Burning questions on Zostavax • Meet the new Minister of Health • Electronic prescription signatures
published by the British Columbia Pharmacy Association | www.bcpharmacy.ca | Volume 22. No. 4
The next generation of pharmacy Community pharmacy residency program Tips & tricks for a first time flu clinic BCPhA members receive pharmacy preceptor awards
BCPhA eTraining is launching in September! Another new member benefit.
Log in from a computer or a tablet
Win an iPad mini!
• Quiz questions
• PowerPoint with voiceovers • Interactive elements
To launch this brand new eTraining member benefit, we will be giving away an iPad mini!* Please visit our eTraining page on our website for more details.
First eTraining module: Expanded Access to Publicly Funded Vaccines
www.bcpharmacy.ca/etraining *More details regarding the iPad mini prize draw available at www.bcpharmacy.ca/etraining.
2013 | VOLUME 22. NO. 4
contents Editor-in-Chief Kathie Taylor 604.269.2863, email@example.com
16 on the cover
5 Hon. Dr. Terry Lake
Senior Editor Elise Riedlinger 604.269.2866, firstname.lastname@example.org Advertising Sales Shannon Ward, OnTrack Media 604.639.7763, email@example.com The Tablet is published by the BCPhA. Views expressed herein do not necessarily reflect those of the Association. Contributed material is not guaranteed space and may be edited for brevity, clarity and content. BCPhA offices: #1530-1200 West 73rd Avenue Vancouver, BC V6P 6G5 telephone: 604.261.2092 or toll-free in bc: 1.800.663.2840 fax: 604.261.2097 toll-free fax: 1.877.672.2211 e-mail: firstname.lastname@example.org web: www.bcpharmacy.ca Pharmassist: 1.800.667.2190 For confidential counselling referral for employment or addiction related assistance
13 electronic signatures
Publication agreement #40810576
Cover Photo: Community pharmacy resident Khushminder Rai created a new vaccine consent form for her first flu clinic. Above: Rai shares the vaccine consent form with pharmacist Prabhjot Gill.
Meet the Minister Hon. Dr. Terry Lake
President’s Message Improving our practice
DPIC Burning questions on Zostavax
Affinity Rx One year later
CEO’s Message No easy answers
Government Relations Update Opportunities for pharmacy to do more
Electronic prescription signatures Is that signature an original?
Professional Services Stakeholder engagement
Financial Trends Beware of bonds
BCPhA Board of Directors The new Board for 2013/14
Member Services Money saved is money earned
Career Listings Find a job in pharmacy
Cover Article: The next generation of pharmacy Pharmacy preceptor awards
Got a suggestion for an article in The Tablet? Email email@example.com with your story ideas.
In the news Canadian Pharmacists Journal (CPJ) Best Paper of the Year Congratulations to BCPhA member Dr. Carlo Marra, who along with Dr. Larry Lynd recently received the CPJ Best Paper of the Year Award for 2012. This award is given annually by the CPJ Editorial Advisory Board to the manuscript judged most likely to positively impact pharmacy practice. Lead authors, Marra and Lynd, from the Collaboration for Outcomes Research and Evaluation and the UBC Faculty of Pharmaceutical
Sciences, and co-authors Dr. Kelly Grindrod, Pamela Joshi and Alana Isakovic, published the paper “Evaluating the labour costs associated with pharmacy adaptation services in British Columbia,” in the March/April 2012 issue of CPJ.
improved health outcomes and health care sustainability. The Professorship will include such innovative techniques as developing the first ever “living laboratory” where practicing pharmacists will learn new skills in working with patients on adherence issues.
UBC announces Professorship in Medication Adherence
De Vera began her new role on July 1.
The UBC Faculty of Pharmaceutical Sciences and AbbVie announced the appointment of Dr. Mary De Vera as assistant professor, recipient of the Professorship in Medication Adherence with the Faculty of Pharmaceutical Sciences. The objective of the Professorship is to conduct research and share knowledge and best practices on medication adherence and its connection to
Saskatchewan launches new medication program Saskatchewan Health and the Pharmacists Association of Saskatchewan have officially launched the Saskatchewan Medication Assessment Program. As of July 8, the newly restructured program provides pharmacy services to beneficiaries of the provincial drug plan who are age 65 and over and on five or more chronic medications, or other eligibility criteria. The program is aimed at providing safe and effective medication therapy to seniors living in the community by preventing medication issues, emergency room visits and hospitalizations, reducing medication duplication and wastage and assisting in cost-effective medication administration.
MEET THE MINISTER
Meet…Hon. Dr. Terry Lake
Honourable Dr. Terry Lake was appointed BC’s Minister of Health in June of this year, following his re-election as MLA for the riding of Kamloops-North Thompson. First elected as MLA in 2009, Lake has served as Minister of Environment, Parliamentary Secretary for Health Promotion to the Minister of Health Services and Parliamentary Secretary for the Ranching Task Force to the Minister of Agriculture and Lands. A veterinarian and faculty member at Thompson Rivers University, Lake served as the mayor of Kamloops from 2005 to 2008 and as a city councillor from 2002 to 2005. Community service has long been a part of Lake’s life, and he and his family continue to work in Sri Lanka to rebuild infrastructure and assist with stray animal control efforts.
What are you most looking forward to as Minister of Health?
Which words or phrases do you most overuse?
To continue improving outcomes while ensuring the system is financially sustainable.
“You know.” What is your most marked characteristic?
Why did you want to enter politics?
Probably determination but some might say stubbornness.
Like most, to make a difference and because it’s (usually) fun.
What do you most value in your colleagues?
What do you consider your greatest achievement?
A sense of humor.
My three daughters but I think my wife would take credit for them.
Nick Hornby and Will Ferguson.
Who are your favorite writers?
What is your idea of perfect happiness?
What is your motto?
Nearing the end of a long run with my dog and thinking about a cold beer.
Just make a start and it gets easier.
Which talent would you most like to have? I wish I could play a musical instrument.
If you could deliver just one message to the pharmacists of BC, what would it be? You are an essential part of a great health care system and can help to make it even better.
Lake and his wife Lisa have three daughters, a dog and a cat.
RALPH LAI | PRESIDENT
Improving our practice
Wow, it’s been a fast paced year for
me as president of the BCPhA – and definitely another year of quantum changes. I was looking towards a “fun” year. That sure didn’t happened with the various issues and financial hits community pharmacy faced. Uncertainty, fear and stress are more in the minds of community pharmacy decision-makers and pharmacists than ever before. Hopefully, we will get the critical mass needed to establish our profession solidly as an important part of primary care, and I believe our advocacy efforts have helped move us in that direction. Now that the BC election is over and we have certainty on who will govern us for the next four years, we will re-launch our efforts to partner with government and stakeholders to move our profession forward with financial stability. We will continue to present and educate politicians and bureaucrats on our clinical services proposals. Our inclusion in the health services, rather than just the drug, budget is important for us to be successful in our patient care services. As provincial governments are aggressively controlling the cost of drugs (a distributive function), our clinical services (which are not about distribution of drugs) must not be lumped with the PharmaCare budget. We need to make government decision-makers and their staff aware of the ideal place for our clinical services budget. From a practical and operational point of view, I would like to share one of my thoughts. When we use health services from the various institutions (blood tests, CT scans, hospital services, etc.), we have to present our BC Services Card or CareCard and a photo ID. We should look at the feasibility of having this procedure a routine part of our pharmacy practice.
Our College bylaws support this but current practice seldom requires us to ID each patient. If we were able to have pharmacy software companies include a scanner or RFID reader with our computers, we could easily scan the CareCard to identify the patient in our file. If the patient is new, the scan will self-populate the patient file leading to time savings on data entry and more accurate prescription fills. The cost of scanners is minimal (under $100) but the time savings over the thousands of prescriptions we have to data input will more than pay for itself. For this to work, we must take out any competitive advantage any community pharmacy may try to get by requiring all pharmacies to ask for CareCard ID when the patient is presenting their prescriptions. (Prescription refill orders will not require this as the patient information is already on file.) This will require re-training of our patients and support from government to make this mandatory. I think our government will accept this as we are properly identifying the patient and perhaps preventing some of the fraud cases. I want us to start thinking of ways to improve our practice (operationally and expansion of scope) that will help us (time savings), the patient (more accurate prescription fills) and the government (cost savings and in this case potential fraud savings) so we can move towards a sustainable, efficient and professional model. Your comments are welcome. Thank you for allowing me to be president of the BCPhA. I have gained new insights and knowledge on our profession and I am glad to have been given the opportunity to be on the Board and serve as your president for this past year.
GERALDINE VANCE | CEO
No easy answers
When I joined the BCPhA
in 2012 I heard much talk about New Zealand. British Columbia policy makers and academics often pointed to New Zealand as the place that managed to get runaway drug costs under control by the simple act of tendering generic drugs. So I did a little digging. My instinct was that it couldn’t be this simple, that there must be more to the New Zealand “success story” than just pushing around generic manufacturers. And my instinct was right.
can prescribe for certain patients or illnesses. The range of medications available to patients is severely restricted. The New Zealand PHARMAC program is driven by cost management. Not best care, not overall costs to the health care system, but cost containment of a single budget line in the health care budget: prescription drug costs. Some would say that’s not all bad. But if cost management gets in the way of patient-focused care, I think that is a real problem.
“There is no dispute New Zealand has saved billions of dollars on its public drug plan … but it got there by imposing restrictions on patients, physicians and pharmacists …”
Some months ago I was connected with New Zealand pharmacist David Mitchell. He had a key role in negotiating the 2012 agreement between community pharmacy and the New Zealand government, and has been involved in the country’s publicly funded medications program for more than 20 years.
Through various discussions, including having David speak at the BCPhA Annual Conference held in Kelowna this past May, it has become clear that the “secret” to New Zealand’s pharmaceutical cost containment is the result of a multi-pronged strategy of restrictions. There is no dispute that New Zealand has saved billions of dollars on its public drug plan over the last decade. But it got there by imposing restrictions on patients, physicians and pharmacists that I think most British Columbians would find unacceptable. The key to New Zealand’s success in saving money has been limiting choice both for physicians and patients. Physicians are restricted in terms of which medications they can prescribe for particular diseases, as well as how much medication they
In BC we know a significant contributor to the increase in our PharmaCare budget is a growth in the volume of prescriptions written – in other words, not the cost of individual drugs but the total volume of drugs consumed. New Zealand is also finding this to be the case. Much like our province, New Zealand has an aging population and they are prescribed the majority of medications - around 80 per cent of prescriptions are for people over the age of 50. Many patients in this age group are taking multiple medications over extended periods of time to manage their chronic conditions. Studies in New Zealand have determined that 50 per cent of people with long term conditions, such as heart disease, are not taking their medications properly, and there’s an increased realization that medication non-compliance comes at a great cost. continued on page 20
PARKASH RAGSDALE | DIRECTOR, PROFESSIONAL SERVICES
Stakeholder engagement – flu to PharmaNet to FNHA
Preparation for another flu season
has been underway for a while now. The private vaccine supply has been ordered and the public supply will be available soon. Our administration of injections training workshops continue to sell out, and we are delighted to report that 86 per cent of community pharmacies in BC now have at least one authorized pharmacist available to administer injections. In preparation for the 2013/14 flu season, we’ve updated the injection resource guide and will soon have a new Administration of Injections Policy and Procedures Manual for members. Other publicly funded vaccines such as flu, pneumococcal and HPV (Cervarix®) vaccines, as well as Td (tetanus diphtheria) and MMR (measles, mumps, rubella) can now be ordered by authorized pharmacists by specific request from their local health unit. Certain vaccines are available in restricted amounts as public health units learn about patient demand at their community pharmacies. An overview of pharmacists’ expanded access to vaccines was the focus of a presentation at the annual conference, and will soon be available as an eTraining tutorial (see the inside front cover for more details). Along with the tutorial on the website, you will also find resources such as the injection resource guide, expanded access implementation guidelines and links to health authority specific resources. Log into the members’ side of bcpharmacy.ca and go to Professional Resources. More than half of the purchased supply of publicly funded Cervarix® for the one-time catch up program launched in April 2012 is still available. As a result, the BC Immunization Committee decided that the eligibility criteria should be expanded and, effective immediately: Women <26 years of age at the time of series commencement and born before 1994 should be offered Cervarix® if unimmunized against HPV. This is a one-time program which started in April 2012 and will continue until available vaccine has expired (August 2015).
