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              Prescribing and Use of Drugs
          by Non-Physician Health Professionals:



A Jurisdictional Review of the Profession of Pharmacy


                      November 2008
Non Physician Prescribing and Use of Drugs                                                                                                                   2
Jurisdictional Review – Profession of Pharmacy
November, 2008

                                                                              Pharmacy

1)        Authority to Prescribe and/or Administer Drugs in Canadian Jurisdictions

Legislative authority under which pharmacists operate in Canadian provinces is cited in HPRAC Pharmacists Jurisdictional Review, available at
www.hprac.org/en/projects/resources/Pharmacy-Scopejurisdictional Review.pdf
Province and          Prescribing and/or                             Framework and Authority                         Standard of                List/class
Regulatory            administration of drugs                                                                        practice/Guidelines/
Body)                                                                                                                Policies

Ontario                                                               Pharmacists are regulated under the following
                                                                      Acts and regulations:
Ontario College of                                                    Drug and Pharmacies Regulation Act
Pharmacists 1                                                         Regulated health Professions Act, 1991
                                                                      Pharmacy Act
                                                                      Pharmacy Regulation
                                                                      Ontario Drug Benefit Act
                                                                      Drug Interchangeability and Dispensing Fee
                                                                      Act

                                                                      -------------------------
                                                                      Scope of practice 2
                                                                      3. The practice of pharmacy is the custody,
                                                                      compounding and dispensing of drugs, the
                                                                      provision of non-prescription drugs, health
                                                                      care aids and devices and the provision of
                                                                      information related to drug use. 1991, c. 36, s.
                                                                      3.

                                                                      Authorized acts
                                                                      4. In the course of engaging in the practice of
                                                                      pharmacy, a member is authorized, subject to
                                                                      the terms, conditions and limitations imposed
                                                                      on his or her certificate of registration, to

1
    http://www.ocpinfo.com/
2
    http://www.ocpinfo.com/client/ocp/OCPHome.nsf/(LegislationForWeb)/Pharmacy+Act,+1991+Act?OpenDocument&PFV
Non Physician Prescribing and Use of Drugs                                                                                                                 3
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and       Prescribing and/or                               Framework and Authority                            Standard of            List/class
Regulatory         administration of drugs                                                                             practice/Guidelines/
Body)                                                                                                                  Policies

                                                                    dispense, sell or compound a drug or
                                                                    supervise the part of a pharmacy where drugs
                                                                    are kept. 1991, c. 36, s. 4 3

Alberta            Prescribing activities fall into three general   Health Professions Act, R.S.A. 2000, c.H-7                                There are no
                   categories: initial access prescribing,                                                                                    lists of drugs,
Alberta College    prescription modification and comprehensive      Schedule 19 (Profession of Pharmacists)                                   instead
of Pharmacists     drug therapy management. The latter only         Health Professions Act R.S.A. 2000, cH-7                                  pharmacists
                   occurs in collaboration with other care          Pharmacy and Drug Act R.S.A. 2000 c.P-13                                  are expected to
                   providers where there is sufficient              Pharmacy Professions Regulation A.R.                                      limit their
                   information available to the pharmacists to      129/2006                                                                  prescribing to
                   make recommendations for drug therapy.                                                                                     situations
                                                                    Scope of Practice                                                         where they
                                                                    In their practice, pharmacists promote health                             have an
                                                                    and prevent and treat diseases, dysfunction                               adequate
                                                                    and disorders through proper drug therapy and                             understanding
                                                                    non-drug decisions and, in relation to that, do                           of the
                                                                    one or more of the following:                                             condition
                                                                    a) assist and advise clients, patients and other                          being treated
                                                                    health care providers by contributing unique                              and the drug
                                                                    drug and non-drug therapy knowledge on drug                               being
                                                                    and non-drug selection and use,                                           prescribed and
                                                                    b) monitor responses and outcomes to drug                                 they have
                                                                    therapy,                                                                  adequte
                                                                    c) compound, prepare and dispense drugs,                                  knowledge
                                                                    d) provide non-prescription drugs, blood                                  about the
                                                                    products, parenteral nutrition, health care aids                          specific
                                                                    and devices,                                                              patient.
                                                                    e) supervise and manage drug distribution
                                                                    systems to maintain public safety and drug
                                                                    system security,

3
    http://www.ocpinfo.com/client/ocp/OCPHome.nsf/(LegislationForWeb)/Pharmacy+Act,+1991+Act?OpenDocument&PFV
Non Physician Prescribing and Use of Drugs                                                                                               4
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or              Framework and Authority                             Standard of            List/class
Regulatory       administration of drugs                                                             practice/Guidelines/
Body)                                                                                                Policies

                                                 f) educate clients, patients and regulated
                                                 members of the Alberta College of
                                                 Pharmacists and of other colleges in matters
                                                 described in this section,
                                                 g) conduct or collaborate in drug-related
                                                 research,
                                                 h) conduct or administer drug and other
                                                 health-related programs, and
                                                 i) provide restricted activities authorized by
                                                 the regulations.

                                                 Authorized Acts
                                                 A clinical pharmacist is authorized to perform,
                                                 within the practice of pharmacy and in
                                                 accordance with the Pharmacists’ Standards of
                                                 Practice, the following restricted activities:
                                                 1) Dispense, compound, provide for selling or
                                                 sell a Schedule 1 or Schedule 2 drug;
                                                 2) Administer a vaccine or parenteral
                                                 nutrition;
                                                 3) Compound blood products;
                                                 4) Insert or remove instruments, devices or
                                                 fingers beyond the anal verge and labia
                                                 majora;
                                                 5) Prescribe a Schedule 1 drug for the purpose
                                                 of adapting an existing prescription;
                                                 6) Prescribe blood products for the purpose of
                                                 adapting an existing prescription; and
                                                 7) Prescribe a Schedule 1 drug and blood
                                                 products if it is not reasonably possible for the
                                                 patient to see a health professional to obtain
                                                 the prescription and if there is an immediate
                                                 need for the drug or blood product.
Non Physician Prescribing and Use of Drugs                                                                                                                           5
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and       Prescribing and/or                                Framework and Authority                          Standard of                       List/class
Regulatory         administration of drugs                                                                            practice/Guidelines/
Body)                                                                                                                 Policies

