Cross-Jurisdictional Pharmacy Services Policy

Purpose:

This policy articulates 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.

For the provision of virtual care to patients located in another jurisdiction, the College expects registrants to comply with this policy as well as the Virtual Care policy.

Definitions:

Prescriber: a person who is entitled under the laws of a province to treat patients with a prescription drug, and is practising their profession in that province. (See ‘practitioner’ in Food and Drug Regulations, CRC, c870, C.01.001)

Informed Consent: consent to treatment is informed if, before giving it, the person received the information about the nature, expected benefit, potential risks or side effects, other options and consequences of not having the treatment (or any information that a reasonable person in the same circumstances would require in order to make a decision about the treatment) and the person received responses to their request for additional information (Health Care Consent Act, 2004, s.11(2)).

Policy:

Registrants providing pharmacy services to patients that are physically located outside of Ontario must meet or exceed all applicable standards, guidance, and legislative requirements that apply when providing care to patients in Ontario.

Providing Pharmacy Services across Canadian Jurisdictions

Registrants providing pharmacy services to patients that are physically located in another Canadian jurisdiction must be aware of, and comply with, the law, regulations, standards and policies, and any other practice requirements applicable in the jurisdiction where the patient is located.

  • Registrants are advised that the pharmacy regulatory authority in the jurisdiction where the patient is physically located may require that they be registered in that jurisdiction prior to providing pharmacy services to patients in that jurisdiction.

Obtain Informed Consent

Registrants providing pharmacy services to patients located in another Canadian jurisdiction must obtain explicit informed consent from the patient or their substitute decision maker before delivering cross-jurisdictional pharmacy services.

  • Patients or their substitute decision maker must be informed that the Ontario College of Pharmacists may share information with the pharmacy regulator in the patient’s jurisdiction for the purposes of regulating the practice of pharmacy.

Out-of-Province Prescriptions

Registrants must only dispense a medication according to a prescription authorized by a practitioner who:

a) is entitled under the laws of another Canadian jurisdiction to treat patients with a prescription medication; and,
b) is practising their profession in that same Canadian jurisdiction. (Food and Drug Regulations, CRC, c870, C.01.001)

Registrants can dispense a medication according to a prescription authorized by a prescriber if in their professional judgement the patient requires the medication be dispensed by the pharmacy in Ontario.

  • 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.
  • Registrants can accept a written, verbal or faxed prescription, including refills, if any. There are no restrictions on accepting new narcotic, controlled drug, benzodiazepine and other target substances prescription orders, provided registrants use professional judgement and practice due diligence in verifying the prescription’s authenticity.

(Drugs and Pharmacy Regulation Act, 1990, s.1; s.158)

Providing Pharmacy Services to Patients in Ontario

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.

Providing Pharmacy Services to Patients Not in Canada

Registrants must not provide pharmacy services to patients that are physically located outside of Canada and who do not have an established therapeutic relationship with the pharmacy professional.

Registrants are permitted to provide care to patients where there is an existing therapeutic relationship, and the patient is temporarily located outside of Canada.

Out-of-Country Prescriptions

Registrants must not dispense a medication that has been authorized by a prescriber who does not hold a valid certificate of registration in a Canadian jurisdiction.

  • As per Canada’s Food and Drug Regulations, an authorized practitioner (i.e. prescriber) must hold a valid certificate of registration to practice their profession in a Canadian jurisdiction and maintain an active practice in the Canadian jurisdiction where they are registered. (CRC, c870, C.01.001)
  • In situations where a registrant suspects that a prescriber does not maintain an active practice in the Canadian jurisdiction that issued their certificate of registration, it is the registrant’s professional responsibility to inquire with the prescriber before dispensing the medication.

Registrants must not facilitate the co-signing or rewriting of prescriptions authorized by prescribers not licensed in Canada.

  • Registrants are reminded that prescribers must have an established therapeutic relationship with the patient for whom the prescription is for (e.g. CPSO’s Prescribing Drugs policy).
  • It is the professional responsibility of registrants to follow-up with the prescriber if there is any uncertainty about the validity of the prescription or whether the prescribing practitioner has an established therapeutic relationship with the patient.

Registrants dispensing medications according to a prescription authorized by a prescriber for patients physically located outside of Canada must use their professional judgement to determine whether the patient requires the medication be dispensed by the pharmacy in Ontario.

  • 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.

(Drugs and Pharmacy Regulation Act, 1990, s.1; s.158)

Legislative References:

Health Care Consent Act, 2004, s.11(2)
Drug and Pharmacies Regulation Act, 1990, s.1; s.158
Food and Drug Regulations, CRC, c870, C.01.001

Additional References:

Pan-Canadian Cross-Jurisdictional Principles and Framework (once approved)
Position Statement – Authenticity of Prescriptions using Unique Identifiers for Prescribers
Fact Sheet – Prescription Transfers – Out-of-Province transfers of prescriptions

Implementation

Published: July 6 2022
Version #: 2.00
College Contact: Pharmacy Practice

Revision History
Version # Date Action
1 2003; 2013 Out-of-Country prescriptions policy; Out-of-Province Prescriptions fact sheet
2 Out-of-Country prescriptions policy and Out-of- Province Prescriptions fact sheet combined and updated into new Cross Jurisdictional Pharmacy Services policy; Out-of-Country prescriptions policy and Out-of-

Province Prescriptions fact sheet retired.