Bill no. 41, An Act to amend the Pharmacy Act, once in force, will entitle Québec pharmacists to perform a number of services that were traditionally reserved for physicians. Bill no. 41 was originally sponsored by Yves Bolduc, the Minister of Health and Social Services at the time it was introduced and was adopted by the National Assembly of Québec on December 8, 2011. The Bill and related regulations were to come into force September 3, 2013, but given the ongoing negotiations regarding certain issues, its implementation has been postponed. An order in council was issued on August 22, 2013 to defer the coming into force of the Bill and related regulations to a date to be determined.
Under the Bill, pharmacists will be permitted to extend prescriptions, subject to certain limitations, prescribe medications when no diagnosis is required, and prescribe and interpret certain laboratory tests. In accordance with newly enacted regulations, pharmacists may adjust a prescription, substitute one medication for an equivalent in case of a shortage, prescribe medications for mild medical conditions when the diagnosis and the treatment are already known and administer medication to show patients its proper usage. The latter four new activities can only be performed by a pharmacist after completion of relevant training. Nearly 5,000 of the 8,300 Québec pharmacists have already completed such training, while others are expected to complete before the end of 2013.
While the new legislation is intended to improve the efficiency of the healthcare system, it gives rise to major implementation issues.
Remuneration of pharmacists
One of the issues that is still in debate relates to the remuneration of pharmacists for the new services they will provide. Negotiations between the provincial government and the Québec Association of Pharmacy Owners (APPQ) are continuing on this point. While pharmacists are of the view that they should be remunerated for the provision of additional services due to the higher operating expenses generated by having to perform additional services, the provincial government has taken the position that only certain new services should be remunerated (namely, the prescription of medications for conditions that have already been diagnosed or that do not require a diagnosis, and the adjustment of prescriptions) and that the other services should be freely provided. Currently, when the same services are performed by physicians, the latter are remunerated by the Régie de l’assurance maladie du Québec.
Coverage by drug insurance plans
The issue of who will bear the cost of the provision of the additional services targeted by Bill n˚ 41 is a further issue that is still unsettled. It is likely that Québec’s public drug insurance plan will cover the provision of said services without any additional charge for the 40% of Quebecers who benefit from the public regime. The remaining 60% of Quebecers covered by private drug insurance plans may have to either pay for the new services out-of-pocket (for some, at least until their insurance plans are adjusted, which may take a few years), or pay higher insurance premiums to reflect the additional services covered. This situation raises several concerns. Critics claim that it creates two classes of patients with regard to services that are currently provided for free to all patients when performed by a physician under Québec’s public health insurance regime. It is also argued that privately insured patients will likely prefer to consult their physician for services that a pharmacist could provide under the new bill in order to obtain those services for free, thus defeating the purpose of the new legislation. Health Minister Réjean Hébert has postponed the entry into force of Bill n˚ 41 until the parties can reach an agreement. Bill n° 41 may be found at:
Related regulations may be found at:
- Regulation respecting the administration of medication by pharmacists (O.C. 601-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2767.pdf
- Regulation respecting prescriptions by a pharmacist (O.C. 602-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2768.pdf
- Regulation respecting the prescription and interpretation of laboratory analyses by a pharmacist (O.C. 603-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2769.pdf
- Regulation respecting the prescription of a medication by a pharmacist (O.C. 604-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2770.pdf
- Regulation respecting the extension or adjustment of a physician’s prescription by a pharmacist and the substitution of a medication prescribed (O.C. 605-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2771.pdf
- Regulation respecting certain professional activities that may be engaged in by a pharmacist (O.C. 606-2013): http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=1&file=2772.pdf