Feedback deadline was: May 24, 2021
Summary
The Ontario College of Pharmacists (OCP) is currently seeking feedback on the draft Cross-Jurisdictional Pharmacy Services policy. The College is inviting all pharmacy professionals, pharmacy stakeholders, and members of the public to comment. Following the consultation, the final draft Virtual Care policy will be brought forward for approval by the Board in June 2021.
The current ‘Prescriptions – Out of Country’ policy and ‘Out of Province Prescriptions’ fact sheet were reviewed as part of OCP’s Policy Review Process. They have been combined into a new draft Cross-Jurisdictional Pharmacy Services policy that reflects the following updates:
- Outlines the College’s expectations for the provision of pharmacy services to patients located in other Canadian jurisdictions, as well as to patients located outside of Canada.
- Facilitates pan-Canadian access to pharmacy services by clarifying that the physical location of the patient influences which legislative and regulatory frameworks are applicable to pharmacy practice.
- Includes the definition and criteria to be considered an authorized prescriber in the Food and Drug Regulations, and how this applies to cross-jurisdictional pharmacy services.
- Clarifies the limits Ontario’s Drugs and Pharmacies Regulation Act, 1990 places on the conditions for dispensing a medication according to a valid prescription, and how this applies to out-of-province and out-of-country prescriptions.
See the draft Cross-Jurisdictional Pharmacy Services Policy
Questions to Guide your Feedback
- The purpose of drafting this policy is to clarify the legal requirements and regulatory expectations related to providing pharmacy services across jurisdictions. Does the draft policy achieve this purpose?
- Is the draft policy clear? For pharmacy professionals, is it comprehensive enough to support your practice? In what ways might the clarity and/or comprehensiveness of this policy be improved?
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This response was submitted by Shoppers Drug Mart. Read the full submission here.
This response was submitted by the Ontario Pharmacists Association. Read the full submission here.
This response was submitted by the Canadian Society of Hospital Pharmacists. Read the full submission here.
This response was submitted by NAPRA. Read the full submission here.
This response was submitted by the College of Pharmacists of Manitoba. Read the full submission here.
This response was submitted by the Neighbourhood Pharmacy Association of Canada. Read the full submission here.
Hôpital Montfort is Ontario Francophone Academic Hospital located in Ottawa, on the border of the province of Québec. The hospital serves both province’s population. The Cross-Jurisdictional Services Policy draft puts at great risk the continuity of care for patients receiving care in Ontario and having their residency in another province affecting all border communities. It also affects telepharmacy services, a service that has been used extensively during the pandemic. Telepharmacy facilitate access to care for patients who live in regions and remote communities where specialty pharmaceutical services are not available. Moreover, patients should be able to choose where they receive pharmaceutical services. Many people work and live in a different province; this is very common in Ottawa, Ontario and Gatineau, Québec. The population may access pharmaceutical care to facilitate their commute and quality of life. The promotion of an efficient access for pharmaceutical care to all Canadians and the facilitation of pan-Canadian access to pharmacy services is essential and should not be limited by the patient location. Thank you for your consideration.
It is good to have all Juradiction to have the same regulation with some exceptions and allow the practitioner to provide service regardless of the jurisdiction.
While I can understand the need for a “Virtual Care” policy given the number of methods flooding the market, either with or without OCP blessing in terms of meeting minimum standards, this Cross-Jurisdictional Pharmacy Service Policy (CJ policy) is going to do nothing but cause massive confusion across Canada, with the patients being caught in the middle. Pharmacy practice has evolved over the last two decades into speciality areas that just don’t fit the “mom and pop” corner drugstore model any longer. An example is mandatory counselling for a non-human patient’s prescription. But the proposed policy is seriously flawed in a number of areas, where too much “grey area” is evident and must be better clarified (as already stated by a number of posters to this consultation). To wit: 1) Having the location of the PATIENT dictate what regulatory scheme applies, but to require that multiple jurisdictional requirements be met, is most likely to be an untenable situation involving CJ interactions, having to take into consideration time zones, etc. in order to meet the patient’s needs. That is not good pharmacy service, certainly not in the patient’s best interests. The pharmacy doing the dispensing is the one that is fully accountable to the patient. The PATIENT chooses the PHARMACY. A provincial border should not complicate that, as noted by the comments made Apr 19th re Quebec patients working in Ottawa, which can also apply to someone in Kenora having their primary care giver in Winnipeg, then using a local pharmacy there to get their supplies prior to returning to Kenora. Similarly, the May 7th comment about the CHEO situation further underscores this issue of concern. Patients coming to a location for treatments from across Canada, should not be limited in where they choose to get their prescriptions over an issue of having to satisfy multi-jurisdictional technicalities that may actually be in conflict with each other. If NAPRA’s MRA recognizes the basic equivalencies of any Canadian pharmacist as “equal” in terms of practising in any province, for lateral movement, Ontario should not complicate this by such a policy as is proposed. 