For more information go to immunizebc.ca, and click on Health Professionals/HPV Vaccine. We have been at the table with the Pharmaceutical Services Division to mitigate the impact of the recent PharmaNet service interruption on community pharmacies. This was to allow for the enhanced PharmaNet 2.0, which will: • Upgrade the PharmaNet infrastructure • Integrate PharmaNet with other Provincial Electronic Health Record components • M ake it possible for community-based medical practices to connect to PharmaNet • M ove PharmaNet to new servers that can handle the anticipated increases in network traffic. The enhancement was a success and a big thanks to all of you who managed the situation with patients during the PharmaNet downtime in your pharmacies. We’ve had an introductory meeting with John Mah, vice president of health benefits for the newly-formed First Nations Health Authority (FNHA). The FNHA is the first and only provincial First Nations Health Authority in Canada. It is poised to take over administration of federal health programs and services currently delivered by Health Canada’s First Nations Inuit Health Branch – Pacific Region, and address service gaps through new partnerships, closer collaboration, and health systems innovation. For the first two years, FNHA will “buy back” services from NIHB. There will be no immediate impact on pharmacy claims adjudication. We’ll work with our members to provide the support needed during the flu season, with PharmaNet and the FHNA, and in other practice areas. Always a pleasure to serve our members.
CYRIL LOPEZ | CHIEF OPERATING OFFICER
Money saved is money earned
The BCPhA’s Member Benefits Program
is designed to provide a return on your membership fees. The more you use the program, the more money you save. Professional training and events assist in growing your practice scope as well as financial top line, whether you practice in an independent pharmacy or one that is part of a chain. For example, the administration of injections training is priced at $400 – below cost after overheads. The annual conference is also priced at $400, one of the lowest in the country. These offerings also help offset the Association’s fixed costs and allow us to retain Pharmacist memberships at $400. Another valuable benefit is the Job Board, in The Tablet and online. This recruitment tool is free to Pharmacy members, who have the satisfaction of knowing they are reaching the target audience at no additional cost. The Pharmassist program supports you in difficult times, whether employment-related or emotional or traumatic incidents. The service is completely confidential.
access this program. Remember: the quality of the insurer is not in the premium level, but in the claims-paid record. We also help you plan your financial future with our Wealth Management advisers from RBC and the Financial Literacy Counsel Inc. You will find that the time it takes to connect with them is more than worth the value of a second opinion and fresh perspective. Another benefit is the Affinity Rx program, bringing you savings to fit every season and lifestyle. The Telus Mobility plan alone is worth an annual savings of $180. But you can also save $30 on Cineplex 10-packs, up to $180 for a pair of Canucks tickets, $45 on a hotel booking, $48 on a pair of Whitecaps tickets, $12 for a pair of PNE tickets, and $50 on a Lexicomp subscription or $52 on a Canadian Pharmacist’s Letter. Every year that you pay $400 for a Pharmacist (General) membership, of which malpractice coverage is $125, you get access to a cash savings of almost $600! Currently, the annual savings going directly in the pockets of members using these benefits is more than $100,000.
All of these benefits plus the value of being part of an Association that is supporting and advancing the professional role and economic viability The Professional Liability coverage included in your membership is of its members! designed to allow you to practice your profession without hindrance. It covers you across Canada, irrespective of practice site or employer, Thank you for being a member and I invite you to sample the benefits includes social settings and most importantly, is an occurrence-based your Association offers. progroup_ad_v3.ai 13/11/2008 4:23:24 PM policy. That means you are covered even after you retire or end your membership, as long as the policy was in place when the adverse event occurred. We believe an occurrence-based policy is a superior risk management tool for practitioners, rather than a claims-based policy that is often at a lower premium. C
Our Insurance program for stores and homes will compete with, if not prove to be superior to, any other product on the market. Many independent owners have become Pharmacy members to
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DRUG AND POISON INFORMATION CENTRE
Answers to some of your ® burning questions on Zostavax by Beverly Louis, B.Sc. (Pharm) and Dorothy Li, B.Sc. (Pharm)
Herpes zoster (HZ) or shingles
is an infection appearing as a vesicular rash along a single dermatome after reactivation of the varicella zoster virus in those who have had clinical or subclinical chicken pox.1-4 The rash is preceded one to five days by a prodrome that may include malaise, headache, photophobia, fever and abnormal dermal sensations ranging from minor tingling and itching to severe pain.1,3 The vesicles typically crust and heal within two to four weeks.3,4 The moderate to severe pain of shingles can be complicated by postherpetic neuralgia (PHN) and herpes zoster ophthalmicus (HZO), which can result in scleritis, uveitis, chronic eye disease or blindness.2,4 The risk of having shingles is estimated to be around 33 per cent, although the number of cases has been observed to be steadily increasing in patients over 40 years of age. PHN results from nerve damage from varicella zoster viral replication and may include allodynia, hyperpathia or dysesthesia.3,4 Symptoms may be intense and interfere with sleep and other normal daily activities. PHN may last for one to more than six months after lesions have healed and become chronic in 30 per cent of cases.3 In 2006, Zostavax® (Zoster vaccine live, attenuated) was approved for the prevention of shingles in patients after the Shingles Prevention Study found that Zostavax® decreased the incidence of shingles by 51 per cent and PHN by 66.5 per cent.2.4 The remainder of this article will list answers to FAQs about Zostavax® received at DPIC from health care professionals. An expanded version of this article as well as Patient FAQs will be available in the “From the Drug Desk Newsletters” at www.dpic.org.
Health care professional FAQs 1. Should Zostavax® be administered subcutaneously to the deltoid or triceps area? The manufacturer of Zostavax® recommends subcutaneous administration in the deltoid area because this site was used in the Shingles Prevention Study.5-7 Administration into the triceps area should be as efficacious and is the recommended site of administration in BC for all subcutaneous vaccines.8 Advantages include ease of administration (looser skin for pinching) and consistent practice. 2. Is any spacing required between Zostavax® and pneumococcal vaccine (e.g., Pneumovax® 23)? The manufacturer of Zostavax® advises against simultaneous administration based on a randomized controlled trial showing lower varicella-zoster virus (VSV) antibody titres at four weeks.5,9 However, evidence fails to suggest that increased VSV antibody titres indicates protection.10,11 A subsequent large observational study found no difference in the rates of HZ between those vaccinated simultaneously versus >30 days separated.12 Concomitant administration appears to be effective and safe and may enhance vaccine take-up.9,12,13 3. Is any spacing required between Zostavax® and influenza vaccine? Inactivated vaccines (e.g., inactivated influenza vaccine) and live vaccines (e.g., Zostavax®) can usually be administered at the same time or at different times without change in effect.14-16 Live
influenza vaccine (intranasal) and Zostavax® can be administered simultaneously or separated by >28 days.
7. Can Zostavax® be given to a patient on methotrexate for rheumatoid arthritis?
4. Is Zostavax® contraindicated if a household contact is an infant, pregnant or immunocompromised?
Observational studies have shown a two-fold increased risk of development of HZ among patients with rheumatoid arthritis, suggesting that this patient population may benefit from immunization.23 However, live vaccines, e.g,. Zostavax®, are contraindicated in immunocompromised individuals due to risk of disease acquisition and a possible decreased efficacy.17,20 There are no published randomized controlled trials that investigated the safety and efficacy of Zostavax® in this patient population. In some subpopulations of rheumatoid arthritis patients, however, administration of Zostavax® may be considered. Based on expert opinion, the Canadian Rheumatology Association recommends that patients, who are >60 years of age with rheumatoid arthritis and who are on methotrexate <25 mg/week and/or prednisone <20 mg/ day, may receive Zostavax®.24 These recommendations are similar to those of the United States’ Advisory Committee on Immunization Practices.18
This is not a contraindication. If a varicella-like rash develops postvaccination, keep lesions covered and avoid direct contact with susceptible household members until the lesions are crusted over.10,17-19 5. Can Zostavax® and Valtrex® be given together? Since Zostavax® is a live vaccine, concurrent use with antiviral medications (e.g., acyclovir, famciclovir and valacyclovir) may decrease its efficacy. Delay Zostavax® until two days after administration of these antiviral agents. Ideally, antiviral therapy should be avoided for 14-28 days following administration of Zostavax®.13, 20, 21 6. What should you do if you accidently squirt Zostavax® in your eye? Immediately flush the eye with normal saline or water for 15 minutes.22 Seek medical attention for any persistent eye symptoms or signs of infection. The risk of HZ is probably very low since the vaccine is attenuated (weakened). Report the incident to your employer. Become familiar with where and how eye flushing should be performed at your work setting.
Pharmacists should refer all patients considered immunosuppressed to their primary care physician or their medical specialist. References available upon request; please contact the BCPhA Communications Team.
Affinity Rx celebrates its first year Since officially launching
A number of prizes were also given out to members through the program as lottery draws or contests promoted through the Affinity Rx monthly email, including VIP tickets to Canucks events, hotel night stays, PNE and Playland tickets, movie tickets, concert tickets and tickets to the Vancouver Whitecaps.
on June 1, 2012, BCPhA members have embraced the new Affinity Rx program, which offers exclusive and limited discounts, as well as value-added services. In the first 12 months of the program: • More than $100,000 in savings were passed on to our members
After only one year, Affinity Rx now has 16 partnering programs as well as discounts on hotels around the world. Our goal continues to be finding discounts that offer great value, are easy to access and can be shared with your friends and family.
• More than 1,000 members, as well as their friends and family, have taken advantage of Affinity Rx offers, including: – 3,600 movie tickets
Read on for a few highlights of members’ feedback on the program, and be sure to check out the outside back cover of this issue for the latest Affinity Rx offerings.
