OPA’s Supplementary Frequently Asked Questions on the Administration of Publicly Funded COVID-19 Vaccines in Ontario Pharmacies

This FAQ is designed to complement the Ministry’s Executive Officer Notices and accompanying Questions and Answers documents and as such may not provide an exhaustive list of Questions and Answers. For more information, please consult the following:

Please note that information provided in this FAQ is subject to change as discussions with government are ongoing. We will continue to update this document as necessary and identify changes as they become available.

Most Recent Updates:

  • Version 5.0 - April 7, 2021
    Pharmacy Participation – Questions 2, 3, 4 and 6 | Program Supplies – Questions 4, 5, 6 and 7 | Scheduling and Patient Eligibility – Questions 2, 3, 4, 6, 8, 9, 10, and 11 | Administration of Vaccine – Question 1 | Documentation and Billing – Questions 3 and 4 | Additional Questions – Questions 1 and 2

Last Updated: April 7, 2021

Pharmacy Participation

For the initial launch of the vaccination program, 327 pharmacies in three public health units (Toronto, Windsor-Essex County and Kingston, Frontenac and Lennox & Addington) were selected to participate. As a result of the short turnaround time for onboarding, the Ministry had decided to select pharmacies from these public health units who were currently participating in the Universal Influenza Immunization Program (UIIP) as they would have already been inspected for cold chain management and approved by their local public health unit. Due to the overwhelming response from pharmacies who were ready and willing to help with vaccination efforts, OPA, the Neighbourhood Pharmacy Association of Canada (Neighbourhood Pharmacies) and the Ministry worked closely together to select stores based on an equitable process.

In total, 472 sites were submitted for consideration through a call for nominations that was shared through OPA’s Owners Advisory Council and Board of Directors and with members of the Neighbourhood Pharmacies. These sites consisted of 321 corporate and 151 independent/banner pharmacies. A systematic methodology was applied to the selection of participating sites including ensuring equitable representation from both corporate and independent/banner pharmacies as well as utilizing influenza vaccine administration claims data obtained from the Ministry for the 2019/2020 and 2020/2021 flu seasons as a surrogate marker to inform discussions on individual pharmacy capacity. The pharmacies in each category (corporate and independent) were ranked from highest to lowest by the average number of flu vaccinations administered per day, recognizing the urgent need for pharmacies to administer a fixed allocation of vaccine within a 2.5-week time period, and prioritized for selection to participate in the initial launch of publicly funded administration of COVID-19 vaccines.

The selection process for phase 1 of the pharmacy rollout focused on high performing pharmacies to ensure no wastage since there was a fixed amount of vaccine that had to be administered within a short time frame before they expired. The number of stores was based on each store receiving a box of 500 doses and administering on average 40 vaccinations per day. The three regions were selected as they were the farthest along with their vaccination plans and liaising with pharmacies. It continues to be OPA’s shared goal with government to have all pharmacies participating when supply is available. Phase 2 will address any gaps and ensure there are pharmacies in all priority areas and vulnerable neighbourhoods.

Following the successful initial launch of COVID-19 vaccine administration in pharmacies, OPA has been working closely with the Ontario government and other stakeholders to expand the pharmacy initiative to include pharmacies from across the province. On April 1, 2021, an additional 371 pharmacies were onboarded to the program as part of phase 2 of the pharmacy vaccine rollout. Pharmacy eligibility and selection criteria can be found in the Executive Officer Notice: Information on the Rollout of Publicly Funded COVID-19 Vaccines in Ontario Pharmacies. In collaboration with the Ministry, the 34 public health units (PHUs) identified the number of stores for their regions to be selected in phase 2 and identified the hotspot areas. OPA and Neighbourhood Pharmacies worked with the Ministry to select the pharmacies in the 34 PHU’s using a robust and consistent methodology to ensure fairness. The criteria included identifying stores that were high performers during the Universal Influenza Immunization Program (UIIP) with a mix of pharmacy type and regional footprint to ensure rural and urban areas were covered. A minimum of three pharmacies were selected to participate in each PHU with more pharmacies in hotspot areas. A full list of participating pharmacies can be found on the Ministry’s COVID-19 pharmacy vaccine locations webpage.

An estimated additional 800 pharmacies is expected to be onboarded by the end of April, for a total of approximately 1,500 participating pharmacies. On April 2, the Ministry put out a call for applications from pharmacies interested in participating in the next round of recruitment for the administration of COVID-19 vaccinations. The selection criteria and process will be the same as in previous phases and is outlined in the Executive Officer Notice: Information on the Rollout of Publicly Funded COVID-19 Vaccines in Ontario Pharmacies. As the timeframe for selecting the next round of pharmacies is short, the call for applications will help to expedite the onboarding process. Interested pharmacies should consult the Pharmacy Readiness Checklist and the COVID-19 Vaccine – Quick Information for Pharmacies documents for more information. Additional information and instructions on where to send the completed COVax Access Agreement can be found in the DDD Notice No. 21046. Please note that not all pharmacies who apply will be selected to participate in this third phase of pharmacy enrollment, as the same methodology, with input from PHUs, will primarily be used to inform the order of enrollments. However, OPA is working with the Ministry to eventually allow all interested UIIP pharmacies to participate as soon as supply permits in the May/June timeframe.