British Columbia   Can prescribe drugs for emergency                 Pharmacists, Pharmacy Operations and Drug        Policy Package, including
                   contraception; renew or dispense drug             Scheduling Act, R.S.B.C. 1996, c.362             Professional Practice Policy
College of         contrary to terms of prescription under           Access to Pharmanet Patient Record               #58 under development- will
Pharmacists of     limited circumstances                             Information Regulation, B.C. Reg. 537/2004       allow BC pharmacists
British Columbia                                                     Drug Schedules Regulation, B.C. Reg. 9/98.       greater authority to carry out
                   As per HPRAC 2008 Jurisdictional Review:          Prescribed Health Care Profession Regulation,    restricted activities e.g. will
                   may adjust an existing prescription to            B.C. Reg 277/97                                  be able to adapt a
                   facilitate patient adherence; may implement a     Advisory Committee on Veterinary Drugs           prescription upon
                   Minor Ailments Scheme (including Schedule         Regulation, B.C. Reg. 239/80                     completion of orientation to
                   11 and 111 medications); may provide              Veterinary Drug and Medicated Feed               manual and workshop.
                   immunization to patient if necessary; may         Regulation, B.C. Reg 47/82.                      Eventually will be allowed
                   administer a substance by inhalation or by                                                         to substitute a drug for what
                   injection for the purpose of education and        Can prescribe, in accordance with guidelines     the MD prescribes once a
                   demonstration, with limits and conditions;        approved by Council, emergency                   credible diagnosis exists.
                   may order relevant lab tests for the purpose of   contraception; renew/dispense drugs contrary
                   monitoring and managing patients’                 to terms of prescription under limited
                   medications; may adjust dosage of existing        circumstances; disseminate information on
                   medications in response to monitoring.            safe and effective use of drugs; interpret and
                                                                     evaluate prescriptions; provide blood products
                                                                     and parenteral nutrition; can interchange with
                                                                     generic brands

                                                                     Authorized to dispense an interchangeable
                                                                     drug, contraception, renew/dispense drugs
                                                                     contrary to terms of prescribing under limited
                                                                     conditions; disseminate

                                                                     Scope of Practice
                                                                     “In this Act, …
                                                                     "practice of pharmacy" includes the practice
                                                                     of and responsibility for
                                                                     (a) interpretation and evaluation of
                                                                     prescriptions,
Non Physician Prescribing and Use of Drugs                                                                                              6
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or              Framework and Authority                            Standard of            List/class
Regulatory       administration of drugs                                                            practice/Guidelines/
Body)                                                                                               Policies

                                                 (b) compounding, dispensing and added
                                                 labeling of drugs and devices,
                                                 (c) monitoring drug therapy,
                                                 (d) identification, assessment and
                                                 recommendations necessary to resolve or
                                                 prevent drug related problems in patients,
                                                 (e) advising persons of the therapeutic values,
                                                 content and hazards of drugs and devices,
                                                 (f) safe storage of drugs and devices,
                                                 (g) maintenance of proper records, including
                                                 patient records, for drugs and devices,
                                                 (g.1) prescribing, in accordance with
                                                 guidelines approved by the council, a drug
                                                 specified in Schedule IV of B.C. Reg. 9/98,
                                                 the Drug Schedules Regulation, for use for
                                                 emergency contraception,
                                                 (h) services, duties and transactions necessary
                                                 to the management, operation and control of a
                                                 pharmacy or to provide pharmacy services in
                                                 a hospital, facility or care centre, and
                                                 (i) sale of drugs by pharmacists.”



                                                 Authorized Acts
                                                 In the course of engaging in the practice of
                                                 pharmacy, a member is authorized, subject to
                                                 the terms, conditions and limitations imposed
                                                 on his or her certificate of registration, to
                                                 perform the following:
                                                 1) Dispense, sell and store a drug (prescription
                                                 and non-prescription) in a manner specified in
                                                 the relevant legislation and drug schedules;
Non Physician Prescribing and Use of Drugs                                                                                                                        7
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                                 Framework and Authority                           Standard of                    List/class
Regulatory       administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                 Policies

                                                                    2) Dispense an interchangeable drug unless
                                                                    the person prescribing the drug indicates
                                                                    otherwise in a manner specified in the relevant
                                                                    legislation;
                                                                    3) Renew or dispense a drug contrary to terms
                                                                    of prescription under limited circumstances
                                                                    pursuant to restrictions under the act; and
                                                                    4) Prescribe Ethinyl Estradiol, Norgestrel and
                                                                    Progestin for use for emergency
                                                                    contraception.

Manitoba         Can substitute or change a prescription with       The Pharmaceutical Act, C.C.S.M. c. P60           Changes to Pharmaceutical      Proposed
                 authority of prescriber.                           Pharmaceutical Regulation, Man. Reg. 56/92        Act underway which will        changes would
Manitoba                                                            Prescribed Drugs Regulation, Man. Reg.            authorize additional refill,   allow extended
Pharmaceutical   As per HPPAC 2008 Jurisdictional Review:           144/98                                            administer drugs via           practice
Association      may authorize further extension of                 Manitoba Drug Interchangeability Formulary        inhalation and injection       pharmacists to
                 prescription where there are no existing refills   Regulation, Man. Reg. 83/2008                                                    prescribe
                 for continuity of care;                                                                                                             specific drugs
                                                                    Can disseminate information about safe and                                       listed in
                                                                    effective use of drugs; sell, store and dispose                                  Schedules 2
                                                                    of prescription and non prescription drugs;                                      and 3
                                                                    can interchange with generic brand.                                              contained in
                                                                                                                                                     College
                                                                    Proposed changes contained in Part 12-                                           Manual, drugs
                                                                    Prescribing by members, Articles 86 (1) to                                       with DIN
                                                                    90(4)                                                                            numbers
                                                                                                                                                     identified in
                                                                    Scope of Practice                                                                the Food and
                                                                    “In this Act, …                                                                  Drugs Act
                                                                    “practice of pharmacy" means                                                     (Canada)
                                                                    (a) responsibility for preparing, distributing
                                                                    and controlling drugs in a pharmacy,
                                                                    (b) compounding a prescription,
Non Physician Prescribing and Use of Drugs                                                                                               8
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or              Framework and Authority                             Standard of            List/class
Regulatory       administration of drugs                                                             practice/Guidelines/
Body)                                                                                                Policies

                                                 (c) dispensing a drug,
                                                 (d) selling a drug by retail,
                                                 (e) operating a pharmacy insofar as the
                                                 operation relates to the practice of pharmacy,
                                                 (f) disseminating information on the safe and
                                                 effective use of a drug when dispensing or
                                                 selling a drug, or
                                                 (g) subdividing or breaking up a
                                                 manufacturer's original package of a drug for
                                                 the purpose of re-packaging the drug in larger
                                                 or smaller quantities for re-distribution or sale
                                                 by retail; ”

                                                 Authorized Acts
                                                 In the course of engaging in the practice of
                                                 pharmacy, a member is authorized, subject to
                                                 the terms, conditions and limitations imposed
                                                 on his or her certificate of registration, to
                                                 perform the following:
                                                 1) Dispense, sell and store a drug (prescription
                                                 and non-prescription) in a manner specified in
                                                 the relevant legislation and drug schedules;
                                                 2) If a prescription directs the dispensing of a
                                                 specific interchangeable product, the
                                                 dispenser shall dispense either the
                                                 interchangeable product that is prescribed or
                                                 another interchangeable product in accordance
                                                 with the relevant restrictions and legislation;
                                                 and
                                                 3) Substitute or change a prescription with the
                                                 practitioner’s consent.
Non Physician Prescribing and Use of Drugs                                                                                                                      9
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                              Framework and Authority                            Standard of                    List/class
Regulatory       administration of drugs                                                                            practice/Guidelines/
Body)                                                                                                               Policies

