PharmaCare Newsletter
Last updated on May 8, 2024
May 2024 PharmaCare Newsletter
On this page:
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- Physician assistants not authorized to prescribe narcotics and controlled substance
- Therapeutics Letter – How useful is Paxlovid™ in 2024
- Temporary addition in PharmaNet of imported colesevelam 625 mg tablets
- New resources for assessing and prescribing for contraception
- New! Guide to essential PharmaCare resources for pharmacy staff
- PharmaCare 101 video series updated
Find past issues on the newsletter search page.
Q: What is the evidence for bupropion for ADHD in adults?
A: The answer is in the current edition of PAD Refills. Make sure to subscribe so you don’t miss out on news and updates!
PharmaCare will reimburse influenza and COVID-19 vaccinations administered by a B.C. medical student in a community pharmacy.
A student can administer a flu or COVID-19 vaccine if they are:
- In a B.C. Doctor of Medicine (MD) program, i.e. the UBC MD Undergraduate Program (MDUP)
- Have completed the required education to administer vaccinations
- Registered with the College of Physicians and Surgeons of BC (already a requirement of all UBC MDUP students), and
- Supervised by a regulated health professional (e.g., pharmacist) authorized and trained to provide vaccinations
Pharmacies are encouraged to confirm that they have the appropriate liability insurance to cover a medical student. Medical students must ensure as part of their professional responsibilities that the appropriate insurance is in place.
UBC’s policy Expectations of Medical Students in Supervised Settings (031) (PDF, 187KB) requires that students working in clinical settings “be identified and identify themselves as medical students”. They must:
- Use their CPSBC licence number on all entries into medical records
- Wear clearly visible identification that shows their name and that they are medical students
- Introduce themselves by name, and as “a medical student” to patients and other members of the health care team
Medical students join nursing students, pharmacy students, retired nurses and pharmacy technicians as non-regulated professionals who can administer the COVID-19 and flu vaccines, with in-pharmacy administration reimbursed by PharmaCare, provided they are supervised by a licensed practitioner.
Paying community pharmacies for flu and COVID-19 vaccines administered by medical students addresses the Health Minister’s mandate to control the spread of COVID-19 in B.C.; improves access to vaccines in rural and remote communities; supports pharmacies facing labour shortages; and aligns with the Ministry’s Health Human Resources strategy goal of developing a more diverse and robust healthcare workforce.
Resources
- Publicly funded vaccines – PharmaCare policy and procedures
- UBC’s expectations of Medical Students in Supervised Settings (031) (PDF, 187KB)
Therapeutics Letter – How useful is Paxlovid™ in 2024?
The Therapeutics Initiative recently published a Therapeutics Letter that reviewed the current evidence for Paxlovid™ as a treatment for COVID-19. The Letter includes a plain language summary, which may be shared with patients. Visit Therapeutics Initiative [149] to read the Letter.
Resources
Physician assistants not authorized to prescribe narcotics and controlled substances
Physician assistants (PAs) certified by the College of Physicians and Surgeons of BC (CPSBC) are not authorized to prescribe narcotics or controlled substances. As noted in the March 2024 PharmaCare Newsletter, pharmacists can expect prescriptions written by PAs, who as of March 15, 2024, are being certified to work in emergency departments under physician supervision.
Practitioners are always expected to practise within their licensed scope, but as PAs are new to the B.C. healthcare system, awareness of their scope of practice may be limited. If a pharmacist believes that a prescription for a narcotic or controlled substance was written by a PA (identified in PharmaNet by the practitioner ref ID M9), they should not dispense the prescription.
Reminder: The PharmaNet practitioner reference ID for certified PAs is M9. Pharmacists must enter the prescriber’s 5-digit practitioner ID, last name, and enter or select the new practitioner reference ID (M9) for transactions to adjudicate correctly. If your pharmacy management software does not include the reference ID for PAs (M9), please contact your software vendor.