 

Unfortunately, due to time and capacity constraints, inspections by public health units for adherence to cold chain management processes are not feasible at this time. As such, the Ministry has decided that only pharmacies who are currently participating in the UIIP will be eligible for selection as a participating pharmacy for the administration of COVID-19 vaccination. OPA recognizes that some pharmacies may not be participating in this season’s UIIP due to various reasons, e.g., new openings after the UIIP application deadline, and have highlighted this for the Ministry. However, at this point in time, exceptions are not possible. OPA will notify members should this selection criteria change.

For the initial launch of the program, it was determined that an average of 40 injections per day would be required in order to administer all 500 doses, which had an expiry of April 2, 2021, that were provided to participating pharmacies. However, moving forward, that minimum expectation remains because in addition to supporting patient access and priority areas, there is considerable emphasis on throughput to expedite the delivery of vaccinations to all Ontarians. In addition to ensuring that the selection process for pharmacies was fair and equitable, this requirement was also used to ensure that there would be no wastage of vaccine and that the pharmacy channel’s capacity for more shots in arms was maximized. This guidance may be revised moving forward depending on vaccine supply and how the pandemic evolves.

Pharmacy professionals at participating pharmacies who will be administering vaccines to patients (i.e., vaccinators) who have not yet been vaccinated themselves are eligible to receive the AstraZeneca/COVISHIELD COVID-19 vaccine at the pharmacy. It should be noted that at this time, this applies only to those individuals authorized to vaccinate patients (i.e., assigned to the role of vaccinator on the COVaxON platform) and does not apply to any other pharmacy staff regardless of whether or not they will be assisting with vaccination efforts. OPA has confirmed with the Ministry that reimbursement for administration of the vaccine to vaccinators can be processed through the Health Network System (HNS) as per the billing instructions in the EO Notice.

However, in light of the recent National Advisory Committee on Immunization (NACI) recommendation that this vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further, vaccinators who are under 55 years of age should not be offered this vaccine. Many public health units have already begun or are in the process of beginning vaccination of priority healthcare workers. Pharmacy professionals who are seeking their COVID-19 vaccination are encouraged to contact their local public health unit for more information.

OPA has developed the Pharmacy Playbook for COVID-19 Vaccine Administration which was presented during a table-top exercise with representatives from the Ministry of Health, the Ministers’ COVID-19 Vaccine Distribution Task Force and various public health units. This comprehensive document addresses operational considerations required to support the successful implementation of COVID-19 vaccine administration in pharmacies as well as workflow considerations presented in table format to help illustrate the process incorporating important factors such as scheduling, screening, obtaining informed consent, IPAC measures, etc. Additionally, OPA has created a pharmacy sign that participating pharmacies may wish to use to notify their patients of the availability of COVID-19 vaccine administration at their location. OPA is also working on developing additional resources including but not limited to, a compilation of a list of resources and tools on COVID-19 vaccines for pharmacy professionals. We will share these additional resources with members as soon as possible.

Program Supplies

Pharmacies participating in the administration of publicly funded COVID-19 vaccine administration may order PPE by accessing the Remedy online intake form. It is important to note that this supply should only be used to support the activity of pharmacies administering the publicly funded COVID-19 vaccine, and that there is an allocation framework in place depending on the current supply and not all orders for PPE may be filled. Pharmacies that belong to a banner or chain corporation should work through their corporate head office, who may centrally coordinate order and facilitate distribution. Independent pharmacies may order directly from the website. Please note that this is the same form/process of accessing PPE as the one used for the UIIP Program. There are three options on the Ministry form and pharmacies must select either:

  • Critical Personal Protective Equipment (PPE) / Swab Kit Requests; OR
  • Critical Personal Protective Equipment (PPE) / Swab Kit Requests with West LHIN(s) (if they belong to the West LHIN region)

DO NOT select the “Vaccination Supplies Requests” option as that will result in orders not being filled and pharmacies will be sent a message to select the PPE option belonging to their region which will delay fulfilling the order.

As stated in the Ministry’s Questions and Answers for: Administration of Publicly Funded COVID-19 vaccine in Ontario Pharmacies, there is an allocation framework in place for access to PPE depending on the current supply. OPA has partnered with two PPE suppliers – RONCO and Safe Direct, to ensure pharmacy professionals have continued access to medical-grade PPE. Pharmacies can now order a variety of products, including masks, face shields, gowns and gloves with the option to order large or small quantities and no restrictions on the number of times an order can be placed. Additional details about ordering from OPA’s partners can be found on the OPA webpage. If you have any questions or concerns, please contact us at 416-441-0788, or toll-free at 1-877-341-0788 option 1 or email us at [email protected].