New Brunswick    As per HPRAC 2008 Jurisdictional Review:        Pharmacy Act, S.N.B. 1983, c. 100 Amended          Act will be coming into        Formulary
                 May adapt an existing prescription to           S.N.B. 1881, c. 88 and 1993, c.25                  effect that will allow
New Brunswick    facilitate patient adherence; May order         Regulations of the New Brunswick                   pharmacists to prescribe
Pharmaceutical   relevant lab tests for the purpose of           Pharmaceutical Society                             certain drugs for chronic
Society          monitoring and managing patients                                                                   conditions; it will be up to
                 medications; May authorize further extension    Scope of Practice                                  the pharmacist to determine
                 of a prescription where there are no existing   The practice of pharmacy promotes health, the      if he/she can safely do so.
                 refills, for continuity of care                 prevention and treatment of diseases,
                                                                 dysfunction and disorders through proper drug
                                                                 therapy and non-drug therapy.

                                                                 Can disseminate information about safe and
                                                                 effective use of drugs; monitor drug therapy
                                                                 provided to patients; supervise and manage
                                                                 drug distribution systems; sell, store and
                                                                 dispose of prescription and non prescription
                                                                 drugs

                                                                 Scope of Practice
                                                                 The practice of pharmacy promotes health, the
                                                                 prevention and treatment of diseases,
                                                                 dysfunction and disorders through proper drug
                                                                 therapy and non-drug therapy.
                                                                 Authorized Acts
                                                                 1) Compound, prepare, dispense and
                                                                 administer drugs,
                                                                 2) Provide non-prescription drugs, blood
                                                                 products, parenteral nutrition, health care aids
                                                                 and devices,
                                                                 3) Subject to any restrictions or conditions set
                                                                 out in the regulations:
                                                                 o Prescribe drugs and treatments that are
                                                                 designated in the regulations,
Non Physician Prescribing and Use of Drugs                                                                                                                       10
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                                 Framework and Authority                           Standard of                   List/class
Regulatory       administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                 Policies

                                                                    o Administer drugs that are designated in the
                                                                    regulations,
                                                                    o Interpret client-administered automated tests
                                                                    that are designated in the regulations, and
                                                                    o Order and receive reports of screening and
                                                                    diagnostic tests that are designated in the
                                                                    regulations.


Newfoundland     As per HPPAC 2008 Jurisdictional Review:           Pharmacy Act, S.N.L. 1994, c. P-12.1              In process of incorporating   Formulary
                 may authorize further extension of a               Pharmacy Regulations, N.L.R. 80/98                Ontario legislation and
Newfoundland     prescription where there are no existing refills                                                     adopting reform relating to
and Labrador     for continuity of care; may adapt an existing      Can dispense a substitute drug; disseminate       authorizing further
College of       prescription to facilitate patient adherence;      information on safe and effective use of drugs;   extensions in instances
Pharmacy Board   may administer a substance by inhalation or        sell, store and dispose of prescription and non   where there are no refills
                 injection for the purposes of education and        prescription drugs; interchange with generic
                 demonstration; may adjust dosage of existing       brands
                 medication in response to monitoring
                                                                    Scope of Practice
                                                                    The "practice of pharmacy" means
                                                                    (i) having responsibility for preparing,
                                                                    distributing and controlling drugs in a
                                                                    pharmacy,
                                                                    (ii) compounding a prescription,
                                                                    (iii) dispensing a drug,
                                                                    (iv) selling a drug by retail,
                                                                    (v) disseminating information on the safe and
                                                                    effective use of a drug when dispensing or
                                                                    selling a drug, or
                                                                    (vi) subdividing or breaking up a
                                                                    manufacturer’s original package of a drug for
                                                                    the purpose of repackaging the drug in larger
                                                                    or smaller quantities for redistribution,
Non Physician Prescribing and Use of Drugs                                                                                                                  11
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and       Prescribing and/or                                 Framework and Authority                           Standard of            List/class
Regulatory         administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                   Policies

                                                                      and includes teaching, consulting or advising
                                                                      in the areas of pharmaceutical services,
                                                                      education, policy or research by a person
                                                                      registered under this Act.

                                                                      Authorized Acts
                                                                      A pharmacist is authorized to:
                                                                      1) Sell Schedule I drugs to the public
                                                                      following the diagnosis and intervention of a
                                                                      practitioner.
                                                                      2) Sell Schedule II drugs following
                                                                      intervention from the pharmacist at the point
                                                                      of sale, subject to the regulations.
                                                                      3) Sell Schedule III drugs, subject to the
                                                                      regulations.
                                                                      4) Sell unscheduled drugs without
                                                                      professional supervision, subject to the
                                                                      regulations.
                                                                      5) Dispense a substitute drug other than the
                                                                      drug specifically as outlined in the relevant
                                                                      statute and regulation.34


Northwest          Can modify prescriptions; renew/dispense           Pharmacy Act, S.N.W.T. 2006, c. 24
Territories        drug contrary to terms of prescription under       Adoption of Formulary for the Substitution of
                   limited circumstances                              Pharmaceutically Equivalent Drugs Order,
Dept of Health &                                                      N.W>T. Reg. 028-2007
Social Services    As per HPRAC 2008 Jurisdictional Review:           Pharmacy Regulations, N.W.T. Reg. 018-
                   may authorize further extension of a               2007
                   prescription where there are no existing refills
                   for purposes of patient continuity; may adapt      Can sell, store and dispose of prescription and
                   an existing prescription to facilitate patient     nonprescription drugs; can interchange with
                   adherence                                          generic brands; can monitor drug therapy
Non Physician Prescribing and Use of Drugs                                                                                              12
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or              Framework and Authority                            Standard of            List/class
Regulatory       administration of drugs                                                            practice/Guidelines/
Body)                                                                                               Policies

                                                 provided to patients; can disseminate
                                                 information on the safe and effective use of
                                                 drugs

                                                 Scope of Practice
                                                 “In this Act, …
                                                 "practice of pharmacy" includes
                                                 (a) the exclusive scope areas of the practice of
                                                 pharmacy,
                                                 (b) the sale of drugs and other medications
                                                 and health related products,
                                                 (c) the provision of information on the
                                                 appropriate use of drugs and other
                                                 medications and health related products,
                                                 (d) the operation of a pharmacy,
                                                 (e) patient counselling, drug therapy
                                                 monitoring and drug use evaluation,
                                                 (f) the conduct of or collaboration in drug-
                                                 related research, and
                                                 (g) other related activities.”

