The Ontario government recognizes that pharmacists have the training and expertise to help manage medical conditions that are short-term, require minimal treatment and don’t require lab tests. Pharmacists are accessible and also have the knowledge and resources to recognize signs and symptoms that require referral to your doctor, other primary care provider or emergency facilities.

Certain medications, including some that were previously only available through a prescription, can now be prescribed by pharmacists, as appropriate, for certain minor conditions, after an assessment of your symptoms and history. After an assessment, the pharmacist has a few options to provide treatment from recommending over the counter medications to medications that previously required a prescription.

Minor illnesses are described as health conditions that can be managed with minimal treatment and/or self-care strategies. Additional criteria include:

  • Usually a short-term condition
  • Lab results aren’t usually required
  • Low risk of treatment masking an underlying condition
  • No medication or medical history red flags that could suggest a more serious condition
  • Only minimal or short-term follow-up is required

Pharmacists can assess and prescribe a prescription level medication when necessary rather than recommending a milder over- the-counter treatment for specific, less serious conditions, as outlined by the Ontario College of Pharmacists.

Minor, or common, illnesses refer to conditions that can initially be managed with non-prescription therapy, such as allergies or skin irritations. All pharmacists can assess minor illnesses symptoms and recommend self-care or over-the-counter treatments. Pharmacists in Ontario can now also prescribe medications for certain minor illnesses, as identified below:

  • Allergic rhinitis (nasal allergies)
  • Candidal stomatitis (oral thrush)
  • Conjunctivitis (pink eye, bacterial, allergic and viral)
  • Dermatitis (atopic, eczema, allergic and contact)
  • Dysmenorrhea (painful menstruation)
  • Gastroesophageal reflux disease (GERD, heartburn)
  • Hemorrhoids
  • Herpes labialis (cold sores)
  • Impetigo
  • Insect bites and urticaria (hives)
  • Tick bites, post-exposure prophylaxis to prevent Lyme disease
  • Musculoskeletal sprains and strains
  • Urinary tract infections (uncomplicated)

No, you don’t need to make an appointment to speak with your pharmacist.

If our store is open, you can consult with the pharmacist. We’re accessible and ready to see you.

Assessment and prescribing for minor illnesses are covered by Ontario’s Health Insurance Plan (OHIP). To be eligible for this service, you’d need to have a valid Ontario Health Number.

Pharmacists, through their training and formal education, possess in-depth knowledge and strong clinical skills that are a critical part of the healthcare system. Pharmacists are highly trained, educated and trusted health care professionals. They are medication experts. Their university curriculum includes training on the assessment and treatment of these minor illnesses. The minor illnesses program includes mandatory regulations that oversee the scope of what a pharmacist can do.

In addition, all Rexall pharmacists completed mandatory training on the processes and standards they are asked to follow before they can offer you this service.

Pharmacists, through their training and formal education, possess in-depth knowledge and strong clinical skills that are a critical part of the healthcare system. Pharmacists are highly trained, educated and trusted health care professionals. They are medication experts. Their university curriculum includes training on the assessment and treatment of these minor illnesses. The minor illnesses program includes mandatory regulations that oversee the scope of what a pharmacist can do.

In addition, all pharmacists completed mandatory training on the processes and standards they are asked to follow before they can offer you this service.

After the pharmacist assesses a patient they, in conjunction with the patient, determine the appropriate course of action. This could be a prescription or a recommendation for an over-the-counter medication. If a pharmacist assesses your condition but feels it is serious or requires follow-up, he or she will refer you to a doctor for additional assessment.

Yes. Pharmacists are required to inform your primary physician when they write a prescription for you.

Yes. If the condition and treatment required are within pharmacists’ prescribing limits, you may still receive treatment even if you do not have a doctor. This service is intended to improve access to health care.

If your illness becomes more serious or you are not seeing improvements with the medication prescribed by your pharmacist, you will be referred to your doctor for a diagnosis. Your pharmacist is trained to recognize when an illness requires additional assessment and care beyond their scope.

Since new legislation came into effect on Jan. 1 allowing Ontario pharmacists to prescribe for 13 “minor ailments,” some have taken to social media to voice concerns. With the ability to assess and write prescriptions for conditions such as pink eye and uncomplicated urinary tract infections — a regulatory change that brings Ontario in step with nine other provinces and territories — some questioned the move in opinion columns and social media posts, suggesting pharmacists could potentially miss a more serious diagnosis, or that their new powers could lead to an over-prescribing of antibiotics.