Read about PA scope of practice in the CPSBC bylaws under the Health Professions Act.
Resources
Temporary addition in PharmaNet of imported colesevelam 625 mg tablets
Effective April 11, 2024, US-labelled colesevelam 625 mg tablets were temporarily added as a regular benefit in PharmaNet. Pharmacists are to use PIN 09858334 when entering the product into PharmaNet.
Canada has permitted the exceptional, temporary importation and sale of US-authorized colesevelam 625 mg tablets, by Glenmark Pharmaceuticals, and has added this product to the list of drugs for exceptional importation and sale. The importation is to help mitigate the shortage of colesevelam as well as other bile acid sequestrants, cholestyramine and colestipol.
The US-labelled product has the same active ingredient, strength, dosage form, route of administration, product formulation, indications, dosage, and administration instructions as the Canadian-authorized products. The products differ in the non-medicinal ingredients, tablet markings, and storage conditions. The US-labelled product has English-only labels. Refer to FDA label for colesevelam hydrochloride for details.
The Canadian Pharmacists Association and the Canadian Association of Gastroenterology Health have produced resources – Managing current drug shortages - Cholestyramine/Colestipol and Cholestyramine Shortage (PDF, 163KB) – to help care providers manage the shortage.
Other important resources are Drug shortages Canada and PharmaCare drug shortages.
Resources
- PharmaCare drug shortages
- Drug shortages Canada
- Cholestyramine Shortage (PDF, 163KB)
- Managing current drug shortages - Cholestyramine/Colestipol
- FDA label for colesevelam hydrochloride
- List of drugs for exceptional importation and sale
New resources for assessing and prescribing for contraception
Since the Minor Ailments and Contraception Service was launched in June 2023, B.C. pharmacists have met with over 49,000 people to support their contraception needs in the first 10 months. Contraception is the second-most requested MACS, after urinary tract infections.
For pharmacists looking for support with contraception assessments, the Canadian Pharmacy Association (CPhA), working with UBC’s Contraception and Abortion Research Team (CART), have created a resources toolkit. The CPhA’s Resources for Pharmacists includes tips and tools for patient assessment, discussing options, screening for drug interactions, counselling and documentation. Materials include:
- Getting Started with Contraception Services (PDF, 991KB) – Steps for a successful assessment
- Assessment tool (PDF, 302KB) – A fillable patient assessment form (PDF)
- Important factors to consider (PDF, 134KB) – Effectiveness, hormone content, patient privacy
- Contraceptive start methods (PDF, 964KB) – “Quick start”, “Sunday start”, “first day of period”
- How to manage side effects from contraception (PDF, 1MB) – Supporting patients experiencing acne, hirsutism, weight gain, etc.
- 10 Facts to Know About Emergency Contraception (PDF, 912KB)
Resources
New! Guide to essential PharmaCare resources for pharmacy staff
The PharmaCare communications team has compiled a guide to essential PharmaCare resources designed to support new pharmacy staff. Visit BC PharmaCare resources for pharmacy staff (PDF, 63KB) to view or download the information sheet. This document contains information on how to:
- Stay up to date with new PharmaCare procedures, policy, coverage during drug shortages, and new listings by subscribing to the PharmaCare Newsletter
- Navigate the PharmaCare Policy Manual
- Access PharmaCare 101, a video series that introduces PharmaCare policies and plans, Special Authority, the formulary search tool, and more
- Enrol in PRIME
- Find PINs and other information to record dispenses
Pharmacy management and owners are encouraged to provide the guide to new hires as part of their training.
Resources
PharmaCare 101 video series updated
PharmaCare 101 is a series of short videos that explain the basics of BC PharmaCare. They were created for students and health professionals, but everyone is welcome to view them. The series was updated in March 2024. A live follow-up Q&A with a PharmaCare pharmacist is available for small groups, classrooms and staff. This is an excellent opportunity to speak directly with a PharmaCare expert.
