Last week, Health Minister Uzoma Asagwara announced an expansion of pharmacists’ scope of practice, which will eventually allow pharmacists to prescribe birth control and HIV medications, but details remain unclear. We are sharing what we know so far, and inviting your feedback to understand physicians’ perspectives and concerns as we prepare a submission to the government. We know physicians want their patients to have good access and pathways to these kinds of medications, but have heard some clinical questions and concerns as well. 

In an interview with CBC Manitoba, Minister Asagwara elaborated that the province is moving quickly to allow pharmacists to prescribe birth control medications ​“in the coming days and weeks.” A government official said HIV medications could be prescribed as early as this summer.

• Currently, Manitoba, Ontario and the three territories are the only places in Canada that do not currently allow pharmacists to prescribe birth control.

• The province has not yet provided specifics on which type of birth control things includes, such as oral contraceptive pills, hormonal injections and IUDs.

• Health officials have also not yet released specifics on the HIV medications pharmacists will be able to prescribe.

A Broader Wish List for Retail Pharmacists?

Retail-based pharmacists have been able to administer vaccines for some time, and the previous PC government expanded the scope in 2021 to include diagnosing and prescribing medications for UTIs after additional training is complete. Retail pharmacists have been advocating for a much broader expansion, something the PCs promised in the 2023 election. 

This is similar to moves already made in Ontario, for example, which includes a broader scope of practice and provincial health coverage for pharmacist tasks such as:

• Diagnosing and prescribing minor ailments such as sore throats, headaches, shingles, diaper rash, menstrual cramps, sprains and strains, acid reflux, and sleep disorders among others. 

• Ordering lab tests and performing point-of-care tests, such as for strep throat.

• Administering a broader set of vaccines, such as TDaP, HPV, Meningococcal, etc. 

• Offering ​“MedChecks” for patients with multiple prescriptions.

While the expansions have continued in Ontario, they aren’t without criticism. In fact, the pharmacist regulator in Ontario launched an investigation and found 80 to over 90% of pharmacists working in retail settings reported experiencing workplace or corporate pressures to complete an activity in a limited time frame or to a certain target number or dollar amount. The Ontario College of Pharmacists reported that they ​“heard that real and sustained business pressures are being placed on registrants, often coming from those working in corporate offices. Registrants are being pressured to complete MedsChecks, dispense Naloxone, assess minor ailments, limit time spent on specific activities and undertake other professional services.”

This has fueled concerns about the potential conflict of interest of prescribing and dispensing, something we have heard from both physicians and patients, and something the Royal Pharmaceutical Society in the UK has taken the position should be separated.

We want to hear from you

Please contact us to share your views to help shape our submission to government. 

• What are your thoughts on the new measures about HIV medications and birth control? 

• What do you think of the further scope retail pharmacists are seeking? What about expanding the role of pharmacists in hospitals and in team-based physician practices?

• Where is an expanded scope for pharmacists beneficial to patients? 

• What guardrails are needed to ensure patient safety and avoid conflicts of interest? What clinical concerns do you have, if any?

Please email us in confidence at practiceadvice@​doctorsmanitoba.​ca.