‘Here to help’: Ontario pharmacists seek expanded role in managing COVID, other diseases

As we continue to learn how to live with COVID-19, pharmacists in Ontario say they can and should play a larger role in helping manage the disease and other ailments to relieve the pressure from family doctors and an already overloaded healthcare system.

Jen Belcher, vice president of Strategic Initiatives and Member Relations for the Ontario Pharmacist Association, said from dispensing vaccinations to now prescribing the COVID-19 pill Paxlovid, pharmacists have played a critical role in the pandemic.

“That end-to-end solution in a pharmacy where you can be tested, you can be assessed, you can have your drug interactions managed, you can receive that prescription, and you can actually have it dispensed at that pharmacy […] In our minds, this has made a lot of sense,” she said.

Earlier this year, Ontario pharmacists were given the authority to prescribe medication for 13 common ailments like allergies, cold sores and acid reflux and in last Thursday’s provincial budget, six more were added, including moderate acne and canker sores.

“I think the next step is to get to where Alberta is, where the pharmacists have full prescribing authority,” said John Papastergiou, pharmacist and assistant professor at the School of Pharmacy at the University of Toronto.

“Probably be a little bit of time until we get there, but I think if we showcase what we could do now, I think in the future, as the burden keeps kind of piling on the traditional health-care system, pharmacists will be here to help. And I think that’s the natural next step.”

Papastergiou said they also have the advantage of accessibility within the community.

“It’s really the patients that are demanding it. They like quick, convenient service, they like access to care when they need it, and they hate wait times. […] So if it’s safe, it’s something we could do, we should be doing it,” he said.

Belcher said one of those things is the ability to substitute medications for patients.

“Right now, in the COVID-19 space, really the big challenge with prescribing is the fact that there are some drug interactions that we still need doctors to help us manage,” she said.

“So allowing pharmacists to do something called therapeutic substitution would help alleviate that because that would allow pharmacists to really manage that assessment and prescribing of COVID-19 treatments completely independently.”

Belcher said that would be particularly useful when there are drug shortages. Currently, when a medication is unavailable, pharmacists have to recommend an alternative and wait for an answer from the doctor.

“They’re overwhelmingly positively accepted by physicians when we make those recommendations because medication management is our skill set. It’s what we go to school for. It is really that, that core foundational knowledge element that the pharmacist brings to that healthcare team.”

Pharmacists role in prescribing medication

Back in December, the province gave pharmacists the authority to prescribe the COVID-19 pill Paxlovid.

Then as of January 1, the Ontario government gave pharmacists the ability to prescribe medications that could treat 13 conditions:

• acid reflux (gastroesophageal reflux disease)
• cold sores (herpes labialis)
• dermatitis (atopic, eczema, allergic and contact)
• hay fever (allergic rhinitis)
• hemorrhoids
• impetigo
• insect bites and hives
• menstrual cramps (dysmenorrhea)
• oral thrush (candidal stomatitis)
• pink eye (conjunctivitis; bacterial, allergic and viral)
• sprains and strains (musculoskeletal)
• tick bites (post-exposure prophylaxis to prevent Lyme disease)
• urinary tract infections (UTIs)

In last week’s budget, the province announced it is planning to expand the list to the following conditions. If approved, the expansion is set to take place in the fall.

• Mild to moderate acne
• Canker sores
• Diaper dermatitis
• Yeast infections
• Pinworms
• Threadworms
• Nausea and vomiting during pregnancy