Resources
- PharmaCare 101
- Book a live Q&A: pharmacareinfo@gov.bc.ca
LGBTQA2S+ articles series: MACS visit for contraceptives
Kai is exploring options for contraception and makes an appointment at his local pharmacy for a Minor Ailments and Contraception Service (MACS). Kai has always felt welcomed at his local pharmacy. Kai is a trans man, and he trusts the pharmacists to provide kind and inclusive care at his appointment.
When Kai arrives for his appointment, his pharmacist Petra meets him at the consultation room. Kai has been going to this pharmacy for about a year now, and he feels comfortable with Petra. As they have worked together before, Petra has noted Kai’s pronouns, and the terms Kai prefers to use when talking about his body in Kai’s PharmaNet profile.
Petra has made learning about LGBTQA2S+ inclusive care a priority in her continuing education. She recently read a BMJ blog post, based on interviews with seven gender-diverse B.C. residents, about how healthcare professionals can provide more accessible and empowering contraceptive health care for trans, nonbinary and gender-diverse people.
Petra understands how impactful MACS can be for people who have difficulty accessing care and understands the importance of making sure the pharmacy environment is safe for trans, nonbinary and gender-diverse people. She approaches her conversation with Kai in a collaborative way, allowing him to take the lead. “Would you like me to begin by providing some general information about different contraceptives? Or, if you would prefer, I can start by answering any questions about a particular method of contraception, or by addressing any concerns you may have.”
Kai explains that he is unsure about which method to choose. He is worried about feeling gender dysphoria. Petra’s ability to discuss contraceptives with Kai in the context of gender-affirming care is important to the quality of care she provides. She can recommend methods that will not interact with Kai’s hormone therapy medications and options that may reduce the chances of gender dysphoria.
After some discussion, Petra and Kai settle on a hormonal intrauterine device, or IUD. Petra explains that IUDs are very effective at preventing pregnancy, and that it is common for people with IUDs to have reduced uterine bleeding – both factors that support Kai’s gender identity by promoting gender euphoria.
Petra writes a prescription for a hormonal IUD that is covered by PharmaCare. She asks Kai if he wants her to dispense it. He does, and Kai pays nothing for the dispense. Petra recommends a local, inclusive sexual health clinic that Kai can visit to have the IUD inserted. Kai feels supported in his choices and thanks Petra for her help.
Recommendations by B.C. gender-diverse residents for contraceptive care
Inclusive language: Using correct pronouns and names, and preferred terms for body parts, improves trust.
Visible displays of allyship: Posting pride flags, posters and pins; adding pronouns to staff name tags with pronouns; and asking clients for their pronouns signal that a patient can safely come out to their pharmacist.
Shared decision-making: Discussing collaboratively all contraceptive options, regardless of patient gender; sharing pros and cons of contraception types; and listening carefully allows pharmacists to best support their clients.
Trauma-informed: Applying trauma-informed approaches regardless of whether patient has disclosed a history of sexual violence, by obtaining consent throughout; asking client if they want to share their coping mechanisms in case of stress; and describing each step of a procedure (“I’m now going to…”). Gender-diverse populations experience sexual violence at a significantly higher rate than cisgender people.
Resources
- More reading: PharmaCare Newsletter November 2023: Patient story – trans male seeking UTI treatment at pharmacy (MACS)
- Poster: Our pharmacy is striving to be
- Canadian Pharmacists Association webinar: Smashing Stigma: LGBT2SQ+ Engagement in Pharmacy Practice
- BMJ Sexual and Reproductive Health blog: How can we Offer Better Contraceptive Care for Trans, Nonbinary and Gender-Diverse People? September 25, 2023
Exchange rate update for prosthetic and orthotic components
As of April 18, 2024, PharmaCare’s exchange rate has increased from $1.3205 to $1.3764.
PharmaCare’s price list for P&O components is adjusted periodically, based on changes to the U.S. exchange rate posted by the Bank of Canada. When the rate changes by at least 5 cents over at least 5 consecutive business days, PharmaCare’s exchange rate is adjusted to reflect the new rate.