– 1,200 PNE and Playland tickets – 330 hotel nights booked at a discounted rate, and – 330 Telus Mobility smartphones and plans (offer started at the end of September)
“Everything went very smoothly with the hotel bookings. We arrived at both locations with no problems at check in. Thanks for having this service available to members.” - Amrik Ghag, Abbotsford “Buying a house for the first time was a huge and overwhelming concept for us. Ryan and Tiffinie [with The Mortgage Group] were two of the people who demystified most of our concerns. They were very patient with all our questions, and graciously accommodated our shifting schedule for discussions … We were very lucky to stumble over this great couple who made our first time home-buying a pleasant experience.” - B&M, Abbotsford “The [VIP Canucks] event was fantastic!! I really enjoyed myself and was lucky enough to get three autographs … Roberto Luongo, Andrew Alberts, and Maxim Lapierre! Everything was very interesting and a true once-in-a-lifetime experience! Thank you very much for everything again.” - Ashleigh Maxwell, North Vancouver
Welcome to the BCPhA! Pharmacist (General) Members: Michael Abdel Sayed, Doaa Abdelazeez, Jason Aggarwal, Olasoji Alakofa, Pranav Amin, Ammar Anjarwalla, Mohamed Awad, Bhupinder Bains, Kanwerjeet Bhanot, Jagdeep Birk, Lauren Bissonette, Noha Boules, Helen Nachor Cabiao, Erica Cahill, Jolene Cha, Judy Chang, Ann Chao, Brenda Chow, Kerry Christy, Winston Chung, Jessica Crowe, Helena Cui, Darrell Dixon, Christopher Dodge, Stefan Eberle, Bssam Elhendawy, Ahmed Elmaddah, Sharon Ertl, Nasreen Esmail, Tullio Esposito, Augusto Estrada, Arinze Ezeilo, Samer Hanna, Carol Hansen, Tyler Hanson, Christy He, Catherine Hebert, Katheryn Hendel, Nathan Howe, Jessica Huang, Peter Hui, Jui Chi Hung, Fatima Ibrahim, Yuk Wah Myra James, Esther Jeon, Joohee Jung, Calvinjit Kaila, Juliana Kan, Min Jeong Kang, Nader Khattab, Brian Kim, Deborah Kirkland, Eric Kosiuk, Vikin Koujian, Shirley Lam, Quintin Larson, Gilly Lau, Sheryl Lau, Buhwan Lee, Kenneth Lee, Mihae Lee, Luke LePage, Tracy Lim, Yi-te Liou, Zachary Luk, Erika Luko, Alicia Martin, Ian McDiarmid, Farvinnisa Micdhadhu, Ae Ra Moon, Kim Nguyen, Michelle Nguyen, Gregory Nikkel, Chidi Nwaogwugwu, Jaeyoung Park, Dhruvalkumar Patel, Maunil Patel, Sanjaykumar Patel, Graham Peacock, Jenny Phu, Vittoria Piga, Pardis Pournazari, Jaideep Puri, Ravinder Puri, David Ram, Rafik Ramadan, Gloria Reid, Tara Ricketts, Pierre Rizk, Roberta Rusk, Vyacheslav Shakhov, Leslie Shay, Enas Shehabel Din, Sami Sheikh, Ranjeet Shukla, Anne Sison, Erica Skopac, Rebecca Smith, Fatemeh Sadat Soleiman-Panah, Ari Song, Melita Szary, Selina Tang, Makoto Tokuhisa, Marija Topalovic, Jimmy (Ka Lam) Tsang, Kit Ying Florence Tse, Babylene Umali, Sabrina Vandesype, Alain Vincent, Vesna Vlacina-Ljepic, Lisa Wallace, Kristen Wanes, Candace Waung, Barbara Wolczak, Chun Hei Wong, Erica Wong, Kenneth Wong, Angela Wu, Bicong Wu, Winnie Ye, Catharina Yih, Jeein Yim, Sameh Younan, Xiao Yu Zhang, Zahra Zirak Pharmacy (Corporate) members: Cridge Family Pharmacy, HealthPlus Pharmacy, Medis Pharmacy, Northwest Telepharmacy Solutions, Peoples Drug Mart #128, Pharmasave #287 Sullivan Square
ELECTRONIC PRESCRIPTION SIGNATURES
Is that signature an original? Avid collectors know
the value of a book, document or autographed picture lies in the authenticity of the signature. The same holds true for prescriptions: the physician’s signature must be an original. Pharmacists in various parts of the province are reporting instances of doctors using electronic “signatures” on their prescription print outs and faxed prescriptions. However, these signatures appear to be an electronic scan of an actual signature stored in the software. Electronic signatures are not allowed unless they are an original electronic signature. Cut and pasted signatures are not allowed. The signature must be originally written each time. The CPBC states that: An electronic prescriber’s signature is only acceptable if the signature is unique. Health Canada considers a unique electronic signature to be equivalent to a paper-and-pen signature. It must be a fresh, new signature written on the prescription with an electronic pen pad, similar to signing a pen to paper prescription. It is an illegal electronic signature if it is cut and pasted into an electronic prescription. To ensure the signature is unique, the pharmacist should compare the signature each time with an old prescription. The signatures should be slightly different if they are unique, as is an original signature each time. If you don’t have an old signature with which to compare the current signature, please call the prescriber to determine if a new, original electronic signature is generated for each new prescription.
A computer-generated prescription that is given to the patient or faxed to the pharmacy must have an original prescriber’s signature or a unique electronic signature.
If a pharmacist has doubts about a physician’s signature, the onus is on the pharmacist to fax it back to the physician or return the prescription to the patient.
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BCPhA BOARD OF DIRECTORS
Meet the 2013-14 Board of Directors The BCPhA is governed by a Board of Directors, whose
mandate is to set, monitor and review the strategic goals and other policies of the Association. Each Director serves for a three-year term that begins on the first day of September of the year they were elected or appointed. Directors may only serve for two consecutive terms. Weâ€™re very pleased to introduce your new Board of Directors, effective September 1, 2013.
President: Don Cocar
Vice-President: David Pavan
Alex Dar Santos
ON THE COVER | THE NEXT GENERATION OF PHARMACY
Tips & tricks
for a first time flu clinic
It’s hard to believe it’s only been four years since pharmacists in BC were first granted the authority to administer injections. Since that time, more than 2,300 have become trained and authorized to provide immunizations, and more than 400,000 publicly funded vaccines have been administered by pharmacists! The latest generation of pharmacists is embracing this expanded scope of practice, and even leading the way with enthusiasm and new ideas. Khushminder Rai is a perfect example of this. After graduating from UBC with her B.Sc. (Pharm) in 2012 and becoming a member of the BCPhA, Rai decided she was ready for her next challenge. The one-year community pharmacy residency program offered by UBC intrigued her because it provides the opportunity to develop more advanced knowledge and skills in a community pharmacy setting. During her rotation at Howe Sound Pharmacy in Gibsons, Rai hosted her first influenza vaccine clinic in early November 2012 as the official start of flu season kicked off. “It can seem pretty daunting when you’re newly authorized to provide immunizations,” she said. “But I found that a little bit of preparation and pre-planning can go a long way in helping ensure a smooth clinic.”
Pharmacist Khushminder Rai holds up the vaccine consent form she created during her rotation at Howe Sound Pharmacy in Gibsons.
Starting a week before the clinic date, a number of videos related to influenza, the importance of immunizations and vaccine safety were played on the TV screen in the pharmacy’s patient waiting area. Posters were put up at the pick-up and drop-off counters, and pharmacy staff members
were asked to book 15-minute appointment slots per person, couple or family. Rai also found it useful to review the eligibility criteria for publicly funded flu vaccines with staff members and post the criteria in the pharmacy for patients to review on their own.
John Shaske, the pharmacy’s owner/ manager, was Khushminder’s preceptor and said it was an excellent experience working with her as a resident. “She’s got a great combination of organizational skills, intelligence, was adaptive in different situations, and kept the patient-focused activities all rolling.” In this case, a fresh set of eyes also meant some innovative ideas for the first flu clinic of the season.
Another idea Rai implemented was individual vaccine kits in small Ziploc bags, with each including a syringe, at least one safety needle, alcohol swabs, a cotton ball and band aid. “This helped ensure that we had all the supplies we needed for each client in one place,” said Rai. The kits were prepared beforehand and used during the clinic and for the rest of the flu season. A sharps container and a copy of the BC Healthlink influenza files were also available at each immunization station. A useful tip Rai suggests is to ensure the emergency/anaphylaxis kit is fully stocked with the required products and that staff members are aware of protocols and procedures to follow during an anaphylactic event. She created a checklist to ensure all the products were available and within their expiration dates. Overall, Rai said that her experience was a really positive and practical way of learning beyond the classroom. Shaske, who is often a preceptor for undergraduate pharmacy students as well, was very pleased with the forms Rai set up, including revamping the pharmacy’s medication management form. “I find that the newer grads are far more adept at patient-interview skills,” he said. “I often have even third and fourth year students working right out on the front line.
The BCPhA hosts community pharmacy residents In June 2013, Khushminder Rai and fellow community pharmacy resident Nicole Chiang completed a two-week rotation at the BCPhA’s office in Vancouver. Rai reviewed the Association’s Injections Resource Guide and provided input based on her recent experience as a newly authorized pharmacist operating a flu clinic at a community pharmacy. Chiang reviewed and provided input into an upcoming Methadone Maintenance Treatment Policy and Procedure Manual that will be available to members later this year. Both residents also attended a College of Pharmacists of BC board meeting with BCPhA deputy CEO and director of professional services Parkash Ragsdale, to better understand the role of the College in pharmacy practice in BC and how the BCPhA engages with the College.
“UBC’s doing a great job, both with teaching them patient skills at school – things we used to only learn hands-on at the job – and in placing students in pharmacies to match personalities.” He strongly recommends being a preceptor to other pharmacists, saying “I find that people really want to learn and it’s a very pleasurable experience.” Rai created a specific vaccine consent form to document the administration of influenza and other vaccines in a consistent manner. “It is always good to be mindful of the reporting requirements from your local health units,” she said. “The sample consent form has a place to ask for and document consent for release of this information as well.”
Shaske currently has a new third year student on rotation at Howe Sound Pharmacy, and also notes a pharmacy resident from back in 2009 recently called him for some advice. “He’s opening up his own pharmacy now and it’s very rewarding to hear.”
As for Rai, since completing the program in June 2013, she is looking forward to applying her newly learned skills in community practice and mentoring other students by being a preceptor. Her tips, checklists and forms are available in the updated BCPhA Immunization Resource Guide, posted on the members’ side of bcpharmacy.ca under Professional Resources – Additional Reference Materials.
ON THE COVER | PHARMACY PRECEPTORS
UBC honours preceptors with Practice Educator awards Four BCPhA members
Mackay, Boyce and Polachek are also alumni of the Faculty and long-time preceptors. While their locations of practice varies, each believes that precepting gives back to the profession and provides students with real world experience.
recently received Pharmacy Practice Educator awards from UBC’s Faculty of Pharmaceutical Sciences. The awards are presented to preceptors demonstrating outstanding dedication and commitment. Preceptors are nominated by their learners and awards are given in two categories, community and institutional, based on the area of practice.
All students complete 20 weeks of clerkships during their four years of the B.Sc. (Pharm) program, with a minimum of four different clerkships. Recently, UBC has also started training fourth year students in their last semester on leadership skills, so they too can be preceptors in the near future.
Michael Lam, pharmacist/owner at Shoppers Drug Mart in Burnaby and Duncan Mackay, pharmacy manager at Peoples Drug Mart in Salmo, received the Advanced Pharmacy Practice Experience (APPE) Community Award.
Preceptors/pharmacies are best-matched to the different levels of clerkship, the first of which focuses on technical functions, regulations and professional practice, followed by an introduction into patient care. The last two clerkships focus on direct patient care.
Marilynn Boyce, pharmacy manager at Shoppers Drug Mart in Victoria, and Paul Polachek, a clinical pharmacist with Fraser Health Authority, received the APPE Institutional Award. “Being a preceptor is rewarding, because for as much as I’m teaching the students, I’m learning a lot as well,” said Lam, who has been a preceptor for more than 10 years. “Precepting should be a two-way street of communication and education. Both parties become the better for it.”
“The Faculty values its preceptors immensely,” said Dr. Angela Kim-Sing, lecturer and director, Office of Experiential Education (OEE). “Our preceptors offer an incredible resource to their learners. They teach,
coach, mentor, role model, provide feedback and evaluate students. Without their dedication and commitment, we would not be able to offer the practicums that our students need to develop essential patient care skills.” She notes that with more than 500 preceptors in UBC’s database, a large percentage are members of the BCPhA. The majority of preceptors are “repeat customers,” with many having done it for 10 or even 15 years, indicating it’s a rewarding experience. “We always need more preceptors,” said Kim-Sing. “Students can really add value to your pharmacy. Preceptors just need to raise the bar and they’ll rise to the challenge. “It’s a very motivated group of students we have, and they really want to do the right thing for patient care.” If you’re interested in becoming a preceptor, and enthusiastic about coaching and mentoring the next generation of health professionals, you can learn more at http://cpd.pharmacy.ubc.ca/content/oeepreceptors or by contacting firstname.lastname@example.org.
Why become a pharmacy preceptor? There are several benefits to the preceptor and training site, including: • P harmacy students are trained to provide superior care and improve patient health care outcomes • P harmacy students are educated to enhance patient care initiatives and
add value (e.g., projects, medication therapy management, adaptation, medication reconciliation) • P harmacy staff have an opportunity to learn from students, as students often bring new knowledge and innovative ideas
• P harmacy staff will maintain or develop new skills and gain experience as educators and supervisors • A ttract pharmacy students to your organization • P artner with the academic institution on projects and research initiatives.
