LAHORE: Pakistan should introduce a structured framework allowing appropriately trained pharmacists to provide expanded pharmacy services and limited prescribing within a clearly defined legal scope, President Pakistan Drug Lawyer Forum Noor Muhammad Mahar has said.
Mahar, a pharmacist and Advocate High Court, said prescribing authority should not automatically be extended to every pharmacist but should be linked with approved clinical training, competency assessment, certification, Standard Operating Procedures (SOPs), professional accountability and regulatory safeguards.
He said an important consultation on pharmacy services and the professional scope of pharmacists in Punjab is expected to be held on August 31 at 11:00am, which could contribute towards developing a practical roadmap for recognising pharmacists as active members of the healthcare system while maintaining patient safety and clear professional boundaries.
According to Mahar, growing interest among young Pharm-D graduates in an expanded professional role is encouraging, but reforms should remain evidence-based, lawful and patient-centred rather than merely profession-centred.
He said discussions with pharmacy experts, including a recent interaction with Drug Regulatory Authority of Pakistan (DRAP) CEO Dr Ubaidullah Malik, had highlighted the importance of pharmacy services and clinical pharmacy within Pakistan's existing regulatory framework. Specialized responsibilities such as limited prescribing, however, would require additional clinical training and competency assessment, he added.
Mahar proposed that pharmacists seeking limited prescribing authority should undergo an approved clinical course, supervised practical training, competency examination and certification, followed by continuing professional development and periodic assessment.
“The objective should not be to turn pharmacists into physicians. The objective is to properly utilize pharmacists as medicines experts within a clearly defined healthcare team,” he said.
He said a formal pharmacy-practice framework could recognise qualified and appropriately trained pharmacists for services including blood pressure and pulse monitoring, blood glucose screening, medication review, monitoring of therapeutic outcomes, patient counselling on the appropriate use of medicines, and identification of potential adverse drug reactions, drug interactions and contraindications.
The scope could also include initial care and dressing of minor wounds, professional use of approved screening and patient-monitoring devices, and timely referral of complicated, undiagnosed and emergency cases to physicians or hospitals.
Mahar said appropriately trained pharmacists could eventually be permitted limited prescribing or supply of specifically authorised medicines under approved clinical protocols. Pharmacists should also be allowed to professionally use relevant equipment, including blood-pressure monitors, stethoscopes and glucose-monitoring devices, subject to defined standards and regulatory requirements.
He referred to a recent communication by the Pharmacy Council of Sindh to the Sindh Healthcare Commission seeking formal recognition of pharmacy practice, pharmaceutical care, patient counselling and appropriate professional use of screening and patient-monitoring tools by duly registered Category-A pharmacists.
Mahar proposed developing a clearly defined “positive list” or formulary specifying medicines and conditions that appropriately trained pharmacists could manage within their authorised scope.
Initially, he said, the framework could cover selected minor ailments, appropriate non-prescription medicines, continuation or monitoring of treatment already initiated by a physician and other circumstances specifically approved by regulators.
He cautioned that commonly used medicines, including paracetamol and diclofenac, should not automatically be considered freely prescribable simply because of their widespread use. Any prescribing or supply must take into account the medicine's legal classification, contraindications, the patient's condition and approved clinical protocols.
Mahar stressed that a clear distinction must be maintained between pharmacy practice and medical diagnosis. Complex diseases, emergencies and conditions requiring medical diagnosis should remain within the appropriate physician-led healthcare system.
“Pharmacists should complement rather than replace physicians through medication management, pharmaceutical care, screening, monitoring and timely referral,” he said, adding that clearly defined boundaries would protect patients as well as pharmacists and prevent legitimate pharmacy practice from being confused with unauthorised medical practice.
He called for coordination among pharmacy councils, DRAP, provincial healthcare commissions, academia and professional organisations to develop a coherent national framework. Relevant provisions of the Pharmacy Act 1967, DRAP Act 2012, pharmacy regulations, professional standards and provincial healthcare regulatory frameworks should be harmonised, he added.
Mahar welcomed initiatives by the Pharmacy Council of Sindh and ongoing discussions in Punjab, saying pharmacists needed a clearly recognised professional role across Pakistan.
He also urged young pharmacists to exercise patience and professional responsibility, stressing that proposed reforms should not be treated as an already acquired legal right until competent authorities formally approve the necessary rules, SOPs and scope of practice.
“Limited prescribing is not merely a professional privilege; it is a clinical responsibility. It should therefore be granted only after appropriate training, competency assessment and regulatory authorisation. The ultimate beneficiary of this reform must be the patient,” Mahar said.
