Ontario pharmacists have seen their practice scope grow since 2012 when they began administering flu shots, says Kimberly Stewart, vice president for commercial insurance at Hub. And these changes raise some issues around professional liability insurance.
The scope of pharmacists’ duties expanded to administering certain vaccines, then to providing COVID-19 testing during the pandemic, and then later to providing COVID-19 vaccines.
“Most recently, the scope of practice has expanded into minor ailment treatment, which began in October 2023,” she tells CU. Minor ailments in this newest expansion include urinary tract infections, pink eye and preventative Lyme disease treatments.
Coverage questions
The insurance program through the Ontario Pharmacists Association includes automatic expansion of scope to cover new risks as they emerge. It’s used the same carrier, Northbridge, since its inception in 2012.
In terms of insurance ramifications from scope creep, Liam Brown, Canadian healthcare and life sciences practice leader at Hub, says it’s important to understand healthcare and medical malpractice risks tend to be longer-tail exposures.
“There is both a delay in how quickly claims are reported, [and] in how long it takes for claims to actually be settled,” he says. “It might be many years down the road before you truly get to how [the insurance coverage] performed.”
From an underwriting perspective, insurers assumed claims would increase in frequency and severity once pharmacists began performing more, and riskier, services, he says. Most recently, he’s seeing rising claims related to vaccine administration, but stresses those increases are to be expected.
“As pharmacists start to treat different ailments…we may see notices of claims, but it’s far too early to say these are the results of every one of those claims, because they wouldn’t have closed as of yet,” Brown says.
Pharmacists understand their ability to treat more ailments brings additional exposure and risk, notes Stewart. But being licensed to practice in a Canadian province requires pharmacists to procure their own professional liability coverage.
Separate policies
Both Stewart and Brown say it’s important to understand that separate insurance solutions cover the pharmacist (the individual dispensing services) and the pharmacy (the business where services are provided).
Many pharmacies operate as part of some form of corporate conglomeration, which would provide coverage for bricks and mortar operations, says Brown. And the provincial insurance programs for pharmacists are portable, so they follow practitioners anywhere they work in Ontario.
What’s more, corporate conglomerates and pharmacy aggregators create their own programs to provide coverage to support employees. This can include programs for the pharmacists themselves, as well as aggregated medical malpractice coverage for the entities’ risks, says Brown.
“Larger entities are very well aware of the changing scope, and they are buying medical malpractice to cover off that broader exposure,” he adds.
In claims scenarios, both pharmacists and pharmacies are usually named, and the game changer on the medical malpractice side is people’s increasing tendency to sue.
“Lawyers and defence counsel are [inclined] to find multiple entities…and it is going to name the pharmacy as well as the pharmacist,” says Stewart. “Most individual pharmacist policies will not expand to cover an operating entity for defense or settlement.”
As for liability allocation, the pharmacist policy would respond on the pharmacist’s behalf and the pharmacy policy would respond for the business entity, adds Brown.
Canada’s scarcity of family physicians could exacerbate the risk.
“Thinking about the most recent expansion of services, you start to overlap with any other type of medical clinic…as [pharmacists] start building relationships with individual patients,” says Brown.
This story is excerpted from the December 2024-January 2025 print edition of Canadian Underwriter. Feature image by iStock/undefined undefined
