Prescribing to Patients Whom You Have Not Assessed In-Person
Semaglutide, sold under the brand name Ozempic and approved to treat Type 2 diabetes, is gaining popularity due to its off-label use for weight loss. Advertising and social media hype about Ozempic's effectiveness as a means of losing weight is creating a demand for the drug in the U.S.
As demand for the drug grows in other jurisdictions, you may be approached by a physician, pharmacist, or pharmacy to "re-write", "co-sign" or “counter-signing” prescriptions for this drug or any other medications. This raises a concern about prescribing to patients whom you have not seen or assessed in-person.
CPSM strongly advises against writing, “re-writing”, “co-signing”, or “counter-signing” prescriptions to supply drugs to patients whom you do not have a doctor-patient relationship with. Engaging in this practice would be a breach of several Standards of Practice as outlined below:
1. The Standard of Practice - Prescribing Requirements sets out requirements for prescribing.
Section 3, Direct Patient Contact of this Standard applies to all prescriptions.
It states:
3.1. Prescribing medication or counter-signing a prescription without direct patient contact does not meet an acceptable standard of care. Subject to subsection (2), there is no direct patient contact when the registrant relies upon a mailed, faxed, or an electronic medical questionnaire or telephone advice to the registrant.
Another consideration is Adverse Patient Outcomes.
When you provide a prescription for a patient whom you have not seen or assessed in person, potential risks and complications may arise if an adverse patient outcome occurs or if you need to contact the physician, patient, or pharmacist.
2. Standard of Practice - Virtual Medicine
CPSM considers the patient's location determinative of where the practice of medicine occurs. CPSM registration does not extend to the provision of medical care in other Canadian provinces or to patients located in other countries.
See the Information Sheet on Virtual Medicine Across Provincial and Interprovincial Borders for further details.
Frequently Asked Questions
Q. Can I prescribe Ozempic for off-label use?
CPSM advised registrants to use their knowledge, skill and clinical judgement and consider current best practices when determining patient treatment options. This is especially important when prescribing medications for "off-label" use.
In some Canadian jurisdictions, U.S. consumer demand is causing a supply shortage for people who need it as medication to treat diabetes.
You can also contact the Canadian Medical Protective Association for advice. Refer to their guidance on the risks of prescribing to non-patients.
Q. Can I "co-sign" or "counter-sign" prescriptions written by a U.S.-licensed physician for patients/residents of the U.S.?
Writing a prescription (including “re-writing, "co-signing" or "counter-signing") is considered as providing medical care and/or patient care. The Standard of Practice - Good Medical Care covers the requirements of providing patient care.
Therefore, CPSM advises against this practice, as it would breach the Standards of Practice – Prescribing requirements and the Standard of Practice – Virtual Medicine (as outlined above).
Q. Why would a physician or pharmacist contact me to write/co-sign/re-write/counter-sign a prescription for a U.S. patient?
There is a supply shortage of Ozempic in the U.S., and U.S. patients are looking for alternative supplies. Manitoba pharmacies, which are an alternative supply source, can only fill prescriptions from prescribers with a certificate of practice (license) in Manitoba, or another Canadian jurisdiction.
Q. Can a pharmacist in Manitoba fill a U.S. prescription?
According to the College of Pharmacists of Manitoba (CPhM), Manitoba pharmacists can only fill prescriptions issued by a physician licensed in a province or territory of Canada.
CPhM's position is that it may be contrary to professional standards for a pharmacist to fill prescriptions by a physician, licensed in a province or territory of Canada, who has not established an acceptable patient-physician relationship with the patient receiving the prescription.