What are the criteria to be a preceptor? • Preceptors should be licensed as a registered pharmacist in BC and be in good standing • Preceptors should have at least six months of practice experience prior to taking the role of a primary preceptor • Preceptors should complete an approved clinical instructor educational program • Preceptors should be interested in the education of students and be willing to accept a role as teacher, mentor, facilitator and coach • Preceptors should be willing to think of their role as an exploratory effort to find new and innovative paths for instructing students • Preceptors should be interested in providing patient-focused care/pharmaceutical care to improve drug therapy outcomes
Jas Jawanda, Paulo Tchen and Nindy Badesha (left to right), lecturers and coordinators with the Office of Experiential Education (OEE) at the Faculty of Pharmaceutical Sciences at UBC, leading a preceptor workshop earlier this year. Jawanda and Tchen are both BCPhA members. Photo credit: UBC.
• Preceptors should exhibit a high degree of professional motivation, unquestionable ethics, good judgment and professional decorum. Preceptors should be willing to work with the Faculty to develop such characteristics in individual students • Preceptors should be interested in promoting inter- and intraprofessional relationships, and must be willing to provide an environment where students can collaborate with other pharmacists and health professionals • Preceptors should not have a conflict of interest with regard to the student (e.g., family relation or personal relationship). This criterion
UBC Pharmaceutical Sciences alumna and BCPhA member Rina Serjeant collaborates with fellow workshop participants during a breakout session. OEE offers several workshops for preceptors, which make for excellent professional development and networking opportunities. Photo credit: UBC.
applies to all staff at the site.
continued from page 7 First and foremost it compromises patient health. It also costs millions of dollars in wasted medications, extra visits to physicians and trips to the ER to deal with complications associated with people not taking their medications properly. And these costs undermine, and may even cancel out, any savings from the restrictions imposed on prescribing. Last year the New Zealand health system signed a new agreement with community pharmacists that reflects the reality that measures exclusively focused on drug costs may have reached maximum effectiveness. Pharmacists are now working directly with patients to increase their compliance with the medications they are prescribed.
Even with the new pharmacy agreement, things are far from perfect in New Zealand. Despite what some of our local experts say, I think it is clear that a short sighted strategy based only on cost containment will cause more harm than good in the longer term. There are no easy answers for fixing the growing demand for health care services in the face of declining government revenues. The problem is complicated and requires a systematic solution. Our job is to ensure that BC policy makers are well informed of all the facts and implications of the choices they are being encouraged to make.
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GOVERNMENT RELATIONS UPDATE
BC’s health care challenges present opportunity for pharmacy to do more by Coco Lefoka
summer is often the quietest season. Usually, the BC Legislature is in recess and MLAs return to their ridings to spend time with constituents, often attending barbecues and community festivals that are the staple of summer in BC. This year MLAs had to put off their summer plans for a few weeks as political, legislative and policy-making took centre stage at the legislature with a five-week long session. The legislature met primarily to pass Budget 2013, which included a number of health care and spending measures of significant interest to community pharmacy. The updated budget revealed that the Province closed its 2012/13 financial books on March 31, 2013, with a $1.146 billion deficit. Finance Minister Mike De Jong has called for $130 million in cuts to provincial spending over the next three years, in part to address BC’s deficit, which is $1.78 million higher than budgeted in the last fiscal year. In the budget, the government committed to curtailing health spending growth to 2.6 per cent over the next three years. It should be noted that the government found $468 million in health care savings – largely from generic drug regulations and
shared Medical Services Plan premium cost agreements.
the largest and fastest growing senior populations in Canada.
As the government shepherded the budget through the legislature, Premier Christy Clark handily won a seat in WestsideKelowna. Incumbent MLA Ben Stewart had vacated the seat so Clark could run.
The fiscal and demographic challenges BC’s health care system faces mean, now more than ever before, government needs solutions that will help curb costs, improve patient outcomes and expand access to services.
With a seat, a majority government and the next election four years away, Premier Clark now faces the task of implementing health care solutions to meet the province’s needs. The task is being led by Health Minister Dr. Terry Lake who faces a number of challenges. Demands for health services are on the rise in BC and changing demographics are expected to add further pressures to these services. Adding to this challenge are changes to the Canada Health Transfer that will take effect in 2014 when the federal government moves to a new method of funding for health transfers to the provinces. Starting in 2014 health transfer payments will be strictly on a per capita basis. BC could be disproportionately affected by these changes because of its higher percentage of seniors. According to the most recent census, BC has one of
As government seeks these solutions, pharmacists will have to be proactive and steadfast in advocating for the key role they play in the health care system to be broadened to include services that pharmacists across the country are already providing. Translating the clinical services proposals released by the BCPhA prior to the election into pharmacy-based health care programs would be a good place to start. This will require continuing the outreach started during the election to MLAs to gain support for the implementation of these proposals. To find out how you can contribute to this effort in your community, contact BCPhA public affairs officer Coco Lefoka by phone at 604.269.2868 or email email@example.com.
IT IS ESTIMATED THAT NEARLY
CANADIANS WILL EXPERIENCE HERPES ZOSTER IN THEIR LIFETIME, AND THE RISK INCREASES AFTER THE AGE OF 50.1 FOR SOME, IT CAN MEAN EXCRUCIATING AND POTENTIALLY DEBILITATING PAIN. * 1,2,
SELECTED IMPORTANT SAFETY INFORMATION ZOSTAVAX® is not a treatment for zoster or postherpetic neuralgia (PHN). If an individual develops herpes zoster despite vaccination, active current standard of care treatment for herpes zoster should be considered. Vaccination with ZOSTAVAX® may not result in protection of all vaccine recipients. ZOSTAVAX® is contraindicated in patients with a history of hypersensitivity to any component of the vaccine, including gelatin; a history of anaphylactic/ anaphylactoid reaction to neomycin; primary and acquired immunodeficiency states due to conditions such as: acute and chronic leukemias; lymphoma; other conditions affecting the bone marrow or lymphatic system; immunosuppression due to HIV/AIDS, cellular immune deficiencies; immunosuppressive therapy (including high-dose corticosteroids); active untreated tuberculosis; pregnancy. In clinical trials, ZOSTAVAX® has been evaluated for general safety in more than 32,000 adults 50 years of age or older. ZOSTAVAX® was generally well tolerated. Vaccine-related injection-site and systemic adverse experiences reported at an incidence ≥1% are shown below. The overall incidence of vaccine-related injection-site adverse experiences was significantly greater for subjects vaccinated with ZOSTAVAX® versus subjects who received placebo (48% for ZOSTAVAX® and 17% for placebo among recipients aged ≥60 (Shingles Prevention Study [SPS]) and 63.9% for ZOSTAVAX® and 14.4% for placebo among recipients aged 50-59) (ZOSTAVAX® Efficacy and Safety Trial [ZEST]). Vaccinerelated injection-site and systemic adverse experiences reported in ≥1% of adults who received ZOSTAVAX® (N=3,345) or placebo (N=3,271) (0-42 Days Postvaccination) in the Adverse Event Monitoring Substudy of the SPS were: erythema† (35.6%, 6.9%), pain/tenderness† (34.3%, 8.6%), swelling† (26.1%, 4.5%), hematoma (1.6%, 1.4%), pruritus (7.1%, 1.0%), warmth (1.7%, 0.3%), headache (1.4%, 0.9%). Most of these adverse experiences were reported as mild in intensity. The remainder of subjects in the SPS received routine safety monitoring, but were not provided report cards. The types of events reported in these patients were generally similar to the SPS subgroup of patients in the Adverse Event Monitoring Substudy. Vaccine-related injection-site and systemic adverse experiences reported in ≥1% of adults who received ZOSTAVAX® (N=11,094) or placebo (N=11,116) (1-42 Days Postvaccination) in the ZEST were: pain† (53.9%, 9.0%), erythema† (48.1%, 4.3%), swelling† (40.4%, 2.8%), pruritus (11.3%, 0.7%), warmth (3.7%, 0.2%), hematoma (1.6%, 1.6%), induration (1.1%, 0.0%), headache (9.4%, 8.2%), pain in extremity (1.3%, 0.8%).
ARE YOUR PATIENTS PROTECTED?
INDICATED FOR THE
PREVENTION OF HERPES ZOSTER
IN INDIVIDUALS 50 YEARS OF AGE OR OLDER.
Please visit our website at: www.merck.ca
* ZOSTAVAX® is not indicated to reduce the morbidity and complications associated with herpes zoster.
† Designates a solicited adverse experience. Injection-site adverse experiences were solicited only from Days 0-4 postvaccination in SPS and from Days 1-5 postvaccination in ZEST. References: 1. Data on file, Merck Canada Inc. Product Monograph. ZOSTAVAX , 2011. 2. Clinical Manifestations: Chickenpox. In: Mandell G, Bennett J, Dolin R eds. Principles and Practice of Infectious Diseases, 6th ed, vol 2. Philadelphia: Elsevier; 2005. ®
Registered trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Used under license. © 2012 Merck Canada Inc., a subsidiary of Merck & Co., Inc. All rights reserved. ®
See See prescribing prescribing summary summary on page page xxx xxx See prescribing summary onon pages 24-25
Beware of bonds - they can produce negative returns!
by Glenn Schoenroth
In the last quarter,
the Canadian long-term bond composite was down 4.6%. If you have an RRSP, or any investment account, chances are you have some fixed income exposure. For the last 30 years, this asset class has produced returns beyond what it’s designed to; however, times are changing. With yields rising from their lows recently, it may be time to evaluate this traditionally conservative asset class to uncover the real risks and what rising interest rates could mean to the fixed income exposure in your portfolio. When rates go up, the value of bonds go down When a bond is purchased for the full face amount, it’s purchased at par (i.e., 100). If the price is less than par (e.g., 94), the bond is purchased at a ‘discount’, and if the price is greater than par (e.g., 105) the bond is purchased at a ‘premium’. The price of a bond is determined by the current rate of return — or yield — demanded by investors. In turn, the general levels of interest rates determine the yield. Other factors such as liquidity, credit quality, or term, also affect the yield. Bond prices move in the opposite direction to interest rates. As interest rates rise, the price of a bond falls, and as interest rates decline, the price of a bond rises. For example, suppose an investor purchased a new 4.5% coupon bond one year ago. Assume that since then, the general level of interest rates has fallen and a similar bond issued today would have a coupon of 3.75%. Therefore, the 4.5% coupon bond is a valuable asset since it pays a coupon greater than the market rate. To entice the investor to sell the 4.5% bond, a second investor would have to pay a higher price than it was originally purchased for, and high enough to earn the second investor the going yield of 3.75%. Thus, prices of bonds rise when the general level of interest rates fall.
This process works in reverse in a rising interest rate environment. The 4.5% bond would be less valuable if current interest rates are 5.5%. Its price would have to fall enough to make the yield to the purchaser 5.5%. Be aware of the term to maturity. When interest rates change, long-term bonds will change in price by a greater amount than short-term bonds, assuming that both have the same coupon and credit profile. Quite simply, in a rising interest rate environment, prices on longer term bonds will decline to a much larger degree than prices on shorter maturities. Pay attention to the bond’s coupon rate, as it affects the degree to which bond prices change with interest rates. Generally speaking, higher coupon bonds change in price less on a percentage basis than lower coupon bonds. Consider the policy, economic and valuation shifts that may be ahead. This is the time to examine your bond positions and think about whether it’s appropriate to shorten duration, seek out higher quality, and/or increase liquidity to position yourself for rising yields. Of course, bond owners can always choose to hold them until maturity, ignoring the ups and downs of the market price. But it can be a long wait living with today’s low bond coupon when rates and perhaps inflation have moved up to a new higher level. This article is supplied by Glenn Schoenroth, an Investment Advisor with RBC Dominion Securities Inc., member CIPF. This article is for information purposes only. Please consult with a professional advisor before taking any action based on information in this article. Glenn Schoenroth can be reached at 604.257.7196.
