Pharmacists’ role in the direct oral anticoagulant dilemma

As a pharmacist working with a family health team, I want to commend Dr Wohlgemut on this well written article “The ‘direct’ dilemma. Oral anticoagulants and the parameters of public prescribing,” which was published in the November issue of Canadian Family Physician.¹ This is a common issue I see in practice, and I appreciate how he has outlined the dilemma.

I would add that pharmacists in the community can act as medication stewards, and can be in the position of reviewing “limited-use” criteria for coverage eligibility. I also present these 2 issues:

• Should a pharmacist refuse to bill a prescription to Ontario Drug Benefits if he or she knows the limited-use code is not appropriate?

• Should a family physician refilling a direct oral anticoagulant prescription originally authorized by a cardiologist with a limited-use code feel obligated to put the code on the refill prescription, even if the patient does not fulfil criteria?

I raise these issues because different professionals within the patient’s circle of care might have different approaches and possibly provide inconsistent messaging to patients.

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