                                                 Authorized Acts
                                                 In the course of engaging in the practice of
                                                 pharmacy, a member is authorized, subject to
                                                 the terms, conditions and limitations imposed
                                                 on his or her certificate of registration, to
                                                 perform the following:
                                                 1) Dispense, sell and store a drug (prescription
                                                 and non-prescription) in a manner specified in
                                                 the relevant legislation and drug schedules;
                                                 2) Substitute and modify a prescription unless
                                                 the person prescribing the drug indicates
                                                 otherwise in a manner specified in the relevant
Non Physician Prescribing and Use of Drugs                                                                                                                          13
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                                 Framework and Authority                            Standard of                     List/class
Regulatory       administration of drugs                                                                               practice/Guidelines/
Body)                                                                                                                  Policies

                                                                    legislation; and
                                                                    3) Subject to the regulations a pharmacist may
                                                                    supply a limited quantity of a drug to refill a
                                                                    prescription under prescribed circumstances.

Nova Scotia      As per HPRAC 2008 Jurisdictional Review:           Pharmacy Act, 2001, c. 36                          Continued Care                  n/a
                 may authorize further extension of a               Practice of Pharmacy Regulations, N.S. Reg.        prescriptions Agreement
Nova Scotia      prescription where there are no existing refills   193/2003                                           lays down conditions under
College of       for continuity of care; may adapt an existing      Qualification and Professional Accountability      which the pharmacists may
Pharmacists      prescription to facilitate patient adherence       Regulations, N.S. Reg. 144/2003                    renew prescriptions for
                                                                                                                       medications.
                                                                    Can disseminate information on safe and            Undergoing broad regulatory
                                                                    effective use of drugs; sell, store and dispose    reform which will result in
                                                                    of prescription and no prescription drugs; can     authority to adjust and adapt
                                                                    interchange with generic brands                    prescriptions

                                                                    Scope of Practice
                                                                    The "practice of pharmacy" means the
                                                                    practice of pharmacy as described in this Act
                                                                    and includes professional services provided by
                                                                    a pharmacist related to the use, dispensing,
                                                                    compounding or distribution of drugs to or for
                                                                    the public and the responsibility for taking all
                                                                    reasonable steps to ensure pharmaceutical and
                                                                    therapeutic appropriateness of the therapy.

                                                                    Authorized Acts
                                                                    A pharmacist is authorized to:
                                                                    1) Compound, dispense, label and sell drugs
                                                                    and devices.
                                                                    2) Take all reasonable steps to ensure
                                                                    pharmaceutical and therapeutic
                                                                    appropriateness of a drug therapy.
Non Physician Prescribing and Use of Drugs                                                                                                                   14
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and       Prescribing and/or                                 Framework and Authority                            Standard of            List/class
Regulatory         administration of drugs                                                                               practice/Guidelines/
Body)                                                                                                                    Policies

                                                                      3) Monitor drug therapy.
                                                                      4) Interpret and evaluate prescriptions.
                                                                      5) Provide information respecting drug and
                                                                      non-drug therapy.
                                                                      6) Dispense interchangeable drug products
                                                                      pursuant to the statutory requirements.
                                                                      7) Carry out medical activities, services or
                                                                      functions under the conditions set out in a
                                                                      written agreement between the College and
                                                                      the College of Physicians and Surgeons of
                                                                      Nova Scotia.

Nunavut            Can renew/dispense drug contrary to terms of       Pharmacy Act, S.N.W.T. 2006, c. 24
                   prescription under limited circumstances;          Adoption of Formulary for the Substitution of
Dept of Health &   substitute or modify a prescription if the         Pharmaceutically Equivalent Drugs Order,
Social Services    prescriber does not object; can prescribe          N.W.T. Reg. 028-2007
                   under emergency situations for pain and            Pharmacy Regulations, N.W.T. Reg. 018-
                   suffering                                          2007

                   As per HPRAC2008 Jurisdictional Review:            Can disseminate information about safe and
                   may authorize further extension for a              effective use of drugs; monitor drug therapy
                   prescription where there are no existing refills   provided to patients; sell, store and dispose of
                   for continuity of care; may adapt an existing      prescription and non prescription drugs; can
                   prescription to facilitate patient adherence       interchange with generic brand

                                                                      Scope of Practice

                                                                      “In this Act, …
                                                                      "practice of pharmacy" includes
                                                                      (a) the exclusive scope areas of the practice of
                                                                      pharmacy,
                                                                      (b) the sale of drugs and other medications
                                                                      and health related products,
Non Physician Prescribing and Use of Drugs                                                                                              15
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or              Framework and Authority                            Standard of            List/class
Regulatory       administration of drugs                                                            practice/Guidelines/
Body)                                                                                               Policies

                                                 (c) the provision of information on the
                                                 appropriate use of drugs and other
                                                 medications and health related products,
                                                 (d) the operation of a pharmacy,
                                                 (e) patient counselling, drug therapy
                                                 monitoring and drug use evaluation,
                                                 (f) the conduct of or collaboration in drug-
                                                 related research, and
                                                 (g) other related activities.”



                                                 Authorized Acts

                                                 In the course of engaging in the practice of
                                                 pharmacy, a member is authorized, subject to
                                                 the terms, conditions and limitations imposed
                                                 on his or her certificate of registration, to
                                                 perform the following:
                                                 1) Dispense, sell and store a drug (prescription
                                                 and non-prescription) in a manner specified in
                                                 the relevant legislation and drug schedules;
                                                 2) Substitute and modify a prescription unless
                                                 the person prescribing the drug indicates
                                                 otherwise in a manner specified in the relevant
                                                 legislation; and
                                                 3) Subject to the regulations a pharmacist may
                                                 supply a limited quantity of a drug to refill a
                                                 prescription under prescribed circumstances.
Non Physician Prescribing and Use of Drugs                                                                                                                 16
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and      Prescribing and/or                                Framework and Authority                            Standard of            List/class
Regulatory        administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                  Policies

Prince Edward     Unless the prescriber objects, can substitute     Pharmacy Act, R.S.P.E.I. 1988, c.P-6.
Island            interchangeable product from a relevant list      Physician Dispensary Regulations, P.E.I. Reg.
                                                                    EC617/87
Prince Edward     As per HPRAC 2008 Jurisdictional Review:          Interchangeable Drug List Regulations, P.E.I.
Island Pharmacy   may authorize further extension of a              Reg. EC288/05
Board             prescription when there are no existing refills   Drug Schedule Regulations, P.E.I. Reg.
                  for purpose of continuity of care                 EC287/05
                                                                    Authorized Regulations, P.E.I. Reg. EC575/92
                                                                    Standards Regulations, P.E.I. EC618/87

                                                                    Can sell, store and dispose of prescription or
                                                                    non prescription drugs; can interchange with
                                                                    generic brands; can disseminate information
                                                                    about safe and effective use of drugs.