2) The comments made on both May 20 and 21st are very important, including the case law (Essilor) where Ontario tried to stop BC from providing eyewear to Ontario patients who had been fully assessed by an Ontario practitioner, such that only the product was now being provided from BC. 3) After 10 years of attempting to amend DPRA section 158, it was finally achieved in 2007 and the OCP made it clear to members that they could now, without question, accept any prescription legally issued in Canada by a Canadian practitioner, using their professional judgement as to need. The OCP regularly states that it does not give opinion on exercising such judgement. Yet, under “Out-of-Province Prescriptions” and in relation to section 158, the first bullet reads that Registrants “must consider the patient’s ability to access the medication in their home jurisdiction…” Why? The patient has already chosen their pharmacy, the prescription is legitimate; why introduce a requirement that was not part of the revised section 158 of the DPRA? That revision was unconditional. 4) “Providing Pharmacy Services to Patients in Ontario” — OCP proposes to permit other provincial practitioners (pharmacy) to provide services to Ontario provided they have a certificate of registration in another CDN jurisdiction. OCP will not require those pharmacists, etc. to be licensed in Ontario. The worry about multi-jurisdictional registration compliance will do nothing more than complicate patient care and delay patient care; to that end, the patient as the focal point appears to be left out of the considerations here. 5) “Providing Pharmacy Services to Patients Not in Canada” — This section has to be better clarified. We know that prescriptions from a non-Canadian are not legitimate in Canada. So, it would appear that even if there is a patient/pharmacist relationship with the non-CDN patient, there would be no way to provide prescription services unless that non-CDN patient came to Canada to see a Canadian practitioner. Then, the next line states that you CAN provide care to such patients with a therapeutic relationship existing and the patient is temporarily outside of Canada. That would still not be legal if, during that being located outside Canada, it was (say) an American prescription that was involved. Because the base federal definition of a “prescriber” is Canada-centric (as noted in the next section of the proposed policy, “Out-of-Country Prescriptions”). 6) The final paragraph of the proposed policy contradicts the CJ (CDN) concept of mutual regulatory compliance in both jurisdictions. (In fact, there could be a 3 jurisdiction consideration where, say, a person living in Lloydminster (Alberta side of the main street, being the border) crosses the street to Saskatchewan to see their doctor, then chooses to have the prescription filled by a specialty pharmacy in Ontario. Professional consideration should be given to all 3 jurisdictions by the pharmacist filling the prescription. Yet, the bulleted point references a patient physically located outside Canada, having to have the Ontario pharmacist consider the ability of the patient to get the prescription in their home jurisdiction in deciding to dispense a VALID PRESCRIPTION. There is no reference to the pharmacist having to also comply with the licensing, etc. in the “out of Canada” jurisdiction, as is required within Canada. For the prescription in this scenario to be legal, it would have to be where a Canadian prescriber issued the order, the patient took it with them outside of Canada, then wanted it filled. That would be authorized by statute, even if the “supply” of the drug was external to Canada, as the prescription status was Canadian-issued. Why question, now, why the patient might be able to get the prescription in their “temporary abode” outside Canada, when they have decided to choose (patient choice prevailing) to have it filled in Ontario? It makes no sense, and complicates what are very clear Canadian federal statutes as well as the clarified section 158 of the DPRA which has functioned fine since proclamation over 12 years ago. Why mess around with what is already working for patient care?
The purpose of drafting this policy is to clarify the legal requirements and regulatory expectations related to providing pharmacy services across jurisdictions. Does the draft policy achieve this purpose? Given the permissive language in the provincial Drug & Pharmacies Regulation Act and the federal Food and Drugs Act and the fact that pharmacy practice is effectively regulated in every jurisdiction in Canada, it is not clear what the public interest rationale is for attempting to impose additional requirements & expectations for cross-jurisdictional pharmacy service within Canada through policy. We do not believe additional requirements & expectations are necessary to protect the public. We are concerned that any additional requirements & expectations will create barriers to the provision of cross-jurisdictional pharmacy service in Canada and could have the unintended consequence of limiting patients’ choice of pharmacy which seems contrary to the public interest. We believe that the location of the dispensing pharmacy should continue to dictate the regulatory oversight requirements for pharmacy service, as is the case for cross-jurisdictional transfers of prescriptions and “central fill” policies of various pharmacy regulatory authorities. This policy’s position that the regulatory requirements for cross-jurisdictional pharmacy service would be dictated by the location of the patient is inconsistent, confusing & likely unenforceable. Finally, we question the enforceability of the proposed policy in light of the Ontario Court of Appeal decision in College of Optometrists of Ontario v. Essilor Group Inc. Is the draft policy clear? For pharmacy professionals, is it comprehensive enough to support your practice? In what ways might the clarity and/or comprehensiveness of this policy be improved? It is not clear how this policy would support specialty practices, for example veterinary pharmacy practice, where ‘office use’ prescriptions are common and asking prescribers for informed consent would be redundant.