Prescribing Summary Prescribing Summary Patient Selection Criteria Patient Selection Criteria
THERAPEUTIC CLASSIFICATION Live, attenuated virus varicella-zoster vaccine INDICATIONS AND Information CLINICAL USE Safety ® ZOSTAVAXSafety is indicated for the prevention of herpes zoster Information (shingles). ZOSTAVAX® is indicated for immunization of individuals 50 years of age or older. Administration SPECIAL POPULATIONS For use in Administration special populations, see Supplemental Product Information, WARNINGS AND PRECAUTIONS, Special Populations. CONTRAINDICATIONS History of hypersensitivity to any component of the vaccine, Study References including gelatin. History of anaphylactic/anaphylactoid reaction toStudy neomycinReferences (each dose of reconstituted vaccine contains trace quantities of neomycin). Neomycin allergy generally manifests as a contact dermatitis. However, a history of contact dermatitis due to neomycin is not a contraindication to receiving live virus vaccines. Primary and acquired immunodeficiency states due to conditions such as: acute and chronic leukemias; lymphoma; other conditions affecting the bone marrow or lymphatic system; immunosuppression due to HIV/ AIDS; cellular immune deficiencies. Immunosuppressive therapy (including high-dose corticosteroids); however, ® is not contraindicated for use in individuals ZOSTAVAXPrescribing Summary who are receiving topical/inhaled corticosteroids or low-dose systemic corticosteroids or in patients who are receiving corticosteroids as replacement therapy, e.g., for adrenal insufficiency. Active untreated tuberculosis. Patient Selection Criteria Pregnancy (see WARNINGS AND PRECAUTIONS - Pregnant Women in the Supplemental Product Information).
Safety Information WARNINGS AND PRECAUTIONS General The health care provider should question the patient about Administration reactions to a previous dose of any varicella-zoster virus (VZV)-containing vaccines (see CONTRAINDICATIONS). As with any vaccine, adequate treatment provisions, including epinephrine injection (1:1000), should be available for immediate use should an anaphylactic/ anaphylactoid reaction occur. Deferral of vaccination References should be Study considered in the presence of fever >38.5°C (>101.3°F). ZOSTAVAX® does not protect all individuals against the development of Herpes Zoster or its sequelae. See ACTION AND CLINICAL PHARMACOLOGY and CLINICAL TRIALS in the product monograph. The duration of protection beyond 4 years after vaccination with ZOSTAVAX® is unknown. The need for revaccination has not been defined. ZOSTAVAX® has not been studied in individuals who have previously experienced an episode of herpes zoster. Transmission In clinical trials with ZOSTAVAX®, transmission of the vaccine virus has not been reported. However, postmarketing experience with varicella vaccines suggests that transmission of vaccine virus may occur rarely between vaccinees who develop a varicella-like rash and susceptible contacts. Transmission of vaccine virus from varicella vaccine recipients who do not develop a varicella-like rash has also been reported and is therefore a theoretical risk for vaccination with ZOSTAVAX®. The risk of transmitting the attenuated vaccine virus to a susceptible individual should be weighted against the 24
risk of developing natural herpes zoster and potentially transmitting wild-type VZV to a susceptible contact. ADVERSE REACTIONS Adverse Drug Reaction Overview In clinical trials, ZOSTAVAX® has been evaluated for general safety in more than 32,000 adults 50 years of age or older. ZOSTAVAX® was generally well tolerated. ZOSTAVAX® Efficacy and Safety Trial (ZEST) in Subjects 50 to 59 Years of Age In the ZEST study, subjects received a single dose of either ZOSTAVAX® (n=11,184) or placebo (n=11,212) and were monitored for general safety throughout the study. During the study, a vaccine-related serious adverse experience was reported for 1 subject vaccinated with ZOSTAVAX® (anaphylactic reaction). All subjects received a vaccination report card (VRC) to record adverse events occurring from Days 1 to 42 postvaccination in addition to undergoing routine safety monitoring throughout the study. Vaccine-related injection-site and systemic adverse experiences reported at an incidence of ≥1% are shown in Table 1. The overall incidence of vaccine-related injectionsite adverse experiences was significantly greater for subjects vaccinated with ZOSTAVAX® versus subjects who received placebo (63.9% for ZOSTAVAX® and 14.4% for placebo). Table 1: Vaccine-Related Injection-Site and Systemic Adverse Experiences Reported in ≥1% of Adults Who Received ZOSTAVAX® or Placebo (1-42 Days Postvaccination) in the ZOSTAVAX® Efficacy and Safety Trial ZOSTAVAX® Placebo (N = 11,094) (N = 11,116) Adverse Experience % % Injection-Site Pain† Erythema† Swelling† Pruritus Warmth Hematoma Induration
53.9 48.1 40.4 11.3 3.7 1.6 1.1
9.0 4.3 2.8 0.7 0.2 1.6 0.0
Systemic Headache Pain in extremity
Designates a solicited adverse experience. Injection-site adverse experiences were solicited only from Days 1-5 postvaccination.
Within the 42-day postvaccination period in the ZEST, noninjection-site zoster-like rashes were reported by 34 subjects (19 for ZOSTAVAX® and 15 for placebo). Of 24 specimens that were adequate for Polymerase Chain Reaction (PCR) testing, wild-type VZV was detected in 10 (3 for ZOSTAVAX®, 7 for placebo) of these specimens. The Oka/Merck strain of VZV was not detected from any of these specimens. Within the same 42-day postvaccination reporting period in the ZEST, varicella-like rashes were reported by 124 subjects (69 for ZOSTAVAX® and 55 for placebo). Of 23 specimens that were available and adequate for PCR testing, VZV was detected in one of these specimens from the group of subjects who received ZOSTAVAX®; however, the virus strain (wild type or Oka/Merck strain) could not be determined. Shingles Prevention Study (SPS) in Subjects 60 Years of Age and Older In the largest of these trials, the Shingles Prevention Study (SPS), 38,546 subjects received a single dose of either ZOSTAVAX® (n=19,270) or placebo (n=19,276) and were monitored for safety throughout the study. During the study, vaccine-related serious adverse experiences were reported for 2 subjects vaccinated with ZOSTAVAX® (asthma exacerbation and polymyalgia rheumatica) and 3 subjects who received placebo (Goodpasture’s syndrome, anaphylactic reaction, and polymyalgia rheumatica). In the Adverse Event Monitoring Substudy, a subgroup of individuals from the SPS (n=3,345 received ZOSTAVAX® and n=3,271 received placebo) were provided vaccination report cards to record adverse events occurring from Days 0 to 42 postvaccination in addition to undergoing routine safety monitoring throughout the study.
Table 2: Number of Subjects with ≥1 Serious Adverse Events (0-42 Days Postvaccination) in the Shingles Prevention Study Placebo ZOSTAVAX® n/N n/N Relative Risk Cohort % % (95% CI) Overall Study Cohort All ages
1.01 (0.85, 1.20)
60-69 years old
1.12 (0.86, 1.46)
≥70 years old
0.93 (0.74, 1.17)
AE Monitoring Substudy Cohort All ages
1.53 (1.04, 2.25)
60-69 years old
1.21 (0.66, 2.23)
≥70 years old
1.76 (1.07, 2.89)
N=number of subjects in cohort with safety follow-up n=number of subjects reporting an SAE 0-42 Days postvaccination
The incidence of death was similar in the groups receiving ZOSTAVAX® or placebo during the Days 0-42 postvaccination period: 14 deaths occurred in the group of subjects who received ZOSTAVAX® and 16 deaths occurred in the group of subjects who received placebo. The most common reported cause of death was cardiovascular disease (10 in the group of subjects who received ZOSTAVAX®, 8 in the group of subjects who received placebo). The overall incidence of death occurring at any time during the study was similar between vaccination groups: 793 deaths (4.1%) occurred in subjects who received ZOSTAVAX® and 795 deaths (4.1%) in subjects who received placebo. Vaccine-related injection-site and systemic adverse experiences reported at an incidence ≥1% are shown in Table 3. Most of these adverse experiences were reported as mild in intensity. The overall incidence of vaccine-related injection-site adverse experiences was significantly greater for subjects vaccinated with ZOSTAVAX® versus subjects who received placebo (48% for ZOSTAVAX® and 17% for placebo). Table 3: Vaccine-Related Injection-Site and Systemic Adverse Experiences Reported in ≥1% of Adults Who Received ZOSTAVAX® or Placebo (0-42 Days Postvaccination) in the Adverse Events Monitoring Substudy of the Shingles Prevention Study Placebo ZOSTAVAX® (N = 3345) (N = 3271) Adverse Experience % % Injection Site Erythema† Pain/tenderness† Swelling† Hematoma Pruritus Warmth
35.6 34.3 26.1 1.6 7.1 1.7
6.9 8.6 4.5 1.4 1.0 0.3
Designates a solicited adverse experience. Injection-site adverse experiences were solicited only from Days 0-4 postvaccination.
The remainder of subjects in the SPS received routine safety monitoring, but were not provided report cards. The types of events reported in these patients were generally similar to the subgroup of patients in the Adverse Event Monitoring Substudy. Within the 42-day postvaccination reporting period in the SPS, the number of reported noninjection-site zoster-like rashes among all subjects was small (17 for ZOSTAVAX ®, 36 for placebo; p=0.009). Of these 53 zoster-like rashes, 41 had specimens that were available and adequate for PCR testing. Wild-type VZV was detected in 25 (5 for ZOSTAVAX®, 20 for placebo) of these specimens. The Oka/Merck strain of VZV was not detected from any of these specimens. The number (n=59) of reported varicella-like rashes was also small. Of these varicella-like rashes, 10 had specimens that were available and adequate for PCR testing. VZV was not detected in any of these specimens. The results of virus testing in subjects with varicella-like and zoster-like rashes should be interpreted with caution due to the number of samples that were not available for testing.
Safety Information The numbers of subjects with elevated temperature (≥38.3°C [≥101.0°F]) within 7 days postvaccination were similar in the ZOSTAVAX® and the placebo vaccination groups [6 (0.2%) vs. 8 (0.3%), respectively]. Other Studies In other clinical trials conducted prior to the completion of the SPS, the reported rates of noninjection-site zoster-like and varicella-like rashes within 42 days postvaccination were also low in both zoster vaccine recipients and placebo recipients. Of 17 reported varicella-like rashes and non-injection site zoster-like rashes, 10 specimens were available and adequate for PCR testing, and 2 subjects had varicella (onset Day 8 and 17) confirmed to be Oka/Merck strain. To address concerns for individuals with an unknown history of vaccination with ZOSTAVAX ®, the safety and tolerability of a second dose of ZOSTAVAX® was evaluated. In a placebo-controlled, double-blind study, 98 adults 60 years of age or older received a second dose of ZOSTAVAX® 42 days following the initial dose; the vaccine was generally well tolerated. The frequency of vaccine-related adverse experiences after the second dose of ZOSTAVAX® was generally similar to that seen with the first dose. Descriptive study P017 is an estimation study with no hypothesis testing. In this double-blind, placebocontrolled, randomized clinical trial, ZOSTAVAX® was administered to 206 subjects 60 years of age or older who were receiving chronic/maintenance systemic corticosteroid therapy at a daily dose equivalent of 5 to 20 mg of prednisone for at least 2 weeks prior to enrollment, and 6 weeks or more following vaccination to assess the immunogenicity and safety profile of ZOSTAVAX®. In this clinical trial, the safety profile was generally similar to that seen in the Adverse Event Monitoring Substudy of the SPS (see CONTRAINDICATIONS regarding corticosteroids). Post-Marketing Adverse Drug Reactions The following additional adverse reactions have been identified during post-marketing use of ZOSTAVAX®. Because these reactions are reported voluntarily from a population of uncertain size, it is generally not possible to reliably estimate their frequency or establish a causal relationship to the vaccine. Gastrointestinal disorders: nausea. Skin and subcutaneous tissue disorders: rash. Musculoskeletal and connective tissue disorders: arthralgia; myalgia. General disorders and administration site conditions: injection-site rash; injection-site urticaria; pyrexia; injection-site lymphadenopathy. Immune system disorders: hypersensitivity reactions including anaphylactic reactions. If a patient experiences an adverse event following immunization, please complete the appropriate Adverse Events following Immunization (AEFI) Form and send it to your local Health Unit in your province/territory. To report a suspected adverse reaction, please contact Merck Canada Inc. in any of the following ways: – Call toll-free 1-800-567-2594 – Complete a Canada Vigilance Reporting Form and fax toll-free to 1-800-369-3090 – Mail to: Merck Canada Inc., Pharmacovigilance, P.O. Box 1005, Pointe-Claire – Dorval, QC H9R 4P8 DRUG INTERACTIONS Overview ZOSTAVAX® must not be mixed with any other medicinal product in the same syringe. Other medicinal products must be given as separate injections and at different body sites. Concurrent administration of ZOSTAVAX® and antiviral medications known to be effective against VZV has not been evaluated. Use with Other Vaccines ZOSTAVAX ® and PNEUMOVAX ® 23 (pneumococcal vaccine, polyvalent, MSD Std.) should not be given concomitantly because concomitant use resulted in reduced immunogenicity of ZOSTAVAX® (see CLINICAL TRIALS in the product monograph).
