What progress has been made so far?

National Initiatives National initiatives related to the regulation of pharmacy technicians began almost ten years ago. Then, in 2007, three important documents were finalized that lay the groundwork for much of what has followed since. In March 2007, the Canadian Pharmacy Technician Educators Association (CPTEA) released the Educational Outcomes for Pharmacy Technician Programs in Canada. This document is intended to describe the essential knowledge, skills, and attitudes that students must develop and demonstrate prior to graduation from a pharmacy technician program. It is then the responsibility of the program to provide learners with appropriate learning opportunities and assessment strategies so that by the completion of the learners course of studies, the program can confirm that graduates have met these outcomes.3 Following that, in September 2007, the National Association of Pharmacy Regulatory Authorities (NAPRA) prepared the Professional Competencies for Canadian Pharmacy Technicians at Entry to Practice. These competencies describe the roles and responsibilities of pharmacy technicians as regulated health care professionals, articulating that pharmacy technicians expertise focuses on the knowledge, skills and abilities related to the technical elements of prescription and patient information, and of product and drug distribution. Individual provinces/territories have adopted or adapted these competencies while developing related legislation, regulations and policies. 2 Finally, in November of that year, the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) released its Standards for Accreditation of Pharmacy Technician Programs, which it had based on the previous two documents. In 2008, CCAPP began to use these Standards to grant accreditation awards to pharmacy technician programs across Canada.4 As of June 2011, 5 programs have been granted Qualifying Status and 41 programs have been granted Provisional Status. These Standards have since been reviewed and a new version will be implemented in 2012.5 In August of 2009, the Pharmacy Examining Board of Canada (PEBC) first piloted the Pharmacy Technician Qualifying Exam in the province of Ontario. It was offered as a pilot once again in March of 2010 before being administered at multiple sites across the country starting in August of 2010.4 The Qualifying Examination consists of two parts: a written multiple choice question examination (MCQ) and a performance-based examination, called an Objective Structured Performance Examination (OSPE). In order to be eligible to write the Qualifying Exam, a candidate must: be a graduate of a CCAPP-accredited pharmacy technician program; have passed the PEBC Evaluating Exam; have passed the Pharmacy Technician Certification Board of Alberta certification exam (no longer offered); have passed the Ontario College of Pharmacists Certification Exam (no longer offered); or be a graduate of an accredited pharmacist degree program in Canada or the United States6 In order to write the PEBC Evaluating Examination, the candidate must show proof of completion of 2,000 hours of work and/or teaching experience in Canada in the past 36 months in the field of pharmacy.6

Most recently, as initiatives began at the provincial level (see more below), it was determined that, in order to retain consistency from province to province, model standards of practice, similar to that of pharmacists, were needed for pharmacy technicians as well. In November 2011, NAPRA finalized the Model Standards of Practice for Canadian Pharmacy Technicians, which uses a format adapted from that of the Model Standards of Practice for Canadian Pharmacists and is divided into four primary domains. Within each of these domains, the Standards are further grouped under general standard statements to provide structure and ease of reading as follows:7 Expertise in drug distribution systems Pharmacy technicians maintain their competence. Pharmacy technicians apply their drug distribution expertise while performing their daily activities. Pharmacy technicians provide evidence of application of their drug distribution expertise through documentation. Collaboration Pharmacy technicians work constructively with students, peers and members of the inter-professional team. Pharmacy technicians communicate effectively. Safety and Quality Pharmacy technicians undertake continuing professional development, quality assurance and quality improvement. Pharmacy technicians respond to safety risks. Professionalism and Ethics Pharmacy technicians demonstrate professionalism and apply ethical principles in their daily work. These Standards were based on, and reference NAPRAs previous document, the Professional Competencies for Canadian Pharmacy Technicians at Entry to Practice.

Provincial Initiatives The provinces have worked in close collaboration and freely share experiences in developing: A pharmacy technician certification system (with PEBC); A registration system framework that can be applied to individual provinces; and Similar scopes of practices for pharmacy technicians in the provinces that have taken the leadership in revising their legislation.4

The Model Standards of Practice for Canadian Pharmacists includes four domains related to medication expertise, collaboration, safety / quality and professionalism / ethics.

