Published: September 2012
Revised: April 2014
College Contact: Pharmacy Practice
The decision by the pharmacist to dispense a prescription refill after a physician’s registration status has changed is made within the context of the pharmacist’s professional judgement, the Code of Ethics and the Standards of Practice. In most cases, the prescription refill will be invalid; however, the pharmacist may decide to honour the refill request based on a patient assessment and the patient’s best interests. Where the pharmacist decides to dispense a prescription refill after the physician’s registration status has changed and the current refill prescription is invalid, the patient should be directed to find a new or interim prescriber before another refill is required.
- No longer an active registration status
- Refills invalid
- Registration suspended
- New Rx valid if written before suspension
- Refills not valid after suspension
- Registration revoked
- New Rx valid if written before revocation
- Refills not valid after revocation
- Practice Restriction
- Active registration (with terms, conditions and limitations)
- New Rx valid if written before restriction
- Refills not valid after restrictions imposed
- Registration cancelled — refills invalid
- Registration active (maintained registration) — MD is responsible for refills for up to one year
- Registration active (maintained registration)
- MD is responsible for refills for up to one year
Issues to consider:
- Professional judgment is specific to each practitioner and is generally based on a combination of practical experience, reflective practice, and learning from one’s peers.
- Code of Ethics highlights the obligation to act in the best interest of the patient and places the well-being of the patient at the centre of the member’s professional practice.
- Standards of Practice permit pharmacists to refuse to fill any prescription that may pose a risk to a patient’s health, which may be a factor to consider where a drug requires clinical monitoring and the patient no longer has a physician to order lab tests and monitor results.
- Prescriptions and refills are invalid once the privileges of registration are removed as a physician no longer has prescribing privileges
- Patients are no longer under the care of a physician in most circumstances where a physician’s registration status has changed. When the pharmacist decides to dispense the refill in these circumstances, the pharmacist is taking on additional responsibility for the patient and his or her medication use.
- Pharmacists may:
- refuse to fill or
- direct patients to a walk-in clinic or
- exercise their professional judgment based on available patient information to ensure continuity of care
- Although part-fills of controlled substances and prescriptions written prior to a suspension or revocation are valid, the pharmacist should use his or her professional judgment in determining whether to honour the part-fills considering any relevant issues related to the physician’s suspension or revocation.
- Physicians who have moved or retired and are maintaining their registration are responsible for any refills that they have opted to prescribe for their patients, for up to one year.
- Where a physician is subject to an imposed practice restriction, pharmacists should carefully review the terms, conditions, and limitation, the effective date of the restriction, and when forming part of the practice restriction, the specific drugs identified.
- Where there are questions about the registration status of a physician or practice restriction, members can access the College of Physicians and Surgeons website www.cpso.on.ca or call CPSO, Practice Advisory (1-800-268-7096 extension 606) to obtain further information.