Prescription Extension by pharmacists

Pharmacists can make a decision to extend certain prescriptions written for six months for up to a maximum of 12 months, if, in their professional judgement, they consider it safe and appropriate to do so.   

It is worth noting a pharmacist does not need to extend up to the maximum of 12 months.  The period of extension can be less than this if it is considered to be more appropriate for the patient.   

Pharmacists may also decide that following consultation with the patient or representative, that extension of a prescription may not be suitable and they may refuse the request for extension. It is still important that records are kept following this consultation.   

Further information can be found in the Guidelines to Support Medicines Therapy Review Counselling and Prescription Extension.  

No, pharmacists have been given authority to extend certain prescriptions up to 12 months if they were originally written for 6 months. Therefore, prescriptions written for periods shorter than 6 months would not be suitable for extension.   

Extending prescriptions is intended for those patients with chronic conditions. Pharmacists should use their professional judgement in reviewing a prescription to assess if the medication is for a chronic condition to decide if it is suitable for extension. 

No. Temporary provisions introduced during COVID-19 that extended the validity of prescriptions from six to nine months and enabled pharmacists to make additional supplies of prescription-only medicines to patients from an existing prescription have been revoked since 1 September 2024.   

Pharmacists can only extend a prescription under the new legislative provisions and in line with the relevant criteria outlined in PSI Guidelines to Support Medicine Therapy Review, Counselling and Prescription Extension. 

There is no specific list of medicines suitable for extension.  However, extension of prescriptions for Controlled Drugs specified in Schedule 2, 3 or 4 to the Misuse of Drugs Regulations 2017 (S.I. No. 173 of 2017) is not permitted.   

Other medicinal products may be excluded for patient safety or operational and reimbursement reasons. The HSE Primary Care Reimbursement Service (PCRS) released a circular on Phase 1 recommendation of the Expert Taskforce.  This highlights the medicines which would not be suitable for extension by pharmacists.  These include High Tech medicines and HIV Pre- Exposure Prophylaxis (PrEP) products.   It is important that pharmacists remain up to date with any such exclusions that may be added to this list over time.   

As referenced in the above circular, it is permissible for hospital clinicians to prescribe up to 12 months of a High-Tech medicine. 

No, extension of prescriptions for Controlled Drugs specified in Schedule 2, 3 or 4 to the Misuse of Drugs Regulations 2017 (S.I. No. 173 of 2017) is not permitted.

A pharmacist should refer a patient to a doctor rather than extending a prescription under the following circumstances:   

• The medicine is not suitable for extension, for example it is a controlled drug.   
• The prescriber has written on the prescription ‘do not extend’.
• The pharmacist, in their professional judgement, does not consider it safe or appropriate to extend the prescription.   
• Following the consultation with the patient or representative the pharmacist decides that a review with the original prescriber or another relevant primary healthcare provider may be required or is the more appropriate course of action.  

There is a defined criteria set out in legislation which must be met when judging if a prescription should be extended for a patient. These criteria include communication with the patient or their representative, consideration of the suitability of the medication, record keeping of the decision to extend, and notification to the original prescriber. Pharmacists should use their professional judgement from the information gained in the criteria above when considering if a medicine is suitable for extension or not.   

Some medicines will need regular monitoring. Specific monitoring requirements for each medication can be found in the Summary of Product Characteristics (SPC) of that medication. The HSE Primary Care Reimbursement Service (PCRS) released a circular highlighting some medicines which are not suitable for extension such as High-tech medicines and HIV Pre- Exposure Prophylaxis (PrEP).

Antimicrobial stewardship (AMS) is an important consideration for a pharmacist when considering whether to extend a prescription. In the majority of circumstances antimicrobials are prescribed for one off supply and would not usually be suitable for extension. Some patients are prescribed a prophylactic antibiotic for certain conditions which may be long-term. Pharmacists should use their professional judgement in these circumstances and consider the needs of the patient along with antimicrobial resistance when it comes to deciding if the medicine is suitable for extension. 