Feedback – Cross Jurisdictional Pharmacy Services Definition of Informed Consent: Can this be amended to include the statement “Unless the patient or substitute decision maker explicitly decline counselling when offered.” Please provide rationale for the practice requirements to be associated with the PATIENT’s location vs the PHARMACIST’s location. Is OCP planning to develop practice tools to assist with laws, regulations, standards in other provinces to highlight key differences to be aware of? Is the intent of this policy to address provincial differences in scope of practice or is it meant to encompass general tasks like dispensing, counselling, compounding. Perhaps Pharmacy Services should be defined at the beginning of the policy. Please identify which provinces currently require the registrant to be registered in the jurisdiction where the PATIENT is located. We feel that this requirement contradicts the section “Proving Pharmacy Services to Patients in Ontario” which aims to support access to pharmacy services. “Patients or their substitute decision makers must be informed that OCP may share information with the pharmacy regulator in the patient’s jurisdiction.” What type of information will be gathered and shared by OCP? This should be detailed in the body of the policy.
I think any pharmacist licensed in Canada should be able to dispense medications in Ontario provided they passed the Jurisprudence exam in Ontario and comply with the laws and professional practice requirements. Although the policies are clear, the member can benefit from some examples as one of the colleague stated.
I have read the draft dock ent and feel that it accurately represents my feelings for the delivery of professional services across boundaries. Well done.
Children Hospital of Eastern Ontario(CHEO) is providing specialty care to out of province patients on a regular basis. About 20% of our care if provided to out of province patients. With specialty care come with the use of specialized medicines. Many of the specialty clinical services have pharmacists supporting them . The policy proposed by the Ontario College of Pharmacists will restrict the provision of virtual care to out of province patients. The unintended consequences could be: 1. Out of province patients will receive sub optimal care compared to Ontario patients as pharmacists may opt-out of providing virtual care (including telephone advice); and/or 2. Ontario hospital pharmacists in providing virtual care will be facing an increased liability as ethically they cannot refuse to provide care; Outside of province patients need to have the same level of care as Ontarian. The liability should be based on where the virtual care originates from not where the patient is residing. The pharmacists are liable not the patients. For your consideration.
Cross jurisdictional verification can sometimes be very labor intensive for a busy pharmacy but I am pleased to see the reminder that documentation is important, for professional and legal purposes.
A pharmacist that is not licensed in ON should not provide health care services to Ontarians.
“draft cross-jurisdictional services policy” – I believe policy achieves expected purpose. I think policy is clear and comprehensive. Thank you.
As a pharmacist working close to the Ontario/Quebec border, there’s some concern about restricting access to pharmacy services to patient’s that reside in the area but that live in Quebec. The following line: «Registrants must consider the patient’s ability to access the medication in their home jurisdiction when deciding to dispense a medication according to a valid prescription.» may lead to blocking a patient’s ability to choose to receive care from a pharmacy in Ontario when they live/work close to this pharmacy. Also have some concern about restricting a pharmacists ability to provide follow-up care for a patient that may need to come to Ontario for care that isn’t available at a hospital in their province (i.e. pediatrics) by mandating that they be registered in that province.
It would be helpful to give examples of what is meant by the policy on cross-jurisdiction pharmacy services. For example, if one of your regular pharmacy clients goes to Florida and needs a prescription filled, outline what must occur, eg can you fill the order from a Florida doctor–can you ask the local doctor to authorize the Florida prescription–does your client need to contact their doctor in Ontario for a prescription before you can fill it and send it to them. If you could outline the acceptable scenario and unacceptable scenarios in a separate narrative, that would help us understand the formal policy. The policy on virtual care seems clear.
I can see that the draft policy is comprehensive enough and clear for pharmacy professionals to support our practice in Draft Cross-Jurisdictional Services Policy
Clear document ‘Registrant’ could be defined at the beginning
Everyone even the best health care professionals make mistakes, even the most experienced pharmacists will make mistakes but if the member got the courses and the advise they needed to avoid more mistake in the future and showed real steps or action plans applied to improve their daily practice, that should be enough, pharmacists are working under so much pressure everyday trying their best to provide the best possible service in their daily practice . We respect confidentiality of patients likewise confidentiality of ourselves should be treated with such high degree of respect and caution as well.
It shouldn’t be pharmacists responsibility to determine if a therapeutic relationship exists between patient and prescriber. Many times multiple pharmacies are involved in patient care and establishing a therapeutic relationship is impossible
Read this change: To support access to pharmacy services, pharmacy professionals who are not licensed to practice in Ontario may provide care to patients that are physically located in Ontario if the following conditions are met: a) they hold a certificate of registration from another Canadian jurisdiction; and, b) they comply with the laws, regulations, standards and policies, and any other professional practice requirements as stipulated by the Ontario College of Pharmacists. Now In my Opinion, Only Pharmacists Licensed in Ontario should be providing Pharmacy services in Ontario. Other proviences does the same. I still don’t get the facilitation ease as we have over supply of Pharmacists which brings profession demand down and now they want pharmacist from other jurisdictions provide care in Ontario. I am totally against this. Apart from this everything else looks fine.
I don’t think it’s a good idea to allow a pharmacist who’s not licensed in Ontario , who hasn’t passed the jurisprudence exams of Ontario, who’s not used to our quality of service in Ontario. To be allowed to dispense medication to a patient in Ontario
No problem with proposed policy. Implement ASAP