Pharmacists want authority to substitute medicines without new prescriptions

Pharmacists can already swap between a brand-name medicine and a generic version, but it is being argued that their skill set should be more effectively used in also substituting for new medication if needed.

Medicine shortages are now a year-round issue, pharmacists warned as they called to be allowed to substitute medications for patients without a new prescription each time.

This crisis and limits on contraception access were highlighted by the Irish Pharmacy Union at the Oireachtas Health Committee on Wednesday.

The national medicines shortages list now shows 247 out of stock. This includes seven types of amoxicillin antibiotics, as well as diazepam which is used for treating anxiety, and somatropin solution for injection to assist growth limited by health conditions.

IPU president Dermot Twomey warned: “It’s not just a Christmas or a winter issue, it’s present all year now. We see this with many particular molecules at the moment, it’s just it was very particularly highlighted during the recent RSV and influenza infections.” 

Pharmacists can already swap between a brand-name medicine and a generic version, but he argued their skill set should be more effectively used in also substituting for new medication if needed.

A pharmacist in Cloyne, Co Cork, Mr Twomey said: “One of the things that has worked in other jurisdictions is a Serious Shortage Protocol. Ultimately, it’s really around getting timely access for the medicines when patients need it.” 

He outlined how this could work to Sinn Féin health spokesman David Cullinane: “Pharmacists would make, according to certain protocol and guidelines, a switch from one therapeutic molecule to another when a particular molecule is short.” 

This would allow for “therapeutic substitution of medicines,” he said, removing the need for a new prescription where there is a critical shortage. “Again, a relatively simple measure which will increase the speed of supply and reduce the stress on patients and pharmacists,” he said.

IPU secretary-general Sharon Foley said: “Medicines shortages have emerged as a key risk to safe and effective healthcare.” The IPU acknowledged legislation would be needed for this and called for the appointment of a Chief Pharmacist to drive changes. 

They also urged pharmacists be allowed to dispense oral contraceptive pills without the need for a GP prescription. IPU Pharmacy Contractors Committee chair Kathy Maher said: “It is a very safe and effective healthcare intervention.

Since 2011 we have been delivering emergency hormonal contraception without prescription to the women of Ireland. At that point, there might have been some fear that use would increase and that has been shown not to be the case.

Pharmacists could assess the most suitable method and refer women onwards for Long Acting Reversible Contraceptives (LARC) if appropriate, she argued.

“We are the medicines experts,” she said. “I see in my own practice when I see young women coming in, even older women, they’ve had to take time off work or arrange childcare to access general practice to have that consultation, when they can come into me on the way home from work or at weekends or late-night.” 

Responding to this, Social Democrats health spokeswoman Roisin Shortall and Green Party spokeswoman Neasa Hourigan proposed a motion calling on health minister Stephen Donnelly to take immediate steps to make oral contraceptives available without prescription from community pharmacists, as is the case in many other countries.

Ms Shortall said: “It just doesn’t make sense that there is a barrier there to accessing oral contraception. I think it is appropriate that we do this today.”