pharmacist’s clinical knowledge, skills, and judgment as well as the suitability of the practice environment, current circumstances, capacity, and comfort level. The decision to prescribe is at the discretion of the individual pharmacist, subject to the Code of Ethics.

Portions of the Code of Ethics that are especially relevant include:

• Section 1(b): “Registrants practice only within the scope of their education, training and competence”; and
• Section 1(g)(ii): “Registrants must provide pharmacy services requested by patients and may only refuse to provide these services for the following reasons: … the registrant does not possess the knowledge, skills and abilities to provide the service or product …”.

A pharmacist must complete the regulatory education requirement and self-declare completion in eServices prior to making a diagnosis or prescribing for a patient. A pharmacist who does not meet those requirements is not authorized to provide PPMAC services as they would not be practicing within the scope of their education, training and competence.

Additionally, a pharmacist who meets those requirements and decides to prescribe for minor ailments and contraception is not obligated to prescribe in every case. As with other health professionals, pharmacists will use their professional judgement to determine if they have the competency and confidence to prescribe in the best interest of the patient in each case.

Will pharmacists who are pharmacy owners be able to prescribe for “minor ailments” or contraception?

Yes. As of June 1, 2023, section 3 of the Pharmacy Operations General Regulation specifies that a pharmacist who is authorized to prescribe a drug may be a direct or indirect owner of a pharmacy. When prescribing, pharmacy owners must continue to act in accordance with the:

• HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions;
• Conflict of Interest Standards;
• Code of Ethics; and
• Other relevant legislation, bylaws, and policies.

Can a student pharmacist complete the assessment, make the diagnosis, prescribe a drug, and document if the pharmacist reviews and signs off on the prescription?

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.

Although pharmacy student registrants are not required to complete the regulatory education module prior to participating in aspects of PPMAC services, the module is available to pharmacy students, and they are encouraged to review the module to ensure a thorough understanding of the legislative framework that governs PPMAC in BC.

Is access to CareConnect required to prescribe under PPMAC?

Access to CareConnect is not a mandatory requirement for providing PPMAC services.

Standard 9 of the College’s Making a Diagnosis and Prescribing Standards, Limits and Conditions states:

“Prior to prescribing a drug, a pharmacist must obtain relevant drug therapy information, which may include a review of: 

1. the patient or resident record1;
2. the patient PharmaNet record; or 
3. information provided by the patient or patient’s representative.” 

Standard 10 of the College’s Making a Diagnosis and Prescribing Standards, Limits and Conditions states:

“A pharmacist must review or conduct a patient assessment to support their diagnosis and/or prescribing decisions. The assessment must include the following as feasible and applicable, but is not limited to these factors:

1. demographic information;
2. medical conditions;
3. medication history;
4. signs and symptoms;
5. allergies and intolerances;
6. risk factors;
7. pregnancy and lactation status;
8. physical assessment;
9. laboratory or other diagnostic tests, if available;
10. patient needs, values, and preferences; and
11. any other information deemed necessary.”

The pharmacist is responsible for ensuring they have obtained the relevant drug therapy information and that they conduct a patient assessment to support their diagnosis and/or prescribing decisions. The pharmacist must use their professional judgement to determine how and where they access relevant information that is sufficient for informing and supporting their prescribing decision. This includes considering whether the patient’s CareConnect records need to be included in the review.

What is considered a “minor ailment”?

Under section 4(1)(a.1) of the Pharmacists Regulation, pharmacists can:

“make a diagnosis identifying, as the cause of the signs or symptoms of an individual, a disease, disorder or condition that is shown in Column 1 of Schedule A, if all of the following conditions are met:

                (i) the disease, disorder or condition, in the form indicated by the individual's signs and symptoms,

                                (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;

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

Pharmacists are responsible for determining if the condition being treated meets the criteria above, based on their professional judgement. Pharmacists may only prescribe for the diseases, disorders or conditions listed in Schedule A of the Pharmacists Regulation, if the criteria above are met.

Are pharmacists limited to prescribing specific drugs for each minor ailment or contraception?

Under section 4(1)(a.2) of the Pharmacists Regulation, pharmacists can:

“for the purpose of treating a disease, disorder or condition diagnosed under paragraph (a.1), prescribe a drug that is

1. specified in Schedule I of the Drug Schedules Regulation, and
2. within a drug category shown opposite the disease, disorder or condition in Column 2 of Schedule A"

While there is no list of specific drugs that a pharmacist is limited to prescribing from for the purpose of treating a minor ailment, pharmacists must refer to Schedule A of the Pharmacists Regulation and are responsible for ensuring that the prescribed drug is included within the drug category corresponding to that condition and is appropriate for the patient and condition being treated.

Do I need additional liability insurance to make a diagnosis and prescribe for minor ailments and contraception?

The College does not require pharmacists to obtain additional liability insurance if they choose to diagnose or prescribe for minor ailments or contraception.  Questions regarding liability coverage for the provision of PPMAC services should be directed to your insurance provider.

Am I required to follow the medSask prescribing guidelines? Is there any particular guideline that I must follow?

MedSask is available to registrants as a clinical reference tool only. It is important to note that the medSask materials may not reflect the standards, limits and conditions set out by the College of Pharmacists of BC, or the requirements set out in the Pharmacists Regulation or the Ministry of Health’s Pharmacare Policy Guide. The Pharmacists Regulation sets out which conditions pharmacists may prescribe for, and the Schedule I drug categories pharmacists may prescribe for those conditions, which may be different than the medSask guidelines. Pharmacists are responsible for understanding and following the regulatory requirements for prescribing in BC.

Can a pharmacist make a diagnosis and prescribe using an assessment conducted by another health professional, such as a nurse or another pharmacist?  

According to Standard 10 of the HPA Bylaws Schedule F Part 8 – Making a Diagnosis and Prescribing Standards, Limits and Conditions: 

“A pharmacist must review or conduct a patient assessment to support their diagnosis and/or prescribing decisions. The assessment must include the following as feasible and applicable, but is not limited to these factors…” 

A pharmacist can review a patient assessment conducted by another health professional and use that assessment to support the pharmacist’s own diagnosis and prescribing decisions. A pharmacist is expected to use their professional judgment to determine if using another health professional’s assessment, would be appropriate and to ensure they have all the necessary information to make a diagnosis or prescribing decision that is safe and in the best interest of the patient. 

In this situation, the pharmacist who diagnoses and prescribes for the patient is still required to follow the Standards, Limits and Conditions, including obtaining the patient’s or patient representative’s informed consent, having appropriate understanding of the patient need, providing the patient with drug information including patient-specific information, and establishing and documenting a follow-up and monitoring plan.  

A pharmacist who makes a diagnosis or prescribes a drug is solely responsible for their treatment decision.  

Please check this page regularly for future updates.