Pharmacist Prescribing in NZ: Collaborative Prescribing and Vaccinations

Expanding the Pharmacist's Scope of Practice

The role of the pharmacist in New Zealand has expanded significantly over the past two decades, moving beyond dispensing and OTC consultations towards more clinical roles including prescribing, vaccination, and chronic disease management. These expanded roles are underpinned by the Health Practitioners Competence Assurance Act 2003 (HPCA Act), which governs registration and scopes of practice for health professionals, and the Medicines Act 1981, which defines who may prescribe medicines.

Types of Prescribing Authority in NZ

Authorised Prescribers: Registered medical practitioners, dentists, veterinarians, nurse practitioners, and midwives (within their scope) have independent prescribing authority under the Medicines Act 1981. Pharmacists do not have general independent prescribing authority.

Designated Prescribers (Pharmacist Prescribers): The Medicines (Designated Prescriber: Pharmacists) Regulations 2021 established a pharmacist prescriber designation in NZ. Pharmacist prescribers must hold an approved postgraduate qualification, be endorsed by the Pharmacy Council of New Zealand, and work within a collaborative practice agreement with a supervising prescriber. The scope initially covers specified conditions and medicines only.

Collaborative Prescribing: Pharmacists can prescribe under a signed collaborative prescribing agreement with a medical practitioner or nurse practitioner. The agreement specifies the patient population, conditions, and medicines within the pharmacist's prescribing scope. This model is used in primary care, aged residential care, and hospital settings. Examples: anticoagulation management (warfarin dose adjustment based on INR results), diabetes management (adjusting insulin doses, initiating SGLT2 inhibitors in stable patients), asthma management (stepping up inhaler therapy based on symptom control).

Standing Orders: A standing order authorises a specified health professional (including trained pharmacists) to supply or administer medicines without a prescription in defined circumstances. Standing orders are commonly used for: influenza vaccination, COVID-19 vaccination, emergency hormonal contraception supply, and nicotine replacement therapy. The standing order must be signed by a medical practitioner or nurse practitioner and reviewed at least every three years.

Pharmacist Vaccination Services

Pharmacists in NZ may administer vaccines under a standing order or as a pharmacist prescriber. The National Immunisation Programme vaccines (including influenza, COVID-19, and others) can be administered by pharmacists who have completed approved vaccination training (including anaphylaxis management).

Requirements for pharmacists administering vaccines in NZ:

• Completion of an approved vaccination training course (covering immunisation theory, injection technique, and anaphylaxis management)
• Current Basic Life Support (BLS) certification
• Access to and competency in using adrenaline for anaphylaxis management (0.5 mg IM, anterolateral thigh)
• Access to emergency equipment (adrenaline, oxygen, BLS kit)
• Ability to maintain cold chain for vaccines (2–8°C)
• Ability to record in the National Immunisation Register (NIR)

Medsafe-Approved Vaccines Available via Pharmacy (NZ)

Common vaccines administered in NZ community pharmacies include: seasonal influenza vaccine (publicly funded for at-risk groups; available for self-pay for others), COVID-19 vaccines, hepatitis A and B, typhoid, Japanese encephalitis, meningococcal ACWY, and HPV vaccines (for those outside the school programme).

The Pharmacy Council of NZ and Professional Governance

The Pharmacy Council of New Zealand is the regulatory body under the HPCA Act responsible for the registration of pharmacists, setting competence standards, and ensuring ongoing fitness to practise. Pharmacists must complete annual practising certificate renewal, meeting continuing professional development (CPD) requirements (minimum 100 CPD points per triennium). The Council's Code of Ethics and Standards provide the ethical and professional framework within which all pharmacists must practise.

Future Directions

The NZ Government and pharmacy sector are actively expanding the pharmacist's clinical role through: wider pharmacist prescriber endorsements, long-term conditions management programmes (e.g., asthma, diabetes, cardiovascular risk), direct referral pathways to specialist services, and integration of pharmacy into primary care teams. These changes require pharmacists to maintain clinical competence, communicate effectively within multidisciplinary teams, and document interventions accurately.