Yes, in keeping with the Code of Conduct, if a pharmacist feels it is in the best interest of the patient that a medicine is not dispensed, then they should communicate this to the patient and contact the patient’s prescriber as appropriate. This is something that should already be standard practice for pharmacists as part of the clinical review of a prescription and does not relate specifically to prescription extension.

Pharmacists should use the information available to them when making a decision about extending a prescription. This includes reviewing the patient’s medication history available in the pharmacy. It will also involve a discussion with the patient about their medication and condition.     

The pharmacist should consider information gathered and use their professional judgement to consider if it is safe and Guidelines to Support Medicine Therapy Review, Counselling and Prescription Extension | PSI (thepsi.ie) in the patient’s best interest to extend the prescription, or if referral back to the prescriber is the more appropriate course of action. 

Monitoring requirements for specific medicines can be found in the Summary of Product Characteristics (SPC) of the medicine.  Pharmacists should also consult and be familiar with relevant guidance and best practice in the management and monitoring of certain conditions, such as those set out in the HSE National Clinical Programmes.   

The PSI has produced principle-based guidelines to help pharmacists in their decision making, and to support compliance with the legislation.     

The IIOP offers a range of information and resources for pharmacists on prescription extension.

No, the role of the pharmacist remains the same regardless of the period for which the prescription has been written.  At each dispensing the pharmacist should continue to carry out a clinical check to ensure the prescription remains suitable for the patient. 

There are defined criteria which must be met when a pharmacist is determining if a prescription is suitable for extension. These criteria include communication with the patient or their representative, consideration of the suitability of the medication, record keeping of the decision to extend, and notification to the original prescriber. It is also important that pharmacists ensure they are adhering to the Code of Conduct and applying professional judgement when considering whether to extend the validity of prescriptions. 

A pharmacist should have access to the patient’s medication record held within the pharmacy which will detail previous dispensing of medication and any changes to medication in the past. The pharmacist should be able to use this as well as having a consultation with the patient to decide if a medication is suitable for extension or not,  If a pharmacist judges that in their professional opinion, they need more information such as blood test results then they should communicate this clearly to the patient as the reason they cannot extend and make notes in the patient’s medical record of the same interaction. 

Pharmacists should ensure that they are working within their clinical competence as per the Code of Conduct in delivering services. If a pharmacist believes a test such as a blood pressure check would assist in the consultation on whether to extend a prescription and they are clinically competent to do so, then provided they have consent from the patient they can complete the test and record the results. A pharmacist, in exercising their professional judgement, may consider it appropriate to communicate the results of such tests to the original prescriber when communicating the decision to extend. 

Those in governance roles have a responsibility to ensure that services offered are appropriately resourced. Further information is set out in the PSI Guidance on Pharmacy Governance Roles. Risk should be appropriately managed, and procedures should be developed to support the pharmacy in delivering safe, quality pharmacy services and patient-centred care. 

Consultation lengths will differ depending on a range of factors including the type and number of medicine(s) the patient would like to be extended. A pharmacist should ensure during the consultation they have enough information that they need to make a decision.

It is ultimately the choice of the pharmacist when deciding to extend a prescription or not.   

All pharmacies in Ireland are required to hold professional indemnity insurance cover as part of the pharmacy’s registration requirements. Pharmacy owners are advised to clarify the status of their indemnity cover and pharmacists should be clear about the cover in place in each pharmacy where they practice.

Pharmacists use their professional judgement and clinical expertise in their everyday practice, while observing the Code of Conduct, relevant legislation, practice standards and guidance. This may involve balancing different responsibilities and priorities. Pharmacists are personally accountable for their actions and must be in a position to justify any decision made. While the PSI will consider complaints relating to ‘professional misconduct’, this does not include an act, omission or pattern of conduct that consists of a, wrongly formed, but honestly formed, professional judgment.  You can read more about the complaints which the PSI consider. 

The Expert Taskforce and PSI are aware of and acknowledge this potential issue.    