Administration DOSAGE AND ADMINISTRATION (see Product Monograph for complete information) Recommended Dose and Dosage Adjustment FOR SUBCUTANEOUS ADMINISTRATION. Study References Do not inject intravascularly. Individuals should receive a single dose consisting of the entire content of the vial (approximately 0.65 mL). ZOSTAVAX® is not a treatment for zoster or postherpetic neuraligia (PHN). If an individual develops herpes zoster despite vaccination, active current standard of care treatment for herpes zoster should be considered. At present, the duration of protection after vaccination with ZOSTAVAX® is unknown. In the Shingles Prevention Study (SPS), protection was demonstrated through 4 years of follow-up. The need for revaccination has not yet been defined. Reconstitute immediately upon removal from the freezer. To reconstitute the vaccine, use only the diluent supplied, since it is free of preservatives or other antiviral substances which might inactivate the vaccine virus. Vial of diluent To reconstitute the vaccine, first withdraw the entire contents of the diluent vial into a syringe. To avoid excessive foaming, slowly inject all of the diluent in the syringe into the vial of lyophilized vaccine and gently agitate to mix thoroughly. Withdraw the entire contents into a syringe, and using a new needle, inject the total volume of reconstituted vaccine subcutaneously, preferably into the upper arm - deltoid region. IT IS RECOMMENDED THAT THE VACCINE BE ADMINISTERED IMMEDIATELY AFTER RECONSTITUTION, TO MINIMIZE LOSS OF POTENCY. DISCARD RECONSTITUTED VACCINE IF IT IS NOT USED WITHIN 30 MINUTES. Do not freeze reconstituted vaccine. CAUTION: A sterile syringe free of preservatives, antiseptics, and detergents should be used for each injection and/or reconstitution of ZOSTAVAX® because these substances may inactivate the vaccine virus. It is important to use a separate sterile needle and syringe for each patient to prevent transfer of infectious agents from one individual to another. Needles should be disposed of properly. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. ZOSTAVAX® when reconstituted is a semi-hazy to translucent, off-white to pale yellow liquid.
70-79 years of age, and 1,263 were 80 years of age or older. ZOSTAVAX® was demonstrated to be generally safe and effective in this population. Pregnant Women: There are no studies in pregnant women. It is also not known whether ZOSTAVAX® can cause foetal harm when administered to a pregnant woman or can affect reproduction capacity. However naturallyoccurring varicella-zoster virus infection is known to sometimes cause foetal harm. Therefore, ZOSTAVAX® should not be administered to pregnant women; furthermore, pregnancy should be avoided for three months following vaccination (see CONTRAINDICATIONS). Nursing Women: It is not known whether VZV is secreted in human milk. Therefore, because some viruses are secreted in human milk, caution should be exercised if ZOSTAVAX® is administered to a nursing woman. Pediatrics: ZOSTAVAX® is not recommended for use in this age group. HIV-AIDS Patients: The safety and efficacy of ZOSTAVAX® have not been established in adults who are known to be infected with HIV with or without evidence of immunosuppression (see CONTRAINDICATIONS). Immunocompromised Subjects: Data are not available regarding the use of ZOSTAVAX® in immunocompromised subjects (see CONTRAINDICATIONS). ®
Registered trademarks Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Used under license.
13-02_153682 VACC-1039532-0007-E-CDN-APR-14 PRODUCT MONOGRAPH AVAILABLE AT www.merck.ca OR UPON REqUEST AT 1-800-567-2594
MERCK CANADA INC. P.O. BOX 1005, POINTE-CLAIRE DORVAL, QUEBEC H9R 4P8
MERCK CANADA INC. C.P. 1005, POINTE-CLAIRE DORVAL (QUÉBEC) H9R 4P8
OVERDOSAGE There are no data with regard to overdose. For management of a suspected drug overdose, contact your regional Poison Control Center. STORAGE AND STABILITY Storage ZOSTAVAX® SHOULD BE STORED FROZEN at an average temperature of -15°C or colder until it is reconstituted for injection (see DOSAGE AND ADMINISTRATION). Any freezer, including frost-free, that has a separate sealed freezer door and reliably maintains an average temperature of -15°C or colder is acceptable for storing ZOSTAVAX®. The diluent should be stored separately at room temperature (20 to 25°C) or in the refrigerator (2 to 8°C). Do not store the diluent in a freezer. Before reconstitution, protect from light. DISCARD IF RECONSTITUTED VACCINE IS NOT USED WITHIN 30 MINUTES. DO NOT FREEZE THE RECONSTITUTED VACCINE. Supplemental Product Information WARNINGS AND PRECAUTIONS Special Populations Geriatric: The mean age of subjects enrolled in the largest (N=38,546) clinical study of ZOSTAVAX® was 69 years (range 59-99 years). Of the 19,270 subjects who received ZOSTAVAX®, 10,378 were 60-69 years of age, 7,629 were
ARE YOU MAXIMIZING THE VALUE OF YOUR MEMBER BENEFITS? Pharmacy members can place free Career Opportunities listings in this section and on the BCPhA website. Job postings for pharmacy technicians and assistants are also distributed by the Pharmacy Technician Society of British Columbia (PTSBC). A new enhancement to the best pharmacy job board in BC!
ABBOTSFORD Pharmacist – full-time Pharmasave in Abbotsford is looking for a full-time pharmacist. The pharmacy is located inside the new Abbotsford Regional Hospital. Remuneration paid according to experience. Please send resumes to info@pharmasaveabby. com or fax: 604.870.2955 or please call 604.870.5600. Pharmacy assistant – part-time Canada Safeway Limited currently has a career opportunity for a part-time pharmacy assistant. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. BURNABY Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to Neerav Joshi, manager, pharmacy recruitment & retention at firstname.lastname@example.org.
Our unique pharmacy is located in the East Kootenay Regional Hospital and very clinicaloriented, specializing in sterile preparations, compounding and many other out-patient services. The store services several nursing homes and extended care facilities. Hours are 9am to 8:30pm Monday to Friday, 9am to 6pm Saturday and 10am to 6pm Sunday. You’ll enjoy the many clinical aspects of your profession – including patient counselling and extensive communications with other health care professionals within the hospital. Our compensation package starts with a negotiable salary, depending on experience. Relocation assistance is available. Benefits include 100% coverage of medical, dental and life insurance premiums, College license fees and BCPhA fees.
CRANBROOK Pharmacist – full-time
The pharmacy manager is responsible for managing store pharmacy operations and maintaining a professional, cohesive working relationship with the front store manager and staff. They are a catalyst in the execution of a superior patient care experience translating into an environment that ensures people make the healthiest decisions quickly, easily and confidently. The ideal candidate has: a pharmacy license to practice in BC; experience in retail pharmaceutical systems and dispensing procedures (e.g., Nexxsys); ability to maintain balance between the profession and business of pharmacy; strong financial acumen; excellent communication and organization; strong patient satisfaction orientation, leadership and decision-making prescription for skills; and previous pharmacy management experience (preferred). Please send resumes to email@example.com or apply online at We currently www.rexallcareers.ca.
Pharmacist – full-time and part-time
Pharmacy assistant position available in a neighbourhood-oriented retail pharmacy in Crystal Mall, Metrotown area. We are proud of our top level of customer service, hence,
week. Competitive wages and benefits package. Come join an excellent team! Experience is ideal but new grads also welcome. Compensation based on experience and positional discussion. Interested individuals can forward all enquiries and resumes via email to firstname.lastname@example.org.
Pharmacy manager – full-time
Pharmacist members looking for new career opportunities can post their resumes for free on the Hire-aPharmacist page. To learn more, visit the Recruitment section of bcpharmacy.ca
Pharmacy assistant – full-time
we have very good rapport with our clients. Potential candidate must possess a diploma of pharmacy assistant program from an accredited institution, and has excellent customer service skills. Cantonese speaking ability is highly preferred. Mostly weekdays, no evenings, no stats. Please send resumes to email@example.com or fax 604.433.2830.
Pharmacy assistant – part-time
have a career opportunity for a Full Time Pharmacy Manager in Port Alberni, BC
Part-time pharmacy assistant position available at SaveOn-Foods Pharmacy. Certification required or two years dispensary experience. Please send resumes to bless.cde@ gmail.com.
If you are a pharmacist who is licensed to practice in British Columbia and looking to provide patient-focused care within a strong team environment, then this opportunity may be for you.
If you would like to pursue this opportunity further, please send a cover letter and resumé by e-mail or fax to the address below:
Pharmacy technician – full-time or part-time Permanent full-time or part-time position available. Hours are to be determined but will likely involve shift work (daytime) and rotating weekends. Position is for a minimum of 24 hours and up to 40 hours per
We offer a Full Compensation and Benefits Package with industry-leading components. We are a company committed to both pharmaceutical care and customer care.
CHRISTINE LEE, B.Sc. Pharm Pharmacy Recruiter Canada Safeway Ltd. Phone (604) 301-2632 Fax (604) 322-2508 Email: firstname.lastname@example.org
Holidays start at three weeks per year. Please send resumes to Rick Lockhart (B.Sc. Pharm), pharmacy manager at email@example.com or fax 250.420.4135 or please call 250.420.4133.
pharmacists’ role to provide excellent pharmaceutical care in order to achieve better patient outcomes. Please send resumes to firstname.lastname@example.org.
Pharmacist – full-time
Pharmacist – full-time
Our newly renovated store offers the most up-to-date dispensary design complete with a large counseling office and compounding room. Compounding and injections training allows you to explore all areas of providing pharmaceutical care to our customers. Staff is encouraged to spend time with patients and go beyond the pharmacy counter to use your professional training to its full potential. Store hours are Monday to Saturday 9am to 6pm, closed Sunday and stat holidays. Our competitive wage and benefits package includes College and BCPhA fees and a rewarding RRSP plan. Relocation assistance is available. Houston lies in the scenic Bulkley Valley where fishing, golfing and camping are second to none. Enjoy the brand new aquatics centre open year round and world class skiing nearby in Smithers. Please send resumes to Linda Gutenberg, director of pharmacy, Forewest Holdings Inc. at email@example.com or please call 604.315.3273.
As a growing company, NAZ’s Pharmacies is seeking a clinically-oriented pharmacist for its new Delta location opening August 2013. We are a community-based pharmacy group that provides patient-centered practices. We enjoy excellent relations with area physicians and other health care providers. We offer the autonomy of an independent pharmacy, with the stability, competitive wage and benefits package of the large chain stores, and without the micromanaging and corporate layers. We pride ourselves on our dedication to our employees and interest in longterm relationships. New graduates and any experience level are welcome to apply. Contact us to learn more about our opportunities and what NAZ’s Pharmacy can offer you! Please send resumes to firstname.lastname@example.org or fax 604.608.3230 or please call 604.603.7923. DUNCAN Pharmacy assistant – part-time Canada Safeway Limited currently has a career opportunity for a part-time pharmacy assistant. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. GIBSONS Pharmacist – full-time London Drugs has a full-time opportunity in Gibsons. Join a clinical and patient focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at email@example.com or fax 604.448.1075. Regulated pharmacy technician – full-time Howe Sound Pharmacy in beautiful Gibsons, BC, is currently looking for a full-time regulated pharmacy technician to join our growing team of dedicated professionals. The ideal candidate is organized, has excellent customer service skills, and is able to multi-task while working independently with minimal supervision. We provide a unique practice environment with personal and professional growth opportunities. Our pharmacy technicians support the
KAMLOOPS Pharmacy manager – full-time Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 95 pharmacies in BC and Alberta, under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging and growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! For more information on career opportunities, please contact or forward your resume in confidence via email to firstname.lastname@example.org. Pharmacist – part-time Overwaitea Food Group, one of Western Canada’s leading food and consumer-goods retailer, operates more than 95 pharmacies in BC and Alberta, under the following banners: Save On Foods, PriceSmart Foods, Coopers Foods, Urban Fare and Overwaitea Pharmacy. We provide a very professional pharmacy practice environment and are committed to: challenging and growing our staff, caring for people, healthy living for our shoppers and patients, innovation and investing in our future. Join the Overwaitea Food Group and make your career prescription complete! For more information on career opportunities, please contact or forward your resume in confidence via email to email@example.com.