                                                                    Scope of Practice

                                                                    “In this Act, …
                                                                    (o.1) “practice of pharmacy” means
                                                                    (i) manufacturing, compounding or otherwise
                                                                    preparing a drug, including packaging,
                                                                    repackaging or labelling,
                                                                    (ii) dispensing a drug, or
                                                                    (iii) giving expert instruction or advice on the
                                                                    use of or appropriateness of a drug, the
                                                                    performance of which skill, in the opinion of
                                                                    the Board, requires specialist knowledge and
                                                                    judgment concerning the properties of
                                                                    drugs.”51

                                                                    Authorized Acts

                                                                    In the course of engaging in the practice of
Non Physician Prescribing and Use of Drugs                                                                                                                17
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                                Framework and Authority                            Standard of            List/class
Regulatory       administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                 Policies

                                                                   pharmacy, a member is authorized, subject to
                                                                   the terms, conditions and limitations imposed
                                                                   on his or her certificate of registration, to
                                                                   perform the following:
                                                                   1) Sell, store and dispense a drug (prescription
                                                                   and non-prescription) in a manner specified in
                                                                   the relevant legislation and drug schedules;
                                                                   and
                                                                   2) Unless the person prescribing the drug
                                                                   otherwise directs, the person who dispenses
                                                                   on that prescription may select and dispense
                                                                   an interchangeable product which is so
                                                                   identified by the relevant list and is priced
                                                                   equal to or lower than the drug prescribed.


Quebec           Can prescribe emergency contraceptives;           Pharmacy Act, R.S.Q. c. P-10
                 initiate/adjust medical therapy according to      Regulation Respecting the Terms and
Ordre des        prescriptions                                     Conditions for the Sale of Medications, R.Q.
Pharmaciens du                                                     c. P-10, r.8.2.
Quebec           As per HPRAC 2008 Jurisdictional Review:
                 may authorize further extension of a              Can sell, store and dispose of non-
                 prescription where there are no existing refill   prescription and prescription drugs; can
                 for continuity of care; may adjust an existing    disseminate information about safe and
                 prescription to facilitate patient adherence;     effective use of drugs
                 may implement a Minor Ailments Scheme;
                 may adjust dosage of existing medications in
                 response to monitoring                            Scope of Practice

                                                                   “The practice of pharmacy consists in
                                                                   determining and ensuring the proper use of
                                                                   medications, particularly to identify and
                                                                   prevent pharmacotherapeutic problems, and in
Non Physician Prescribing and Use of Drugs                                                                                                                        18
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                                 Framework and Authority                           Standard of                    List/class
Regulatory       administration of drugs                                                                              practice/Guidelines/
Body)                                                                                                                 Policies

                                                                    preparing, storing and delivering medications
                                                                    in order to maintain or restore health.”

                                                                    Authorized Acts

                                                                    The following activities in the practice of
                                                                    pharmacy are reserved to pharmacists:
                                                                    1) issuing a pharmaceutical opinion
                                                                    2) preparing and selling Schedule I, II or III
                                                                    drugs
                                                                    3) supervising medication therapy
                                                                    4) initiating or adjusting medication therapy,
                                                                    according to a prescription, making use of
                                                                    laboratory analyses, where applicable
                                                                    5) prescribing and dispensing emergency oral
                                                                    contraception medication, providing a training
                                                                    certificate has been issued to the pharmacist
                                                                    by the Order pursuant to s.94(o) of the
                                                                    Professional Code.

Saskatchewan     Can prescribe emergency contraceptives             The Pharmacy Act, 1996, S.S. 1996, c. P-9.1       Only properly trained          May prescribe
                                                                    The Drug Schedules Regulations, 1997, c. P-       pharmacists may prescribe      Schedule 1
Saskatchewan     As per HPRAC 2008 Jurisdictional Review:           9.1. REG. 2.                                      emergency contraceptives       Contraceptive
College of       May authorize further extension of a                                                                 and must follow guidelines
Pharmacists      prescription where there are no existing refills   Can sell, store and dispose of non prescription   included in “Emergency
                 for continuity of care; May adapt an existing      and prescription drugs; can interchange with      Post Coital Contraception
                 prescription to facilitate patient adherence;      generic brands                                    Standards and Guidelines for
                 May administer a substance by inhalation or                                                          Pharmacists Prescribing”
                 injection for purpose of education or              Drug Schedules Regulations 1997 article 9.1
                 demonstration                                      “A licensed pharmacist may, subject to the
                                                                    terms, conditions, and restrictions on his/her
                                                                    license, prescribe any drug in Schedule 1 that
                                                                    is an oral contraceptive….”
Non Physician Prescribing and Use of Drugs                                                                                                               19
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                              Framework and Authority                             Standard of            List/class
Regulatory       administration of drugs                                                                             practice/Guidelines/
Body)                                                                                                                Policies

                                                                 Scope of Practice
                                                                 “23(1) No person other than a licensed
                                                                 pharmacist or intern practising under the
                                                                 supervision of a licensed pharmacist, may
                                                                 prepare, compound, dispense or sell drugs in
                                                                 Saskatchewan.”

                                                                 Authorized Acts
                                                                 In the course of engaging in the practice of
                                                                 pharmacy, a member is authorized, subject to
                                                                 the terms, conditions and limitations imposed
                                                                 on his or her certificate of registration, to
                                                                 perform the following:
                                                                 1) Sell and dispense a drug (prescription and
                                                                 non-prescription) in a manner specified in the
                                                                 relevant legislation and drug schedules;

                                                                 2) Select and dispense an interchangeable
                                                                 pharmaceutical product for the drug specified
                                                                 in the prescription, unless the practitioner
                                                                 prescribing the drug otherwise directs; and
                                                                 3) Subject to terms, conditions and
                                                                 restrictions, prescribe an oral contraceptive for
                                                                 the use of emergency contraception.

Yukon            N/A                                             Pharmacists Act, R.S.Y. 2002, c. 170
                                                                 Drug Supply (Registered Nurses) Regulation
Yukon Dept of    “No pharmacist shall, except pursuant to a      Y.O.I.C. 1998/164
Community        written prescription signed by a medical
Services         practitioner, dentist, veterinary surgeon, or   Scope of Practice
                 optometrist supply any drug or preparation      Not Defined in Legislation
                 thereof listed or described in the prescribed
                 schedule of drugs for which such a              Authorized Acts
Non Physician Prescribing and Use of Drugs                                                                                                         20
Jurisdictional Review – Profession of Pharmacy
November, 2008

Province and     Prescribing and/or                           Framework and Authority                          Standard of            List/class
Regulatory       administration of drugs                                                                       practice/Guidelines/
Body)                                                                                                          Policies

                 prescription is required.” Pharmacists Act   Pharmacists are authorized to, pursuant only
                 S.Y. 1998, c.21, s.6; R.S., c. 131, s.10.    to a prescription signed by a medical
                                                              practitioner:
                                                              1) Supply any drug or preparation thereof
                                                              listed or described in the prescribed schedule
                                                              of drugs for which such a prescription is
                                                              required.
                                                              2) Supply any drug or preparation thereof
                                                              listed or described in the prescribed schedule
                                                              of poisons.
Non Physician Prescribing and Use of Drugs                                                                                                                   21
Jurisdictional Review – Profession of Pharmacy
November, 2008

