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Friday Five (September 17, 2021)

This week's edition of the Friday Five includes a consultation reminder, information on COVID-19 vaccine eligibility, and a reminder on changes to coverage on methadone products

A Consultation on Barriers and Enablers for Attaining and Maintaining an Extended Practice Pharmacist (EPPh) Designation 

The College Board of Examiners (Board) would like to hear from pharmacists about their perceptions of existing and potential barriers and enablers to attaining and maintaining an EPPh designation.  

A consultation was sent out to all practicing pharmacists via email on September 10, 2021, and it will remain open until October 4, 2021. The consultation takes approximately 20 minutes to complete.  

The information gathered will help inform the Board’s next steps on further facilitating the attainment of the EPPh designation within the current legislative framework while ensuring that EPPhs continue to provide the highest quality of safe and effective care to the public.  

Consultation link: https://www.surveymonkey.com/r/9G2RHNH 

 

Reminder: Changes to Coverage of Methadone Concentrate Products  

Manitoba Health and Seniors Care (MHSC) previously released Bulletin #112, and effective August 5, 2021, generic methadone products were listed as a Part 1 (open) benefit. These generic methadone products are NOT interchangeable with each other nor with the brand name methadone products.  

Brand name methadone concentrate products (Methadose, Methadose Sugar-Free, and Metadol-D) have been moved from a Part 1 benefit to a Part 2 benefit for patients who are being treated with the brand name methadone product, or for patients who have previously been treated with two or more generic methadone products listed under Part 1.

Pharmacists dispensing methadone should review the updated MHSC Methadone Claims Submission Procedure and Background and updated Frequently Asked Questions, or see the MHSC page here.   

A safety review completed by Health Canada found that there may be a link between switching methadone-containing products used to treat opioid use disorder and the risk of lack of effect, which may present as withdrawal symptoms, although the reason for this is unclear.   

Healthcare professionals should be aware that:  

  • Some patients may experience withdrawal symptoms after being switched from one methadone-containing product to another; these patients should be clinically managed and monitored regularly.  
  • Dose adjustments may be necessary in some patients.   
  • Withdrawal symptoms can lead to a failure to remain in treatment and subsequent problematic substance use, leading to serious harm.  

Methadone products are not interchangeable from a clinical perspective nor a coverage perspective. A new prescription from an approved prescriber is required to switch a client from one methadone product to another.  

If a patient is new to taking methadone and appears at a pharmacy with a prescription that does not specify the brand (i.e., written as “methadone”), the pharmacist can dispense whatever generic is usually used by the pharmacy. It is good practice for the pharmacist to notify the prescriber of the generic brand that is being used. This may be done by fax.  

If the patient is already taking methadone and presents with a new script, consideration must be given to what brand the patient has been receiving, and it may be necessary in some cases to avoid changing the brand, if possible. If the patient receives a different methadone brand, the patient and prescriber must be made aware, and arrangements for monitoring and management should be in place. Early withdrawal symptoms can lead to a failure to remain in treatment and subsequent problematic substance use, which may lead to serious harm.   

The Opioid Agonist Therapy Guidelines for Manitoba Pharmacists will be updated at the earliest opportunity to reflect these changes. 

 

Professional Liability Coverage for Pharmacists 

During the initial licensure and license renewal period, pharmacists are required to declare they have met their obligation to hold professional liability insurance coverage. 

As a condition of licensure, all pharmacists are required to have professional liability insurance as outlined in section 123 of the Regulation to the Pharmaceutical Act: 

Professional liability insurance 

123 Every member, unless registered under section 14 of the Act (emergency registration), must be covered by professional liability insurance that provides a minimum of $2,000,000 per claim or per occurrence and a minimum $4,000,000 annual aggregate. 

To comply with this mandatory obligation, each pharmacist must have individual professional liability insurance coverage in the minimum amounts outlined in the Regulation. Non-compliance with the mandatory requirement for individual professional liability insurance jeopardizes a pharmacist’s license status. 

It is important for all pharmacists to recognize that employer group liability insurance coverage (such as offered through HIROC) does NOT meet the requirement for individual professional liability insurance. 