Pharmacist – part-time London Drugs has a part-time opportunity in Kamloops. Join a clinical and patient focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at firstname.lastname@example.org or fax: 604.448.1075. Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. KELOWNA Pharmacist – full-time Medical Pharmacies has an exciting opportunity in a specialized long-term care setting with no retail. The right candidate will embrace our leading technology and services; be innovative in their approach to providing excellent care to the residents we provide for; be clinically-oriented; and be licensed with the CPBC. Long-term care experience an asset, but not necessary. Great potential for career advancement. Responsibilities include institutional dispensing; checking orders, data entry, medication reviews, and possibly educational seminars; attending care conferences and Medication Safety Advisory Committee meetings; and creating great working relationships with facility directors. Position may require travel within the Okanagan. Please send resumes to email@example.com or fax 250.717.1565 or please call 250.317.6823. Pharmacist – part-time Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to firstname.lastname@example.org or apply online at www.rexallcareers.ca.
Pharmacy assistant – part-time Canada Safeway Limited currently has a career opportunity for a part-time pharmacy assistant. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. LANGLEY Pharmacist – part-time In business since 1922, Otter Co-op is a successful $160M retail operation, located minutes east of Langley. Due to our tremendous growth and expansion plans, we are accepting applications for a part-time ‘experienced’ staff pharmacist . We provide an excellent pharmacy practice environment with personal growth and career development opportunities. Our benefit package includes extended health, pension contributions and a very competitive salary. If you are highly motivated to provide excellent pharmacy care and customer service, please contact us by email at email@example.com or fax 604.856.3101. Pharmacist – part-time Remedy’s Rx is looking for a dedicated and dynamic staff pharmacist for one of our Langley locations. You will provide superior patient care and excellent client service. You will be part of a superb health care team in a patient focus practice that is making a difference in the health of the community it serves. For more information see the attachment at www.bcpharmacy.ca/jobs. Please send resumes to Kiran Basra, director, retail pharmacy operations, at firstname.lastname@example.org. MAPLE RIDGE Pharmacist – full-time Medlandia Compounding Pharmacy has an opening for an outstanding full-time pharmacist. Must be familiar with KROLL and have two years of work experience in BC. For more information please see the attachment at www.bcpharmacy. ca/jobs. Please send resumes to satthari@gmail. com or please call 604.465.3375. Pharmacist – full-time or part-time We are looking for a part-time or full time experienced pharmacist with good communications skills for our new location in Maple Ridge. Our team is dedicated to giving our customers the best possible pharmaceutical care. If you are interested, please send us your cover letter, resume, and references to email@example.com or apply online at www.medlandia.com. MILL BAY Pharmacist – full-time Join the team at our established community pharmacy, working closely with professional colleagues, patients, and their families. You’ll play an integral role in creating highest quality patient outcomes by providing traditional and alternative therapies; med reviews; injections;
community education seminars; blister packaging; compounding; patient counseling; and prevention outreach. We are a PCCA certified compounding center, and have a large natural health section and on-site natural health specialist. Our support staff is excellent! We provide competitive wages, benefits, continuing education and a desirable Island lifestyle just 30 minutes north of Victoria. Wages, benefits, incentives and learning opportunities are negotiable, based on experience and performance. Please send resumes to Erika Pfahl, pharmacy manager at firstname.lastname@example.org. Pharmacy technician or assistant – full-time Pharmasave in Mill Bay is looking for a pharmacy technician or assistant to join our busy dispensary team in providing health care expertise to the community. We’re looking for a positive team player who is a quick learner and patient-oriented, with strong communication skills, the ability to take direction, proven customer service expertise and a can-do attitude. Our work environment is fast-paced and high volume. Duties include: ensure patients are well looked after, answer phones to assist patients or direct calls appropriately, prescription data entry, bill prescriptions to govt/third parties, medication packaging, send/ receive drug orders via Kroll and wholesalers, inventory management, and basic tidying of the pharmacy. Experience with Kroll or compounding training is an asset. Please send resumes to email@example.com. NANAIMO Pharmacist – full-time London Drugs has a full-time opportunity in Nanaimo. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long-term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at firstname.lastname@example.org or fax 604.448.1075. NELSON Pharmacy assistant – full-time Pharmasave in Nelson is looking for a full-time pharmacy assistant. Previous experience is a requirement. We provide a competitive wage and benefits package. Our store hours are 9am-6pm Monday to Friday, 9am-5:30pm Saturdays, and 11am-3pm Sundays. Please provide a resume and references along with wage expectations to Eric Sollid, pharmacy manager at email@example.com or fax 250.352.3768 or please call 250.352.2313. NEW WESTMINSTER Pharmacist – full-time and part-time Are you proud to be a pharmacist? Do you like giving patients pharmaceutical care?
Does learning excite you? Then, come join our dynamic team and help deliver pharmaceutical care to our friendly, loyal customers base. You are the right candidate if you enjoy an atmosphere where your customers know you by name and rely on you as an integral part of their well-being. Punjabi speaking would be an asset. Clinical and retail pharmacy management experience is an asset. We offer a benefit package with a competitive salary. Please send resumes to firstname.lastname@example.org. Pharmacy technician or assistant – full-time The Medicine Shoppe #142 is looking for a pharmacy assistant or technician to join our team. The candidate must be fluent in English, and a second language is an asset. We welcome someone with experience working in hospital, and knowledge in home health care and applied robotics. We provide clinical services such as renal dialysis, diabetes, injections, medication reviews, compression socks fitting, and home health care products. The candidate must possess good communication skills, being able to work independently and with team members. We offer competitive wages, a great working environment and an excellent support team. Pharmacy hours are Mon-Fri 9am-6pm (no evenings or weekends) and we are closed on stat holidays. No phone calls or drop-ins. Please email resume only to pharmacy manager at email@example.com. PENTICTON Pharmacist – part-time London Drugs has a part-time opportunity in Penticton. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at firstname.lastname@example.org or fax 604.448.1075. PORT ALBERNI Pharmacy manager – full-time Canada Safeway Limited currently has a career opportunity for a full-time pharmacy manager. If you are a pharmacist who is licensed to practice in BC and looking to provide patientfocused care within a strong team environment, then this opportunity may be for you. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. If you would like to pursue this opportunity further, please send a cover letter and résumé by e-mail or fax to Christine Lee, BSc. Pharm, pharmacy recruiter Canada Safeway Ltd. at email@example.com or fax 604.322.2508 or please call 604.301.2632.
PRINCE GEORGE Pharmacist – full-time London Drugs has a full-time opportunity in Prince George. Join a clinical and patient focused team using the latest robotic dispensing machines plus counseling booths and counseling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at firstname.lastname@example.org or fax 604.448.1075. QUESNEL Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. RICHMOND Pharmacist – full-time HealthPlus Pharmacy is seeking a BC-licensed full-time pharmacist. We offer competitive compensation and an excellent work environment. The goal of our pharmacy is to become an integral part of the community by focusing on patient care. It is essential that candidates possess strong interpersonal skills and have a commitment to providing exceptional customer service in a team environment. Please send resumes to Mandeep Aulakh, pharmacy owner at mvirk_@hotmail. com or fax 604.304.1295. SALT SPRING ISLAND Pharmacist – full-time Pharmasave on Salt Spring Island has an opening for a full-time pharmacist. If you dream about living in one of the most vibrant and beautiful Gulf Island communities in BC while still maintaining an interesting and rewarding career, then you should consider joining our team of experienced and dedicated professionals. We offer a competitive compensation and benefits package and the opportunity for a truly great lifestyle. Our standards are high and we aim to offer our customers the best service and pharmacy counseling available. Come and find out why The New York Times calls Salt Spring Island one of the “gems” of the Pacific Northwest. Please send resumes to gary@saltspringpharmasave. com or please call 250.537.5534. SECHELT Pharmacist – full-time If you are a pharmacist who is looking for a great opportunity that provides growth, development and a great work environment then we have the opportunity for you! Excellent
compensation and benefits plan, relocation allowance, on-going career development and training programs. Opportunity to work with seasoned professionals and participate in our customer clinic day events. We offer an annual bonus plan, company stock purchase plan, employee discount program, comprehensive health and dental benefits, and employee share ownership plan. Flexible hours with no 24-hour pharmacies in any of our locations. We support continuing education and offer various in-house training programs. Please send resumes to email@example.com or apply online at www.drugstorepharmacy.ca or fax 1.866.628.5329 or please call 1.905.216.6010. SIDNEY Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. SURREY Pharmacy manager – full-time Pharmacy manager needed for independent community pharmacy. Friendly environment. We offer a competitive wage. Must be able to work some weekends. Please fax 604.543.4433 or please call 604.543.6677. Pharmacist – full-time and part-time Are you proud to be a pharmacist? Do you like giving patients pharmaceutical care? Does learning excite you? Then, come join our dynamic team and help deliver pharmaceutical care to our friendly, loyal customers base. You are the right candidate if you enjoy an atmosphere where your customers know you by name and rely on you as an integral part of their well-being. Punjabi speaking would be an asset. Clinical and retail pharmacy management experience is an asset. We offer a benefit package with a competitive salary. Please send resumes to firstname.lastname@example.org. Pharmacist – part-time Part-time pharmacist needed for independent community pharmacy. Friendly environment, flexible shifts and no evenings. We offer a competitive wage. Must be able to work some weekends. New grads welcome! Please fax 604.543.4433 or please call 604.543.6677. Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs.
TERRACE Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. TSAWWASSEN Pharmacy technician – full-time or part-time Tsawwassen Pharmacy is looking for an experienced part-time or full-time pharmacy technician to join our team. The ideal candidate will be self-motivated and possess excellent communication skills, nursing home experience and prior knowledge of ARI WinRx would be an asset. We are located in a medical building with a focus on customer care and service. We have excellent clientele and working environment. No Sunday or evening shifts. Tsawwasssen is a friendly and family-oriented community conveniently located 20 minutes south of the Oak Street Bridge. We offer a competitive compensation package. If you would like to be part of our pharmacy team, please email your resume in confidence to Edwin Lee at email@example.com. VANCOUVER Pharmacist – full-time Labpharma Health Solutions Inc. is a sociallyfocused pharmacy looking for a full-time pharmacist with a strong background in both clinical and dispensing practice. The position might also interest hospital-trained pharmacists. Applicants must have methadone maintenance training and have a strong passion to help those struggling with mental illness and addictions in the Downtown Eastside. To learn more about our exciting practice, send your application and resume by email to firstname.lastname@example.org. Pharmacist – full-time or part-time Part-time or full-time pharmacist position, Mon. to Fri. no evenings. Wages commensurate with experience. East End Pharmacy in Vancouver. Please fax resumes to 604.255.9815 or please call 604.255.9890. Pharmacist – part-time Shoppers Drug Mart at 2303 West 41st Avenue has a part-time opening. Ideally we are looking for someone who has SDM/HWNG experience and is injection-certified. Store hours are 8am to 10pm, seven days a week. Please email your resume to Serena Lam, pharmacy manager at email@example.com. Pharmacist – part-time, relief The staff pharmacist is responsible for providing pharmacy services to customers and medical practitioners. Working under the direction of the pharmacy manager, your role will be key in achieving departmental excellence in patient-focused care, customer service,
workflow efficiencies and PROfile programs. Responsibilities include providing guidance and supervision to pharmacy students and assistants. In your role you will ensure all patients are offered and receive professional clinical services. Job requirements include: license to practice pharmacy in BC or eligible for licensure; flexible working daytime, evenings, and weekend shifts; excellent communication, leadership and organizational skills. Previous retail pharmacy experienced preferred. Please apply online at www.sobeyscareers.com.