2)       Authority to Prescribe and/or Administer Drugs in Australia, New Zealand, and the United Kingdom


Jurisdiction        Prescribing/ and/or administration of drugs       Framework and Authority                          Standards of                   Use of
                                                                                                                       Practice/Guidelines/           Formulary/
                                                                                                                       Restrictions                   List/
                                                                                                                                                      Class
Australia           (Queensland) explicitly authorized to             Pharmacist Registration Act 2001 (Qld);
                    substitute brand for generic products, provides   Pharmacists Registration Regulation 2001         Pilot projects currently
The Pharmacists     directly supervised opiate substitute treatment   (Qld); Health Practitioner (Professional         underway which are examining
Board of                                                              Standards) Act 1999 (Qld)                        what competencies would be
Queensland                                                                                                             required for prescribing
                                                                      Pharmacy Practice Act 2007 (SA); Pharmacy
                                                                      Practice Regulations 2007 (SA); Controlled
                                                                      Substance Act 1984 (SA); Controlled
                                                                      Substances Regulations 1996 (SA)

                                                                      Scope of Practice
                                                                      In their practice, pharmacists:
                                                                      Promote and contribute to optimal use of
                                                                      medicines;
                                                                      Dispense medicines;
                                                                      Prepare pharmaceutical products;
                                                                      Provide primary health care;
                                                                      Provide medicines and health information and
                                                                      education; and
                                                                      Apply organizational skills in the practice of
                                                                      pharmacy.

                                                                      4 The Pharmacists Board of Queensland has
                                                                      endorsed and adopted the Pharmaceutical
                                                                      Society of Australia’s guidelines and
                                                                      standards.
                                                                      5 Pharmaceutical Society of Australia,
                                                                      Professional Practice Standards, Version 3,
                                                                      2006.
                                                                      6 Pharmaceutical Society of Australia,
Non Physician Prescribing and Use of Drugs                                                           22
Jurisdictional Review – Profession of Pharmacy
November, 2008

                                                 Professional Practice Standards, Version 3,
                                                 2006.

                                                 Authorized Acts
                                                 In the course of engaging in the practice of
                                                 pharmacy, a member is authorized, subject to
                                                 the terms, conditions and limitations imposed
                                                 on his or her certificate of registration, to
                                                 perform the following:

                                                 1) Adopt a structured approach to reviewing,
                                                 evaluating and monitoring the consumer’s use
                                                 of medicines with the aim of promoting the
                                                 quality use of medicines to ensure safe and
                                                 effective therapy;

                                                 2) Systematically review and evaluate the
                                                 consumer’s medication treatment regimen and
                                                 take appropriate action to optimize therapeutic
                                                 outcomes and ensure their access to regular
                                                 reviews;

                                                 3) Ensure that dispensing occurs accurately,
                                                 reflects the prescriber’s intentions, and is
                                                 consistent with the needs and safety of the
                                                 consumer;

                                                 4) Brand substitution;

                                                 5) Provide a comprehensive dose
                                                 administration aids service that involves
                                                 assessing the needs and risks of the consumer;
                                                 selecting the most appropriate device; ensuring
                                                 that the correct medications are packaged with
                                                 respect to the current medication regimen, drug
                                                 stability and safety issues; and regularly review
                                                 and monitor consumers;
Non Physician Prescribing and Use of Drugs                                                            23
Jurisdictional Review – Profession of Pharmacy
November, 2008

                                                 6) Prepare and dispense compounded products
                                                 in a manner that ensures product quality, safety
                                                 and efficacy;

                                                 7) Follow established procedures to provide
                                                 directly supervised opioid substitution
                                                 treatment to optimise therapeutic outcomes and
                                                 quality of life and to help reduce harm
                                                 associated with illicit drug use;

                                                 8) Ensure that cytotoxic drug products are
                                                 prepared in a way that maximises product
                                                 quality, and that cytotoxic drugs and related
                                                 waste are handled in accordance with
                                                 documented procedures that ensure the safety
                                                 of personnel and the environment;

                                                 9) Provide a smoking cessation service that
                                                 follows established procedures to optimise
                                                 therapeutic outcomes and quality of life for the
                                                 consumer and to contribute to the reduction of
                                                 harm associated with tobacco use;

                                                 10) Contribute to the reduction of harm
                                                 associated with injecting drug use by providing
                                                 a needle and syringe program and promoting
                                                 safer practises to injecting drug users and the
                                                 community; and

                                                 11) Provide a monitoring and case detection
                                                 service that involves testing, explaining results,
                                                 documentation, and appropriate follow-up and
                                                 referral, with the aim of optimising health and
                                                 quality of life.
Non Physician Prescribing and Use of Drugs                                                                                                                         24
Jurisdictional Review – Profession of Pharmacy
November, 2008

New Zealand        Proposed Legislation includes:                      Health Practitioners’ Competence Assurance         n/a                               Not known
                   registration as an Advanced Pharmacist              Act, 2003
Pharmacy           Practitioner
Council of New     work in partnership with other health care          Scope of Practice
Zealand            professionals in extended clinic roles              The practice of pharmacy includes the custody,
                   work in specific clinical practice areas            preparation and dispensing of medicines and
                    using advanced skill and knowledge                 pharmaceutical products; the provision of
                                                                       advice on health and well-being, including
                   Currently, practice is restricted to custody,       health screening, and the selection and
                   preparation and dispensing of medications and       provision of non-prescription medicine
                   pharmaceutical products, provision of advice        therapies and therapeutic aids.
                   on health and wellness, including health
                   screening, selection and provision of non-          Proposed legislation would allow pharmacists
                   prescription medicine therapies and therapeutic     to apply for prescribing authority for patients
                   aides.                                              with confirmed diagnoses

                                                                       Pharmacy Council is proposing four step
                                                                       approach to prescribing authority i.e.
                                                                       pharmacists with right to prescribe would be
                                                                       required to demonstrate competence in three
                                                                       preceding and increasingly difficult levels of
                                                                       knowledge related to use of medicines. First
                                                                       three levels fall within usual scope of practice
                                                                       of pharmacists while final level would be
                                                                       categorized as advance practice and qualify the
                                                                       individual to prescribe drugs within a
                                                                       collaborative framework