“Although there are a few voices that are raising these flags, generally most health care professionals and physicians welcome this,” said Mina Tadrous, an assistant professor of pharmacy at the University of Toronto who specializes in drug policy and has been monitoring the reaction. “I think some of these concerns are coming from a place of thinking about what’s best for their patients and what’s best for the health-care system,” said Tadrous, who was on the advisory committee that helped decide which minor ailments pharmacists should start prescribing for in Ontario. Concerns from the public or the medical community could be eased with a better understanding of what the changes actually mean — and the fact that pharmacists have already been prescribing medications in other parts of Canada for years, Tadrous said. “We’ve been able to watch what’s occurred in other provinces and learn from it,” said Tadrous,

In Alberta, pharmacists can prescribe most medications, with the exception of narcotics. Pharmacists in Saskatchewan, Manitoba, Quebec, New Brunswick, Prince Edward Island, Nova Scotia, Newfoundland and Labrador and Yukon can prescribe medication for several “common or minor ailments,” according to information gathered by the Canadian Foundation for Pharmacy and the Canadian Pharmacists Association. British Columbia is set to allow pharmacist-prescribing for minor ailments and some forms of contraception this spring.

Beverley Zwicker, CEO and registrar for the Nova Scotia College of Pharmacists, said pharmacists outside Ontario are “sort of scratching our heads a little about a lot of hoopla over something that everyone has been doing for a long time, clearly without harm.”

 

The Canadian Press asked Belcher, Tadrous, Zwicker and other experts to respond to the three most common questions they’ve been getting.

For example, what if a heartburn complaint is really a heart condition, or an uncomplicated urinary tract infection is really a sexually transmitted infection?

Pharmacists are clinically trained to recognize “red flags” when a patient comes in looking for a treatment for what appears to be a minor condition, Tadrous said. “We have already been assessing for these ailments as part of general practice for decades, just without the ability to prescribe.” Zwicker agreed, noting, for example, that customers were already coming in to seek advice on over-the-counter products that could help alleviate the symptoms of heartburn. The only change with the ability to prescribe, she said, is that pharmacists can offer more suggestions for available treatments. During that interaction, pharmacists can talk to patients about what to do if their condition doesn’t get better and redirect them to their doctor, nurse practitioner or the emergency department if there are indications it could be something more serious. “Although what the public sees is mostly pharmacists dispensing medication, their scope is actually much broader,” Zwicker said.

“We are professionals and ethically bound to do what is best for our patients, no different than any other health-care professional,” said Margaret Wing, chief executive officer of the Alberta Pharmacists’ Association. Pharmacists in that province have had the broadest prescribing scope in Canada for more than a decade, and there’s no reason to believe inappropriate prescribing has occurred, she said.

“Pharmacists in Alberta are initiating 433,500 new prescriptions annually, or less than 1% of the total 55 million prescriptions dispensed annually in Alberta. I believe that is evidence that pharmacists are not over-prescribing,” Wing said in an email. Ontario legislation stipulates a patient receiving a prescription from a pharmacist can fill it anywhere they choose, Tadrous said, meaning there’s not necessarily a financial incentive for the prescribing pharmacist. There are potential conflicts of interest in any profession, Tadrous said, adding pharmacists are licensed and must follow professional ethics. Plus, “in many cases, pharmacists aren’t paid by the prescription,” Tadrous said. “These are (mostly) people who work as employees somewhere, and if they give out more prescriptions there’s no incentive there for them personally.”

There has been no “uptick” in antibiotic prescriptions in provinces where pharmacists have prescribing authority, Tadrous said. “Most of the evidence points in the other direction — that pharmacists are better (antibiotic) stewards than physicians are,” he said. Andrew McArthur, a professor at the David Braley Centre for Antibiotic Discovery and M.G. DeGroote Institute for Infectious Disease Research at McMaster University, agreed. “Overall, pharmacists are highly trusted members of our health systems and already play a strong role in combatting AMR by ensuring patients do not misuse their antibiotics,” McArthur wrote in an email. “One of the major drivers of AMR is patients stopping use early because they feel better and pharmacists have been key in reducing this behaviour.”