Pharmacist – full-time London Drugs has a full-time opportunity in Victoria. Join a clinical and patient focused team using the latest robotic dispensing machines plus counselling booths and counselling rooms. Competitive salary and compensation packages, scheduled meal breaks and opportunities to advance to roles such as travel medicine, long term care, pharmacy management, CDE, injection pharmacist and patient care pharmacists. Please send resumes to Shawn Sangha, Rx operations manager at firstname.lastname@example.org or fax 604.448.1075.
Pharmacy technician – full-time or part-time Permanent full-time or part-time position available. Hours are to be determined but will likely involve shift work (daytime) and rotating weekends. Position is for a minimum 24 up to 40 hours per week. Competitive wages and benefits package. Come join an excellent team! Experience is ideal but new grads also welcome. Compensation based on experience and positional discussion. Interested individuals can forward all enquiries and resumes via email to email@example.com. VANDERHOOF Pharmacist – full-time If you are a pharmacist who is looking for a great opportunity that provides growth, development and a great work environment then we have the opportunity for you! Excellent compensation and benefits plan, relocation allowance, on-going career development and training programs. Opportunity to work with seasoned professionals, participate in our customer clinic day events. Annual bonus plan, company stock purchase plan, employee discount program, comprehensive health and dental benefits, and employee share ownership plan. Flexible hours with no 24-hour pharmacies in all our locations. We support continuing education and offer various in-house training programs. Please send resumes to kay. firstname.lastname@example.org or apply online at www.drugstorepharmacy.ca or fax 1.866.628.5329 or please call 1.905.216.6010. VERNON Pharmacist – full-time Pharmacist required in the beautiful Okanagan. Would prefer a new grad. Please contact us for further details: Gudrun Wiens, associate owner at email@example.com or fax 250.260.8279 or please call 250.260.8576. VICTORIA Pharmacist – full-time Pharmacist required to work at Victoria Peoples Pharmacy owned and operated by Naz Rayani. We are looking for an engaged, clinically oriented outgoing, part-time pharmacist to work at our unique community pharmacies. Our focus is on patient-centered practice with a desirable and friendly population. All applications are confidential. Compensation is commensurate with experience. Please send resumes to firstname.lastname@example.org.
confidential. Compensation is commensurate with experience. Please send resumes to email@example.com. Regulated pharmacy technician – part-time Canada Safeway Limited currently has a career opportunity for a part-time regulated pharmacy technician. We offer a full compensation and benefits package with industry-leading components. We are a company committed to both pharmaceutical care and customer care. Please apply online at www.safewaypharmacy.jobs. WEST VANCOUVER
Pharmacist – full-time
Pharmacy manager – full-time
We are seeking a full-time pharmacist to join our Peoples Drug Mart location in Victoria, BC. Our store has an elderly population base and is located adjacent to physicians’ offices and walk-in medical clinics. We are seeking the following skills: ability to work collaboratively with physicians and staff; ability to counsel patients on the use of OTCs; ability to perform medication reviews; and ability to communicate effectively with elderly patients. Candidates with injections authority are encouraged to apply. Please send resumes to firstname.lastname@example.org or please call 250.818.1468.
We are looking for a pharmacy manager for a boutique-style brand-new pharmacy in West Vancouver. Possibility of profit sharing for a dedicated candidate, you must be a businessoriented, hard-working individual. Competitive salary and package with a stunning view of the Pacific Ocean. Please send resumes to email@example.com or please call 604.790.7862.
Pharmacist – full-time and part-time Forbes Pharmacies are a local success story, located in beautiful Victoria, BC. To support our growth and expansion we are accepting resumes for part-time and full-time pharmacists to join and add to our success. When you join The Forbes Pharmacy Group you become one of the family. We offer a competitive salary and benefits package, and full pharmacy technician coverage. If you are interested in working for Forbes Pharmacies please submit your CV along with cover letter to Mike Forbes, Forbes’ president at firstname.lastname@example.org. Pharmacist – part-time Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic fast-paced team. Please send resumes to Neerav Joshi, manager, pharmacy recruitment & retention at email@example.com. Regulated pharmacy technician – full-time Pharmacy technician required to work at Victoria Peoples Pharmacy, owned and operated by Naz Rayani. Our focus is on patient-centered practice with a desirable and friendly population. All applications are
WHISTLER Regulated pharmacy technician – full-time Whistler Rexall has an immediate opening for a full-time regulated pharmacy technician. We offer a very competitive compensation package. Please send resumes to njoshi@rexall. ca or apply online at www.rexallcareers.ca.
OPPORTUNITIES ACROSS BC
Rewarding ownership opportunity – Surrey
Pharmacist - full-time, relief
Enjoy the best of both worlds and be in business for yourself instead of by yourself. Unique business opportunity for the right person. Seeking a pharmacist/partner for Surrey, BC area. Phone 604.543.6677 for further details.
If you are a pharmacist who is looking for a great opportunity that provides growth, development and a great work environment then we have the opportunity for you! Excellent compensation and benefits plan, relocation allowance, on-going career development and training programs. Opportunity to work with seasoned professionals and participate in our customer clinic day events. We offer an annual bonus plan, company stock purchase plan, employee discount program, comprehensive health and dental benefits, and employee share ownership plan. Flexible hours with no 24-hour pharmacies in any of our locations. We support continuing education and offer various in-house training programs. Please send resumes to kay. firstname.lastname@example.org or apply online at www.drugstorepharmacy.ca or fax 1.866.628.5329 or please call 1.905.216.6010. LOWER MAINLAND Pharmacist – full-time Medical Pharmacies has an exciting opportunity in a specialized long-term care setting with no retail. The right candidate will embrace our leading technology and services; be innovative in their approach to providing excellent care to the residents we provide for; be clinically-oriented; and be licensed with the CPBC. Long-term care experience an asset, but not necessary. Great potential for career advancement. Responsibilities include institutional dispensing; checking orders, data entry, medication reviews, and possibly educational seminars; attending care conferences and Medication Safety Advisory Committee meetings; and creating great working relationships with facility directors. Position may require travel within the Lower Mainland. Please send resumes to email@example.com or fax 250.717.1565 or please call 250.317.6823. NORTHERN BC Pharmacist – full-time, relief Dedication to the health and well-being of our customers and patients is at the core of our business. We offer excellent base salary rates, annual bonus opportunities, full benefits package, educational allowance, paid med checks and career growth opportunities. Qualifications: pharmacy license to practice in BC, experience in retail pharmaceutical systems and dispensing procedures, exceptional communications and organizational skills, strong patient satisfaction orientation, ability to maintain optimum balance between the profession and business of pharmacy, strong problem solving and analytical skills, and the ability to work productively as part of a dynamic, fast-paced team. Please send resumes via email to firstname.lastname@example.org or apply online at www.rexallcareers.ca.
Community pharmacy for sale – Port Alberni A super community pharmacy for sale. Viable Rx department. Price will include 2,700 square foot strata lot. Easier financing if required. Alberni Valley economy is on rebound. Phone 250.723.9323 or fax 250.723.8221. Are you thinking of selling your pharmacy? OVERWAITEA FOOD GROUP may be interested. If you would like more information contact us at email@example.com At PHARMASAVE we understand that you want to be in business for yourself, not by yourself. You can have the best of both worlds! Maintain your freedom and independence while having access to the most comprehensive retail and professional programs in the industry. Pharmasave’s proven products, programs and strong national Brand are always at your service. Pharmasave is unlike any other independent pharmacy venture in Canada. We are a true cooperative that is 100 per cent member owned and governed. With Pharmasave, not only do you benefit from owning your own business, but you also share in the economic advantages of a 400 plus strong group of stores. Plus, you will be an owner in an organization that delivers all of its profits directly back to you, the shareholder. Allow us to demonstrate the advantages of Pharmasave. If you are a store owner or a pharmacist interested in purchasing a pharmacy, or if you are planning on selling your business, please give us a call. Pharmasave’s only priority is you and your success! Contact Dave Reston, CEO, Pharmasave Pacific, phone 604.575.5730 or 1.800.665.3344, or email firstname.lastname@example.org.
ASSOCIATION CONTACTS Geraldine Vance Chief Executive Officer 604.269.2860, email@example.com Parkash Ragsdale Deputy CEO, Director, Professional Services 604.269.2862, firstname.lastname@example.org Cyril Lopez Chief Operating Officer 604.269.2869, email@example.com Kathie Taylor Director, Communications 604.269.2863, firstname.lastname@example.org Elise Riedlinger Manager, Communications 604.269.2866, email@example.com Vince Lee Manager, Member & Corporate Services 604.269.2867, firstname.lastname@example.org Bryce Wong Manager, Professional Services 604.269.2865, email@example.com Riva Pickering Coordinator, Professional Services 604.269.2880, firstname.lastname@example.org Letlotlo “Coco” Lefoka Public Affairs Officer 604.269.2868, email@example.com Linda Tinnion Assistant, Member & Corporate Services 604.269.2864, firstname.lastname@example.org Ray Chow Database Administrator Member & Corporate Services 604.269.2882, email@example.com Starr Rempel Receptionist and Administrative Assistant 604.261.2092, firstname.lastname@example.org 604.261.2092, Toll-free: 1.800.663.2840 info@bcpharmacy
BC Lions Canucks BC Lions Car rental Canucks Cineplex Car rental Hotels around the world Cineplex PNE and Playland Hotels around the world Show tickets PNE and Playland and tickets much more! Show
BCPhA prescribed member discounts BCPhA prescribed member discounts
Canucks playoff tickets! Limited amount of tickets
and much more!
$150 in bill credits plus a $100 Visa cash card
Tickets will be discounted from the regular price and will be available in mid to late April. Our tickets are in the lower bowl in Section 102 Row 17 share (no alcohol section). Tickets General members with your immediate familywill be sold on a first come first served basis. Corporate members share with your pharmacy staff Photo from www.canucks.com
Visit www.bcpharmacy.ca/canucks for more information.
Fully loaded voice & data plan
per month** Vancouver Whitecaps
● 300 anytime minutes ● Unlimited local calling weekend and evenings after 6pm ● Unlimited local BCPhA in-network calling ● Unlimited Canada-wide text messaging (SMS) The Mortgage Group ● Voicemail 10, caller ID, call conference, call waiting, call forwarding ● 3GB data across Canada, tethering included Complimentary evaluation
Save big on all ticket types! Save from $13 to $24 depending and a $200 gift card upon *new three year activation means either transferring from another wireless providered or opening a new account with Telus with a brand new phone number on a three year contract. You must be subscribed on our plan on the ticket type you choose! completion for at least 6 months or an additional cancellation fee equivalent to the applicable bonus credit will be applied. **Taxes extra. There are no system access fees or 911 fees, so the typical bill will be $56 per month.
Vancouver Whitecaps Hotels around the world Save big on all ticket types! 10 to 15% cheaper than other booking websites on average Save $13 to $24 per ticket
Hotels around the world 10 - 15% cheaper than any other booking website on average
Se pte LowerCar bowl mb National Rental er tickets!Rent-A-Car Enterprise
Savings plus off regular season 20 - 35% added services and benefits
55% off pre-season
PNEoffers and Playland More Fully loaded plan for $50 a month $150 to $250 in cash and credit back
BC Lions tickets PNE and Playland events Car purchase Real estate services Best tickets prices in town Cineplex Retail Clearlycontacts.ca for Playland! Great savingsSubscriptions Events, on allshows, otherrestaurants PNE events and more new offers coming...
HOW TO TO ACCESS ACCESS THE THE DEALS DEALS HOW Login to www.bcpharmacy.ca and go to the Member Support - Affinity Rx section or email email@example.com Login to www.bcpharmacy.ca and go to the Member Support - Affinity Rx section or email firstname.lastname@example.org