One of the recommendations of the Expert Taskforce is that operational supports and infrastructure should be facilitated to evolve to reduce any undue administrative burden, optimise communication, and facilitate reporting and feedback between professions.    

The Department of Health and HSE are working collaboratively to improve digital health infrastructure across the health system, including for pharmacy. It is expected that these changes will introduce significant efficiencies and improve information sharing and access for those involved in the care of patients. 

The Expert Taskforce has recommended to the Department of Health that operational supports and infrastructure should be facilitated to evolve to reduce any undue administrative burden, optimise communication, and facilitate reporting and feedback between professions.    

It is important however that appropriate records are maintained for patients who have had their prescription extended and for this decision to be communicated to the original prescriber.  It is also important for the decision to be recorded where a pharmacist, in their professional judgement, does not consider it appropriate to extend a prescription.  

Yes, a pharmacist is required to notify the prescriber within seven days following a decision to extend. 

No, you are not required to undertake specific training to extend a prescription. The PSI has engaged on the development of appropriate training and supports for pharmacists. Information about the available supports is provided on the IIOP website. 

The PSI has developed guidelines to support pharmacists with prescription extension. The guidelines offer a principle-based framework to give flexibility with implementation in practice. They detail key responsibilities of all pharmacists, including those in governance roles, regarding medicine therapy review, counselling and prescription extension.  

In addition to the guidelines, a number of other supports are available through the IIOP for pharmacists including webinars and online workshops on prescription extension.  These provide further support to pharmacists in practice. The IIOP will provide updates and information via email and through their website about these supports. 

An appropriate risk assessment should be carried out by pharmacists, including those in governance roles, for every service that they are offering patients. It is important that pharmacies have robust governance arrangements in place to support delivery of prescription extension within the pharmacy. Managing risk and commitment to continuous improvement is one of the principles in PSI Guidance on Pharmacy Governance Roles.     

A subgroup of the Expert Taskforce was established to focus on the implementation of the first recommendation of the Taskforce. The subgroup included representatives from the PSI, the Medical Council, Nursing and Midwifery Board of Ireland, the Dental Council and the HSE PCRS. Communication activity was a key consideration of this group.   

A dedicated webpage for patients and the public was created by the Department of Health that includes example scenarios for patients. The PSI has also created a dedicated webpage for patients and the public. We will continue to work with the Department of Health and other key stakeholders as part of our role in supporting the Expert Taskforce and commitment to expanding the scope of practice for pharmacists. 

It is important that a pharmacist records information from the consultation with the patient and the reason(s) for extension. This can then be communicated to the prescriber to explain the rationale for extension, if needed.  Pharmacists and prescribers should decide collaboratively what the appropriate course of action should be, ensuring that they are always acting in the patient’s best interest. 

It is important for pharmacists to explain to a patient why in their opinion as a healthcare professional they do not think it is safe or appropriate to extend a prescription and to direct the patient to the most appropriate next step, for example, to see their doctor for a check-up.  

• Information for patients is available on the PSI website and a dedicated page with scenarios on the Department of Health website explains some of the reasons why a prescription may not be extended. Pharmacists may direct patients to these sites if appropriate.   

The PSI supported the Expert Taskforce through its work. The PSI Registrar & Chief Officer, Joanne Kissane, was a member of the Expert Taskforce, and the PSI was also represented on a Taskforce subgroup focused on implementation of prescription extension. 

We also engaged with several key stakeholders on the safe implementation of the first recommendation. In December 2023, we ran a workshop with pharmacists to explore the regulatory tools, supports and information, such as guidance, that may be needed to support pharmacists in their decision-making when extending prescriptions for patients. We  met with the IIOP and IPU to discuss the implementation of the recommendation, including resources to support pharmacists.  

We have developed updated guidelines to support pharmacists with the safe implementation of the first recommendation. The IIOP also have dedicated supports on their website in relation to the Expert Taskforce, including training resources to support with implementation of the recommendations.