Many pharmacy associations in Canada say they should be playing a bigger role in prescribing and dispensing a new COVID-19 antiviral medication to ensure patients get the drug during the five-day treatment window.
Paxlovid, the brand name of the first oral antiviral medication approved by Health Canada to treat COVID-19, is in short supply in much of the country and can be difficult to find. In many provinces, people who meet the narrow criteria for access to the drug, which was approved in January, often have to navigate a complex process requiring visits to multiple physical locations in order to get the medication.
For these reasons, the associations are pushing for greater involvement in providing access to Paxlovid and other COVID-19 antivirals that may be approved.
“We’re really advocating for that role of pharmacist as a medication expert who would provide the full testing, assessment, screening, prescribing and dispensing and monitoring,” said Jen Belcher, a practising pharmacist and vice-president of strategic initiatives and member relations at the Ontario Pharmacists Association.
Each province and territory has different rules and guidelines for how pharmacists operate and the type of duties they can perform, called the scope of practice. Alberta, for instance, gives pharmacists more range, allowing them to prescribe any drug, except for narcotics and other controlled substances. But in most other provinces, pharmacists can only prescribe a select few drugs.
To be effective, Paxlovid, which is manufactured by Pfizer, has to be administered within the first five days of symptom onset, meaning that convenience and ease of access play important roles. The medication, a combination of antiviral drugs nirmatrelvir and ritonavir, stops the SARS-CoV-2 virus from replicating, which significantly reduces a person’s chances of becoming severely ill. Those eligible to receive Paxlovid include immune-compromised adults and unvaccinated seniors, although the criteria are expected to widen as supplies increase.
The drug can also have serious interactions with dozens of other common medications, so people who get a prescription will likely need assistance from pharmacists, who have expertise in managing such issues.
Danielle Paes, chief pharmacist officer with the Canadian Pharmacists Association, said this situation highlights why a national scope of practice would be beneficial, allowing pharmacists to play a consistent role and be part of the conversation when policy decisions about drugs and related issues are made.
“There’s a need for a thoughtful approach to make sure we are using this very valuable tool and treatment option in a way that helps as many Canadians as possible,” she said.
“I think it is possible,” she said.
When it comes to Paxlovid, provinces each have their own system, with some similarities. But some within the pharmacy profession say it’s often not an ideal set up for patients, who may have to go to an assessment centre or health care provider and then make a separate visit to a pharmacy dispensing the antiviral. Availability in pharmacies varies by province. In Ontario, for instance, only a select few hospital pharmacies are dispensing the drug.
Sandra Hanna, the CEO of the Neighbourhood Pharmacy Association of Canada, said part of the problem is a limited supply of the drug in Canada, given the global demand.
Ms. Hanna said pharmacists are uniquely positioned to help make access to Paxlovid easy, convenient and fast. For instance, in many parts of Canada, pharmacists have been administering COVID-19 tests and giving vaccines.
“We want to minimize contacts with the health care system so we can shorten that time to treat,” Ms. Hanna said. “We are in every community. A lot of pharmacies, we are already distributing and administering COVID tests.”
Gregory Marchildon, Ontario Research Chair in health policy and system design with the University of Toronto’s Institute of Health Policy, Management and Evaluation, said there’s a case to be made for increased use of pharmacists’ expertise to make the health care system function more efficiently.
“It’s very clear that pharmacists have much more education, training and experience, knowledge [in] pharmaceuticals than physicians,” he said.
But he also said rather than simply expanding the scope of practice of pharmacists, it makes sense to integrate them into family health clinics so they can work with physicians and other health care professionals at the time of prescribing medications to patients.
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