The Pharmacy Evolution: From Dispensing to Direct Care

Canada’s healthcare system is under significant strain, and pharmacies have stepped into an increasingly critical role. Once primarily places to pick up prescriptions, pharmacies may now serve as convenient mini clinics offering vaccinations, infusions, point of care testing, and medication reviews — expanding their operations and teams to meet rising patient needs.

According to Michael Brennan, Director – Healthcare & Life Science at CNA Canada, “Pharmacies are undergoing a fundamental shift from traditional dispensers to full spectrum care providers, and that shift naturally brings new exposures and responsibilities.”

As pharmacies take on more direct patient care duties, they face greater professional malpractice exposure and heightened vicarious liability. In this evolving environment, brokers can support pharmacy clients by identifying blind spots, reviewing insurance coverage, and helping strengthen operational processes.

Key Risk Considerations for Today’s Pharmacies

Off label Prescribing and Dosing:

Health Canada maintains clear definitions and regulatory frameworks for authorized drug uses through its Drug Product Database, which outlines approved indications, dosage guidelines, product monographs, and safety updates. However, label  prescribing, while legal and sometimes clinically necessary, carries increased uncertainty. The Institute for Safe Medication Practices (ISMP Canada) notes that off-label  use may involve limited evidence, creating heightened risk for dosing errors and adverse reactions.

“Off-label prescribing itself isn’t inherently unsafe, but the gray areas create heightened legal scrutiny and greater potential for dosing errors or reduced treatment effectiveness,” says Michael. “For brokers, this is an opportunity to help pharmacies review their malpractice coverage, ensure entity-level protections account for off label counselling risks, and reinforce the importance of standardized documentation protocols.”

Pharmacists are advised to conduct thorough script reviews and provide, and document, effective patient counseling, particularly when medications are used off-label.

Scope of Practice Violations

Scope of practice issues occur when staff perform tasks they are not authorized to do. Pharmacies must understand and operate within provincial regulations and refer patients to appropriate healthcare professionals when needed.

The Canadian Pharmacists Association (CPhA) outlines which jurisdictions allow pharmacists to prescribe for minor ailments, administer injections, renew prescriptions, or order lab tests — each governed by distinct regulatory boundaries.

Michael emphasizes, “Clear delineation of staff responsibilities is essential — even well-intentioned overstepping can expose a pharmacy to significant liability. Brokers can support pharmacy clients by helping them understand how regulatory differences across provinces affect liability, ensuring coverage aligns with permitted activities in the jurisdiction, and recommending clarity in job descriptions and delegation policies.”

Staffing Shortages

Financial pressures, expanding clinical duties, and increased demand have resulted in staffing shortages. This can strain operations and elevate error risk.

“When teams are stretched thin, error rates rise — and so does liability,” explains Michael. “There are operational mitigation steps that pharmacies can implement that don’t rely on increased headcount, such as:

• Implementing workflow audits to identify inefficiencies
• Using technology-enabled dispensing checks
• Introducing mandatory doublechecks at high risk steps
• Prioritizing task delegation based on certification levels
• Enhancing staff training on cognitive load and fatigue management”

These operational safeguards not only reduce error frequency but can also strengthen the pharmacy’s risk profile from an underwriting perspective.

Inadequate Documentation

As pharmacies take on more direct care, documentation becomes critical. Missing or inconsistent records can significantly weaken legal defenses.

Michael explains, “Even when the right clinical decisions are made, weak documentation can undermine a defense. Good records protect both the patient and the pharmacy. Brokers can guide clients to implement standardized electronic documentation templates, ensuring consistency that helps support defensibility in the event of a claim.”

Best Practices to Mitigate Risk

Across all these risk areas, certain foundational practices can significantly reduce exposure. Key mitigation strategies include:

• Licensing and Training: Before offering vaccinations or infusions, pharmacies must ensure all staff are properly licensed and trained to administer treatments, screen conditions, document informed consent, and manage complications.
• Medication Management: Clear, standardized prescription handling protocols — including secure storage and dispensing accuracy — are key to patient safety and risk reduction.
• Good Documentation: Staff should obtain full patient histories, maintain consistent records, document all interactions, and update information regularly.
• Workplace Safety: Pharmacies must implement safeguards related to hazardous substances, sharps disposal, infection control, and emergency procedures.

At CNA, we work with brokers to perform comprehensive coverage reviews, identify gaps, and support clients as they adapt to their expanded roles.

As Michael puts it, “Effective risk mitigation is a partnership — pharmacies, brokers, and underwriters working together to enable safe, trusted patient care.”

For brokers, understanding these emerging exposures positions you to better advise pharmacy clients as their clinical roles evolve and to differentiate your expertise in a rapidly changing healthcare environment.