RAT kit payment update
Since the last newsletter, PharmaCare has paid pharmacies for COVID-19 rapid antigen test (RAT) kit distribution as follows:
| Payment month | Payment date |
|---|---|
| February 2024 | May 6, 2024 |
Limited Coverage benefits: tazarotene (Arazlo™), eptinezumab (Vyepti®), tiotropium (Lupin-Tiotropium Lupinhaler®)
PharmaCare has added the following Limited Coverage items to the PharmaCare drug list. Special Authority approval is required for coverage.
| Drug name | tazarotene (Arazlo™) | ||
|---|---|---|---|
| Date effective | April 9, 2024 | ||
| Indication |
For the topical treatment of acne vulgaris in patients 10 years of age and older. |
||
| DINs | 02517868 | Strength & form | 0.045% lotion |
| Drug name | eptinezumab (Vyepti®) | ||
|---|---|---|---|
| Date effective | April 23, 2024 | ||
| Indication |
For the prevention of migraine in adults who have at least 4 migraine days per month. |
||
| DINs | 02510839 | Strength & form | 100 mg/1 mL solution in a vial for intravenous infusion Note: Vyepti® 300 mg/3 mL solution in a vial (DIN 02542269) will be listed when the product supply is available |
| Drug name | tiotropium (Lupin-Tiotropium Lupinhaler®) | ||
|---|---|---|---|
| Date effective | May 2, 2024 | ||
| Indication |
Maintenance bronchodilator treatment of chronic obstructive pulmonary disease. |
||
| DINs | 02537850 | Strength & form | 18 mcg capsule for oral inhalation with the LupinHaler® device |
Non-benefit: ravulizumab (Ultomiris®)
PharmaCare has decided not to cover the following drug for the noted indication.
| Drug name | ravulizumab (Ultomiris®) | ||
|---|---|---|---|
| Date effective | April 17, 2024 | ||
| Indication | For the treatment of anti-acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (gMG). | ||
| DINs | 02491559 02533448 02533456 |
Strength & form | 10mg/mL and 100mg/mL concentrate for solution for intravenous injection |
Your Voice: Input needed for drug decisions
The knowledge and experience of patients, caregivers and patient groups is integral to B.C.’s drug review process. If you know someone who’s taking one of the drugs below or who has a condition any of the drugs treats, please encourage them to visit www.gov.bc.ca/BCyourvoice.
Your Voice is now accepting input on the following drugs:
| Drug | Indication | Input window |
|---|---|---|
| burosumab (Crysvita™) | X-linked hypophosphataemia (XLH) in adults | April 24 to May 21 at 11:59 pm |
| atogepant (Qulipta®) | Prevention of chronic migraine in adults | April 24 to May 21 at 11:59 pm |
April 18, 2024 update
Paxlovid™ – Important dispensing information
Public supply of full-dose Paxlovid kits has now expired—use 2 renal packs to make up the full dose as necessary
- For patients who meet Paxlovid criteria and require the regular full dose, use 2 of the renal impairment dose packs and adjust the tablets, instructions and counselling as necessary
- Do not return expired public supply to the distributor. Pharmacies should dispose of expired public supply as they would normally dispose of medications, usually through a medication disposal bin
PharmaCare coverage is currently under review for the private supply of Paxlovid
Private supply of Paxlovid is now available to order. PharmaCare coverage is currently under review.
- Do not dispense private supply to patients who meet Paxlovid criteria. Instead, use any available public supply, including renal impairment dose packs and adjust the tablets, or help patients find supply at another pharmacy if out of stock
- Keep public and private supply separate in your pharmacy
- PharmaCare is currently reviewing Paxlovid for coverage. Coverage decisions will be published in a future PharmaCare Newsletter
Dispensing instructions
If using the renal impairment dose packaging (DIN: 02527804) for a patient requiring the full dose:
- Dispense 2 renal impairment dose packages
- From 1 package, remove one ritonavir 100 mg (white tablet) from both the morning and evening dose of each daily card and discard the extra ritonavir tablets
Additional information
Paxlovid was previously supplied federally by the Public Health Agency of Canada (PHAC). This program has come to an end, and each province is reviewing Paxlovid for coverage through their usual processes.
