JUNE 2020 - Governments at all levels have enacted a wide range of temporary laws, regulations, policies and services in response to COVID-19. A number of these changes affect pharmacy practice and have put pharmacists very much at the forefront of ensuring continuity of care for patients.
To help put these changes in perspective, the Canadian Foundation of Pharmacy (CFP) contacted all of the provincial pharmacy associations and sifted through documentation from pharmacy regulators and ministries of health. The outcome will be a chart that summarizes the changes, coming in July.
We are also producing a series of articles that take a closer look at individual provinces. Last month we focused on Alberta. This month, we summarize what’s happening in Ontario.
Ontario is the first province to raise the very real possibility of pharmacists testing patients for COVID-19. “If everything were to go according to plan, optional testing models with specific criteria could be in place by fall,” Justin Bates, CEO of Ontario Pharmacists Association (OPA) told CFP in late June. “However, all of this may change. It may not happen at all. There are a lot of variables between then and now,” he added.
The conversation grew out of the fact that Ontario was already moving to expand scope of practice to enable pharmacists to perform point-of-care testing (POCT) for certain chronic conditions. This coming authority was announced as part of the provincial budget in April 2019, along with other new authorities such as prescribing for minor ailments. Discussions and consultations on the required regulatory changes have been underway since.
The declaration of pandemic in March 2020 prompted both government and OPA to consider taking the coming POCT authority one step further by enabling diagnostic testing. This would require additional changes to the Laboratory and Specimen Collection Centre Licensing Act (LSCCLA), giving pharmacists access to labs and the ability to interpret lab results.
According to the Pharmacy Act, the practice of pharmacy includes the promotion of health, prevention and treatment of disease, disorders and dysfunctions through monitoring and management of medication therapy. “We are urging government to implement these changes, for COVID-19 as well as for general health and wellness promotion and disease prevention,” said Bates.
On June 15, the Ontario College of Pharmacists (OCP) approved a series of proposed regulatory amendments to the Pharmacy Act to enable, amongst other scope changes, POCT. These amendments are now before the Ministry of Health for final consideration. The additional required changes to the LSCCLA are outside the purview of OCP, and would need to be managed by the Ministry.
In addition to regulatory changes, OPA and the Ministry are in discussions on several other key variables that need to be resolved before COVID-19 testing can be put in place in pharmacies: the type of test to be used, the provision of adequate personal protective equipment (PPE), workplace conditions, operational considerations and the funding model.
If the new authority does come into effect, OPA proposes that it be voluntary for pharmacies to participate. “This service won’t be for everyone. Just like with other scopes of practice, not everybody does everything, and operational and logistical capabilities may be a significant determinant,” said Bates.
And while implementation is still far from assured, it’s important to at least try to put the option in place. “Government has asked us to look at how we can play a role. Testing for COVID-19 is very important from a public health perspective, to add to current testing capacity, and to help government reopen the economy,” noted Bates.
He reiterated that COVID-19 testing would be part of what’s already coming in the area of POCT, which lays the groundwork for pharmacies to become active in areas such as INR, strep throat and HIV testing, to name a few. “Timeliness to care and access to results is a growing area within health care and we have a responsibility to be in this space. This is an opportunity to be part of the transformation of how health care is delivered, to be more service-oriented and to complement what we do in medication management. It’s all part of establishing pharmacies as a community-based healthcare hub,” said Bates.
Early in the pandemic the government allowed pharmacists to conduct MedsCheck medication reviews and other billable services by phone or videoconference. The latter could be done using MedMe Health, a government-approved video platform, or other consumer platforms such as FaceTime (with explicit patient consent).
“I think we’ve demonstrated across all healthcare providers that virtual care does work and patients will accept it. Hopefully the option to provide services virtually will continue after COVID-19,” said Bates.
At the start of the pandemic, OPA lobbied government to designate pharmacy professionals as essential healthcare providers in order to gain access to the government’s supply of PPE. However, “it became clear that we were not making progress there, as inventories have been challenging to maintain. Government was not in a position to do that, as there is still a shortage for doctors and nurses,” noted Bates.
The association decided to lobby for economic aid instead. “Pharmacists will continue to procure their own PPE but they need to be reimbursed or subsidized.” The Association also established a supplier relationship with RONCO to supply PPE to Ontario phamacies.
In March, Ontario was one of five provinces to recommend that pharmacies limit the filling of chronic prescriptions to 30-day supplies. Three provinces—Saskatchewan, Manitoba and New Brunswick—implemented mandatory 30-day maximums for a brief period of time. On June 15, Ontario announced the return to the usual 100-day maximums and advised pharmacists to use professional judgment to reduce quantities if stock is limited or unavailable. Thirty-day supply policies, whether recommended or mandatory, are no longer in place in any province.
“The 30-day policy was quite challenging here in terms of the impact on both patients and pharmacies, but it was the right thing to do protect the supply chain and prevent drug shortages,” stated Bates.
After extensive lobbying by the OPA, on May 13 the Ministry of Health allocated $25 million to cover the costs of additional co-pays for seniors for eligible prescriptions, effective until the 30-day policy was rescinded or June 30, whichever date came first. “Patients didn’t have to take on additional financial burdens because of the 30-day policy. That was welcome news,” said Bates.