 

Eligibility Criteria for a Third (Booster) COVID-19 Vaccine Dose 

Manitoba’s Vaccine Implementation Task Force recently announced the third (booster) dose of the COVID-19 vaccine will be available to individuals who:   

  • aremoderately to severely immunocompromised due to a medical condition and/or treatment;   
  • wishto receive a third dose for travel purposes; and   
  • individualswho have received one or two doses of a vaccine that is not approved by Health Canada.  

Pharmacists are reminded to review the specifics of the eligibility criteria for the third (booster) dose of the mRNA COVID-19 vaccine found here: https://manitoba.ca/covid19/vaccine/eligibility-criteria.html and are further encouraged to collaborate with other healthcare professionals providing care to an individual to confirm eligibility when necessary while employing professional judgement.  Pharmacists should also review the updated Manitoba COVID-19 Vaccine: Clinical Practice Guidelines for Immunizers and Health Care Providers. 

Of note, a prescription is required from an authorized practitioner (i.e., physician or nurse practitioner) in order for a pharmacist to administer a third dose of a COVID-19 vaccine for travel purposes, since this is not included in the Ministerial Order as part of the government’s pandemic response program.   

 

 Prescribing Authority Table Updated 

The authority and scope of prescribing varies for each healthcare profession in Manitoba and even within each profession.  The Prescribing Authority Table provides general guidance to pharmacists related to prescribing within community practice in Manitoba for outpatients. Prescribing practices within a hospital or healthcare facility for inpatients may vary depending on the policies and procedures of the individual hospital or regional health authority. 

The information within the table was obtained from the respective regulatory bodies according to their legislation.  Any specific or further questions regarding the scope of practice of other health care professionals should be directed to the appropriate regulatory authority.  

The Prescribing Authority Table can be a useful resource and can be found on the College website within the Resource Library under any of the following categories – Information, Legislation or Practice Directions and Standards of Practice. 

 

Health Canada Updates to the FDR and MDR 

Health Canada has recently made updates to the Food and Drug Regulations (FDR) and the Medical Devices Regulations (MDR) to incorporate some of the abilities they used to address drug shortages that were provided via Interim Orders and make them more permanent abilities under the FDR/MDR.  

To view the regulations amending certain regulations concerning drugs and medical devices, click here: https://canadagazette.gc.ca/rp-pr/p2/2021/2021-09-01/html/sor-dors199-eng.html
 

The amendments: 

  • Prohibit drug establishment licence holders from selling certain drugs intended for the Canadian market for consumption or used outside of Canada if that sale could cause or exacerbate a shortage. 
  • Allow the Minister to permit importation and sale of products that do not fully meet Canadian regulatory requirements, but that are manufactured to comparable quality standards, to address a shortage or an anticipated shortage. 
  • Allow importers and sellers of exceptionally imported biocides and foods for a special dietary purpose to exhaust stock in Canada by specifying final dates for importation and sale for these products. 
  • Provide Health Canada with additional tools to assess existing or potential shortages of drugs or medical devices: 
  • Power to compel information from industry about a shortage 
  • Power to require manufacturers and importers to report shortages, including discontinuances of certain medical devices that may lead to a shortage of specified medical devices. 
  • Temporarily extend regulatory flexibilities related to drug establishment licences for drug-based hand sanitizers. This extension permits persons conducting licensable activities related to hand sanitizers without a Drug Establishment License to continue doing so until September 1, 2023, or until a decision is made on their Drug Establishment License application, whichever is sooner. 

 

 Notice: CPhM Office Closure  

Please be advised that the College of Pharmacists of Manitoba will observe the National Day for Truth and Reconciliation on Thursday, September 30, 2021 and will be closed for the day to encourage reflection and meaningful discussions about the impacts of residential schools.   

The College office will re-open on Friday, October 1, 2021 at 8:30 a.m. 

 

Professional Development Opportunities & Events 

Pharmacists Manitoba Fall Conference

September 18, 2021   

View the full program and register here. 

Opioid Agonist Therapy 101 Introduction to Clinical Practice  

September 23 and 24 2021 Killarney MB 

Register here. 

ISMP Medications Safety Considerations for Compliance Packaging E-learning Module  

Complete the module here

Community Connectors Workshops 

For a list of accredited workshops and dates, click here.