United Kingdom     Individual pharmacists can apply for                Health and Social Care Act 2001, c. 15             Numerous practice guidelines      Formulary
                   prescribing authority. Two types of prescribing     The Pharmacists and Pharmacy Technicians           and ethical decision making
Royal              authority- supplementary (partner with              Order 2007, No. 289                                guidelines in place. Only those
Pharmaceutical     physician) or independent.                                                                             individuals who have
Society of Great                                                       2007 No. 289                                       completed required upgrading
Britain            Currently authorized to 1) further extend a         Health Care and Associated Professions             are eligible
                   prescription where there are no existing refills,   The Pharmacists and Pharmacy Technicians
                   for continuity of care. Involves refilling          Order 2007
Non Physician Prescribing and Use of Drugs                                                                            25
Jurisdictional Review – Profession of Pharmacy
November, 2008

                chronic medications under a defined protocol      Scope of Practice
                when the appropriate medical information is       Pharmacists’ scope of practice is not defined
                available to the pharmacist to accurately         per se but pharmacists work within the
                determine the suitable refill, and refilling a    Society’s practice guidelines and guidelines for
                patient’s chronic medication on a one time        ethical practice and related matters.
                only basis if the original prescription is not
                available                                         Authorized Acts
                2) adapt an existing prescription ( change in     In addition to the traditional authorized acts
                dose, dosage form, product selected or quantity   that pharmacists take part in, pharmacists in the
                required for treatment based on the               United Kingdom have been able to obtain
                appropriateness for each available patient) in    limited prescribing authority (known as
                order to facilitate patient adherence             “supplementary prescribing”) since 2003 and
                3) initiate therapy for minor ailments from a     in 2006 gained the ability to obtain
                set formulary                                     “independent prescribing” status. This
                                                                  authority exists pursuant to s. 63 of the Health
                                                                  and Social Care Act, which enabled the
                                                                  Government to extend prescribing
                                                                  responsibilities to other professions, such as
                                                                  pharmacists.
                                                                  Pharmacists may qualify as both independent
                                                                  and supplementary prescribers or as simply a
                                                                  supplementary prescriber. A pharmacist with
                                                                  independent prescriber status may practice as
                                                                  either type of prescriber.
                                                                  Definition of supplementary prescriber: “A
                                                                  voluntary partnership between an independent
                                                                  prescriber (doctor or dentist) and a
                                                                  supplementary prescriber to implement an
                                                                  agreed patient-specific clinical management
                                                                  plan (CMP) with the patient’s agreement.”

                                                                  Definition of independent prescriber:
                                                                  “Prescribing by a practitioner (e.g. registered
                                                                  nurse, pharmacist) who is responsible and
                                                                  accountable for the assessment of patients with
                                                                  undiagnosed or diagnosed conditions and for
                                                                  decisions about the clinical management
Non Physician Prescribing and Use of Drugs                                                          26
Jurisdictional Review – Profession of Pharmacy
November, 2008

                                                 required, including prescribing.”
                                                 Legal requirements for pharmacist prescribers:

                                                 • Completion of a Society accredited program
                                                 and the pharmacist’s name in the Society’s
                                                 practicing register must have the proper
                                                 annotation reflecting the prescriber
                                                 qualification

                                                 • Pharmacist must prescribe only in relation to
                                                 status (supplementary or independent) and
                                                 must comply with all statutory practice
                                                 requirements

                                                 • Pharmacist prescribers are legally
                                                 accountable for all prescribing decisions,
                                                 including actions and omissions, and are not
                                                 permitted to delegate this accountability (joint
                                                 accountability under supplementary status and
                                                 sole accountability under independent status)
       Non Physician Prescribing and Use of Drugs                                                                                                                           27
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

       3)      Authority to Prescribe and/or Administer Drugs in United States Jurisdictions


State          Prescribing or        Framework                   Authority                                Standards/Policies/Rules              List/classes/
(regulatory    Administering                                                                                                                    categories of drugs/substances
body)          Authority
                                                                 Scope of Practice                        2008 Legislation Affecting            Subd. 13d.Drug formulary.
                                                                                                          Pharmacy 6 :
                                                                 Subd. 27. Practice of pharmacy.                                                (a) The commissioner shall
                                                                                                          Clarifies that pharmacies can         establish a drug formulary. Its
                                                                 "Practice of pharmacy" means:            redispense medications returned       establishment and publication
                                                                 (1) interpretation and evaluation of     from jails provided certain           shall not be subject to the
               No prescribing                                    prescription drug orders;                conditions are met. Already in        requirements of the
               authority;                                        (2) compounding, labeling, and           effect. 7                             Administrative Procedure Act,
               permitted to alter                                dispensing drugs and devices (except                                           but the Formulary Committee
               original              Pharmacists are             labeling by a manufacturer or            Establishes that a prescription or    shall review and comment on
               prescriptions         regulated under             packager of nonprescription drugs or     drug order for controlled             the formulary contents.
Minnesota
               within restrictions   numerous statutes           commercially packaged legend drugs       substances and certain other drugs    (b) The formulary shall not
               identified in         (mainly chapters 151 4      and devices);                            (carisoprodol, tramadol,              include:
Minnesota
               legislation.          and 152 5 ), rules set by   (3) participation in clinical            muscle relaxants, erectile            (1) drugs or products for
State Board
                                     the state board and         interpretations and monitoring of        dysfunction drugs) is not valid       which there is no federal
of Pharmacy.
               Prescribing rights    board guidelines            drug therapy for assurance of safe and   unless                                funding;
               are limited to a                                  effective use of drugs;                  the prescription or order was based   (2) over-the-counter drugs,
               formulary (see                                    (4) participation in drug and            on a documented patient               except as provided in
               rightmost column)                                 therapeutic device selection; drug       evaluation, including an in-person    subdivision 13;
               listing low risk                                  administration for first dosage and      examination, adequate to              (3) drugs used for weight loss,
               drugs.                                            medical emergencies; drug regimen        establish a diagnosis and identify    except that medically
                                                                 reviews; and drug or drug-related        underlying conditions and             necessary lipase inhibitors
                                                                 research;                                contraindications to treatment.       may be covered for a recipient
                                                                 (5) participation in administration of   Prohibits pharmacists from            with type II diabetes;
                                                                 influenza vaccines to all eligible       knowingly filling such                (4) drugs when used for the
                                                                 individuals over ten years of age and    prescriptions. This provision was     treatment of impotence or

       4
         https://www.revisor.leg.state.mn.us/statutes/?id=151
       5
         https://www.revisor.leg.state.mn.us/statutes/?id=152
       6
         http://www.phcybrd.state.mn.us/documents/2008law.pdf
       7
         2008 Session Law – Chapter 321
       Non Physician Prescribing and Use of Drugs                                                                                                                         28
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