Paxlovid is unnecessary for most people living in B.C. The drug is only beneficial to groups that are considered at higher risk of progressing to serious illness, such as patients who are severely immunosuppressed. Lower-risk patients including people aged 70 years or older without serious comorbidities are not likely to benefit from treatment. Since Paxlovid became available in January of 2022., B.C. residents have developed even stronger immunity to COVID-19 through previous infections and widespread vaccinations.
Treatment decisions should also consider safety risks, as Paxlovid is known to interact with many medications and is associated with adverse effects. Refer to COVID-19 Care Treatments for more information.
Resources
- March 2024 PharmaCare Newsletter (page 6)
- Paxlovid: Guidance for B.C. pharmacists
- HLTH 2368 - Nirmatrelvir/ritonavir (Paxlovid®) 5-day Treatment Pack Prescription
- COVID-19 Care Treatments – BC COVID-19 Therapeutics Committee
Vyvanse covered during dextroamphetamine shortage
As of April 5, 2024, Vyvanse (lisdexamfetamine) capsules are temporarily a regular benefit until dextroamphetamine sustained-release (SR) capsules (brand name Dexedrine or generic formulations) are back in stock.
Dextroamphetamine immediate-release (IR) tablets remain in stock and are regular benefit. Vyvanse chewable tablets remain a non-benefit.
The Drug Benefit Council's clinical evidence review determined similar efficacy and safety between IR and extended-release (ER) formulations in adult and pediatric patients, and no significant differences between the ER stimulant drugs; however, there may be other differences (such as ability to sprinkle some medications).
Pharmacists should consult with the prescriber to assess appropriateness and to issue a new prescription. Dextroamphetamine and lisdexamfetamine are controlled drugs and switching to Vyvanse (lisdexamfetamine) may not be suitable for all patients.
As per College of Pharmacists of BC’s PPP-58: Adapting a Prescription, a pharmacist must not make a therapeutic substitution of a prescription, for a narcotic, controlled drug or targeted substance.
Coverage of Vyvanse is temporary until April 19, 2024. Future coverage will need Special Authority, with patients meeting the coverage criteria. Coverage is not available for diagnoses other than ADHD.
Visit Drug shortages for more information.
Resources
- Drug shortages
- Special Authority criteria – lisdexamfetamine
- College of Pharmacists of BC’s PPP-58: Adapting a Prescription
- PAD refill – Vyvanse vs Dexedrine
Previous newsletters
About the PharmaCare Newsletter
PharmaCare newsletters are published on the first Tuesday of each month, with special releases sometimes published mid-month. Newsletters communicate drug listings, PharmaCare and PharmaNet policy updates, and other pertinent information for PharmaCare providers and other B.C. health professionals.
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The PharmaCare Newsletter team works from the territory of the Lekwungen People, including the Songhees and Esquimalt Nations. Our gratitude extends to them, and all the Indigenous Peoples on whose territories and lands we build relationships.
Search past newsletters on the Newsletter search page.
BC PharmaCare counts on pharmacy and device providers to practise cultural safety and humility.
To learn more, read Coming Together for Wellness, a series of articles by First Nations Health Authority (FNHA) and PharmaCare, and consider taking the online San’yas Indigenous Cultural Safety course.
Active advisories:
Dextroamphetamine SR capsules; Cholestyramine, colestipol and colesevelam; Tamsulosin capsules and tablets; Prazosin tablets, Sabril® tablets; nitroglycerin sprays & tablets; pediatric antibiotic suspensions; Glucagon for injection.
Visit Drug shortages for full list and details.