The following table describes the progress that has been made with regard to Pharmacy Technician Regulation across the country. The College of Pharmacists of British Columbia began work on pharmacy technician regulation in 2006 with the development of a White Paper and Business Case. In 2009, the Council of the College affirmed their intent to move forward with regulation of technicians. Changes to the Pharmacists Regulation and Bylaws were approved in 2010, with the restricted title of Pharmacy Technician coming into force on Jan 1, 2011. 8 More than 20 pharmacy technicians were registered as of October 2011 with about 1000 more candidates in progress. Regulators in Alberta have been working for more than a decade on pharmacy technician regulation. Similar to Ontario, Alberta also had a provincial certification exam and a voluntary register for pharmacy technicians. Over 1000 technicians were on this list.4 The Alberta College of Pharmacists (ACP) began working on legislative changes to support pharmacy technician regulation in 2006 and changes to the Pharmacists Profession Regulation and Standards of Practice finally came into effect on July 1, 2011.4,9 As of October 2011, ACP has registered 5 pharmacy technicians with many more in the process of working their way through the process. Over 900 remain on the voluntary register. In December of 2008, the Saskatchewan College of Pharmacists Council made a motion to develop a regulatory framework to meet the needs of regulation of pharmacy technicians. In September 2009, the Pharmacy Technician Regulation Advisory Working Group finalized a concept paper that described the regulatory process. This concept paper was submitted to government and it was agreed that changes to the Pharmacy Act would be required but this has yet to be prioritized by government or placed on the legislative agenda in Saskatchewan.10 As of right now, it appears that legislation related to the regulation of pharmacy technicians may be different in Manitoba than in much of the rest of the country. At this time, it is unclear how this will proceed but it is possible that pharmacy technicians may not be regulated by the Manitoba Pharmaceutical Association but by a separate and distinct regulatory body. Ontario has led the way in Canada in its quest for official recognition and regulation of pharmacy technicians. The Ontario College of Pharmacists (OCP) began the process in 1996 with the first voluntary pharmacy technician certification exam in Canada. This exam led to more than 2400 technicians being certified by OCP. Changes to existing legislation were requested in 2005 and were ultimately passed by the Ontario government in 2007. These legislative changes enabled the regulation of pharmacy technicians. Subsequent to this, regulations were drafted and approved in December of 2010.4 Since this time, OCP has registered almost 400 technicians and have many more in various stages of the regulation process.

BC

AB

SK

MB

ON

QC

Quebec is still in the early stages with pharmacy technician regulation with the Ordre des pharmaciens du Qubec having not yet taken a position on developing a legal scope of practice for pharmacy technicians. It is expected that discussions with provincial pharmacy stakeholders on the subject will be revisited in the near future.4 The New Brunswick Pharmaceutical Society has drafted legislative changes to the Pharmacy Act related to pharmacy technician regulation which it anticipates being passed in early 2012.4 In the Spring of 2010, the Nova Scotia College of Pharmacists prepared and submitted a proposal on pharmacy technician regulation to the provinces Regulatory Advisory Committee. The proposal was accepted and work on changes to the legislation began.4 In May of 2011, the new Pharmacy Act passed in the legislature but will not be proclaimed until changes to regulations are completed. It was expected that this would occur by the end of 2011.11 The Prince Edward Island Pharmacy Board has included defining the role of pharmacy technicians and implementing a regulatory process to support the use of qualified technicians on an optimal supportive role for pharmacists as part of their 5 year Strategic Plan (2010-2015). Based on the timeframes laid out in the plan, it is anticipated that this issue would be addressed sometime in 2012.12 In March, 2010, the Newfoundland and Labrador Pharmacy Board (NLPB) endorsed a framework that would enable the regulation of pharmacy technicians and establish their role in pharmacy practice. Since that time, the NLPB has been discussing the issues internally as well as with a variety of stakeholders.13 It has been determined that changes to the Pharmacy Act will likely be required but this has yet to be prioritized by government or placed on the legislative agenda.

NB

NS

PEI

NL

Progress in the provinces seems to continue to move forward at a slow but steady pace. At this time, there have been no formal discussions of regulating pharmacy technicians in either of the three territories. Despite the fact that pharmacy technicians are already regulated in the larger provinces of British Columbia, Alberta and Ontario, it may still be many years before regulatory changes are complete across the country.