State            Prescribing or       Framework               Authority                                 Standards/Policies/Rules               List/classes/
(regulatory      Administering                                                                                                                 categories of drugs/substances
body)            Authority
                                                              all other vaccines to patients 18 years   intended to prevent pharmacies and     erectile dysfunction;
                                                              of age and older under standing           pharmacists from working               (5) drugs for which medical
                                                              orders from a physician licensed          with illegitimate Internet websites.   value has not been
                                                              under chapter 147 or by written           Already in effect. 8                   established; and
                                                              protocol with a physician provided                                               (6) drugs from manufacturers
                                                              that:                                     2008 Session Law – Chapter 189.        who have not signed a rebate
                                                              (i) the pharmacist is trained in a        Modifies the definition of “practice   agreement with the
                                                              program approved by the American          of                                     Department of Health and
                                                              Council of Pharmaceutical Education       pharmacy”. Allows pharmacists to       Human Services pursuant to
                                                              for the administration of                 administer influenza vaccine to any    section 1927 of title XIX of
                                                              immunizations or graduated from a         person over the age of 10 and          the Social Security Act.
                                                              college of pharmacy in 2001 or            allows them to administer any
                                                              thereafter; and                           vaccine to adults. Removes the
                                                              (ii) the pharmacist reports the           phrase “case-by-case” from
                                                              administration of the immunization to     language concerning protocols. (i.e.
                                                              the patient's primary physician or        protocols will no longer have to
                                                              clinic;                                   refer to specific patients). 9
                                                              (6) participation in the practice of
                                                              managing drug therapy and
                                                              modifying drug therapy, according to
                                                              section 151.21, subdivision 1,
                                                              according to a written protocol
                                                              between the specific pharmacist and
                                                              the individual dentist, optometrist,
                                                              physician, podiatrist, or veterinarian
                                                              who is responsible for the patient's
                                                              care and authorized to independently
                                                              prescribe drugs. Any significant
                                                              changes in drug therapy must be
                                                              reported by the pharmacist to the
                                                              patient's medical record;

       8
           http://www.phcybrd.state.mn.us/documents/2008law.pdf
       9
           http://www.phcybrd.state.mn.us/documents/2008law.pdf
       Non Physician Prescribing and Use of Drugs                                                                                                    29
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

State         Prescribing or    Framework           Authority                                  Standards/Policies/Rules   List/classes/
(regulatory   Administering                                                                                               categories of drugs/substances
body)         Authority
                                                    (7) participation in the storage of
                                                    drugs and the maintenance of records;
                                                    (8) responsibility for participation in
                                                    patient counseling on therapeutic
                                                    values, content, hazards, and uses of
                                                    drugs and devices; and
                                                    (9) offering or performing those acts,
                                                    services, operations, or transactions
                                                    necessary in the conduct, operation,
                                                    management, and control of a
                                                    pharmacy.

                                                    Subdivision 1.Generally.

                                                    Except as provided in this section, it
                                                    shall be unlawful for any pharmacist
                                                    or pharmacist intern who dispenses
                                                    prescriptions, drugs, and medicines to
                                                    substitute an article different from the
                                                    one ordered, or deviate in any manner
                                                    from the requirements of an order or
                                                    prescription without the approval of
                                                    the prescriber.

                                                    Subd. 7.Drug formulary.

                                                    This section does not apply when a
                                                    pharmacist is dispensing a prescribed
                                                    drug to persons covered under a
                                                    managed health care plan that
                                                    maintains a mandatory or closed drug
                                                    formulary.
       Non Physician Prescribing and Use of Drugs                                                                                                            30
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

State         Prescribing or      Framework                Authority                                   Standards/Policies/Rules   List/classes/
(regulatory   Administering                                                                                                       categories of drugs/substances
body)         Authority
                                                           Subd. 8.List of excluded products.

                                                           The Drug Formulary Committee
                                                           established under section 256B.0625,
                                                           subdivision 13, shall establish a list of
                                                           drug products that are to be excluded
                                                           from this section. This list shall be
                                                           updated on an annual basis and shall
                                                           be provided to the board for
                                                           dissemination to pharmacists licensed
                                                           in the state.

                                                           Subd. 3.Administer.

                                                           "Administer" means to deliver by, or
                                                           pursuant to the lawful order of a
                                                           practitioner a single dose of a
                                                           controlled substance to a patient or
                                                           research subject by injection,
                                                           inhalation, ingestion, or by any other
                                                           immediate means.

                                                           Majority of changes that a pharmacist
                                                           is permitted to make to a prescription
                                                           can only be done after the pharmacist
                                                           contacts the prescribing physician.
Colorado      No prescribing or   Pharmacists are          Scope of Practice                           Schedules, formulary
              administration      regulated under the
Dept. of      rights              following statutes and   (23.6) "Pharmaceutical care" means
Regulatory                        rules:                   the provision of drug therapy and
Agencies –                                                 other pharmaceutical patient care
Board of                          Pharmaceuticals and      services by a pharmacist intended to
Pharmacy                          Pharmacists (CRS 12-     achieve outcomes related to the cure
       Non Physician Prescribing and Use of Drugs                                                                                                         31
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

State         Prescribing or    Framework              Authority                                    Standards/Policies/Rules   List/classes/
(regulatory   Administering                                                                                                    categories of drugs/substances
body)         Authority
                                22-101)                or prevention of a disease,
                                Uniform Controlled     elimination or reduction of a patient's
                                Substances Act of      symptoms, or arresting or slowing of
                                1992 (CRS 18-18-101)   a disease process. In addition to the
                                Rules and              preparation, dispensing, and
                                Regulations —          distribution of medications,
                                 Effective November    "pharmaceutical care" may include
                                30, 2008               assessment and evaluation of the
                                3 CCR 719-1            patient's medication related needs and
                                Rules and              development and communication of a
                                Regulations —          therapeutic plan with defined
                                 Effective September   outcomes in consultation with the
                                1, 2008                patient and the patient's other health
                                3 CCR 719-1            care professionals to attain the desired
                                Rules and              outcome. This function includes
                                Regulations —          efforts to prevent, detect, and resolve
                                 Effective June 30,    medication related problems for
                                2008                   individual patients. "Pharmaceutical
                                3 CCR 719-1            care" does not include prescriptive
                                                       authority.

                                                       Unlawful acts - licenses - penalties.
                                                       (1) Except as otherwise provided in
                                                       this article or in article 22 of title 12,
                                                       C.R.S., the following acts are
                                                       unlawful:
                                                       (a) The dispensing or possession of a
                                                       schedule I controlled substance
                                                       except by a researcher who is
                                                       registered under federal law to
                                                       conduct research with that Schedule I
                                                       controlled substance;
                                                       (b) Except as provided in subsection
                                                       (2) of this section, the dispensing of
       Non Physician Prescribing and Use of Drugs                                                                                                           32
       Jurisdictional Review – Profession of Pharmacy
       November, 2008

State            Prescribing or      Framework                 Authority                              Standards/Policies/Rules   List/classes/
(regulatory      Administering                                                                                                   categories of drugs/substances
body)            Authority
                                                               any Schedule II controlled substance
                                                               unless such substance is dispensed
                                                               from a pharmacy pursuant to a
                                                               written order or is dispensed by any
                                                               practitioner in the course of his
                                                               professional practice;
                                                               (c) The dispensing of any schedule
                                                               III, IV, or V controlled substance
                                                               unless such controlled substance is
                                                               dispensed from a pharmacy pursuant
                                                               to a written, oral, mechanically
                                                               produced, computer generated,
                                                               electronically transmitted, or
                                                               facsimile transmitted order or is
                                                               dispensed by any practitioner in the
                                                               course of his or her professional
                                                               practice; 10




       10
            http://www.dora.state.co.us/Pharmacy/Title18.pdf

				
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