Pharmacies participating in the administration of publicly funded COVID-19 vaccines will be provided with the following vaccine ancillary supplies:

  • BD Eclipse Needle with SmartSlip Technology, 23G x 1 1/4inch (0.6mm x 30mm) Injection Needle
  • BD Eclipse Needles with SmartSlip Technology, 25G x 1 (0.5mm x 25mm) Injection Needle
  • BD 3mL Syringe with Luer-Lok Tip
  • Tech Choice 70% Isopropyl Alcohol Prep Pads
  • Covidien Curity Sheer Adhesive Bandage (7/8inch)
  • Covidien Dermacea Non-Woven Gauze Sponges 4-Ply (2 inch x 2 inch)
  • Sharps Container (22.7L)
  • Covidien SharpSafety Sharps Container 3 Gallons (or 11.3L)

Pharmacies do not have to order these supplies; it will be shipped based on vaccine allocations. However, due to different delivery requirements, these supplies may not arrive at the same time as vaccine deliveries. Please also note that there is a limited supply of sharps containers available, and they will be provided as long as stock is available. Once depleted, pharmacies would have to dispose of sharps through their own arrangements with waste stewardship programs.

Currently, two COVID-19 vaccine products are available to pharmacies: COVISHIELD and the COVID-19 Vaccine AstraZeneca (U.S). In order to expedite the distribution of the products in Canada, these supplies have either COVAX English-only labels or US-labels. AstraZeneca COVID-19 Vaccines with COVAX or US labels are the same as the Health Canada authorized AstraZeneca COVID-19 Vaccine in all aspects (i.e., formulation, strength, route of administration). These labels are presented in English-only and are missing some important Canadian-specific information normally found on Health Canada approved labels. Pharmacy professionals should consult the Health Canada notice on the AstraZeneca COVID-19 Vaccine, COVAX English-only vials and carton labels, as well as the notice pertaining to the US vial and carton labels for more information. Vaccine supply with Canadian-specific information will be implemented by June 2021.

OPA is also advocating for the addition of mRNA vaccines into the pharmacy channel. Although the provision of these vaccines will have different requirements compared to the AstraZeneca vaccine, we believe that with appropriate planning, pharmacies can administer both Pfizer and Moderna COVID-19 vaccines. The addition of other vaccine products will allow greater flexibility to expand the age brackets for patient eligibility as well as allow pharmacies to assist with vaccinating essential workers. OPA will apprise members of any updates when it becomes available.

On March 29, 2021, as a precautionary measure, NACI issued a recommendation that AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further. At this time, this recommendation does not affect the pharmacy program as those eligible for pharmacy administration of AstraZeneca COVID-19 vaccine are 55 years of age and older at the time of the vaccination or any time in 2021. As per NACI, adults 55 years of age and older may still be offered the AstraZeneca vaccine with informed consent, given the increased risk of hospitalization and death due to COVID-19 disease in this population and since VIPIT appears to be a rarer event in that age group. Anyone receiving the AstraZeneca COVID-19 vaccine should be informed of this potential adverse event and advised to seek immediate medical attention if they develop symptoms of thromboembolism and/or thrombocytopenia between days 4 and 20 following receipt of the AstraZeneca vaccine. Symptoms to be vigilant for include shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms including sudden onset of severe or persistent worsening headaches or blurred vision, skin bruising (other than at the site of vaccination) or petechiae. NACI will continue to reassess this recommendation based on the rapidly evolving evidence. For more information about the rationale behind NACI’s recommendation, please consult the NACI statement. Additional information about this adverse event can be found in Health Canada’s Healthcare Professional Letter on AstraZeneca COVID-19 Vaccine and COVISHIELD: Risk of Thrombosis with Thrombocytopenia as well as the science brief, Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) Following AstraZeneca COVID-19 Vaccination, and Lay Summary from the Ontario COVID-19 Science Advisory Table.

All pharmacies participating in the initial launch received a shipment of 500 doses of COVISHIELD vaccine, which had to be administered by April 2. For newly onboarded pharmacies in phase 2 of the pharmacy vaccine rollout, each pharmacy will receive up to 2 boxes (each with 100 doses) of the AstraZeneca COVID-19 vaccine for administration. As there may be regional differences in allocation, pharmacies may wish to check with their distributor for specific details on their region.

Similar to the UIIP, all pharmacy re-orders for COVID-19 vaccines will be placed and distributed through a pharmaceutical distributor (McKesson Canada Corporation or Shoppers Drug Mart Inc.). As distribution and allocation quantities are dependent on vaccine supplies, the Ministry has decided to put restocking guidelines in place. For pharmacies who participated in the initial rollout (phase 1) who have less than 80 doses remaining at their pharmacy, a replenishment supply of 100 doses will be distributed. Phase 1 pharmacies that did not receive a replenishment of 100 doses will be reviewed by the Ministry on a case-by-case basis for replenishment. Moving forward, all pharmacies (both those who were part of the initial launch and those newly onboarded pharmacies as part of phase 2), will be able to place a re-order for vaccines in increments of 100 doses per order for consideration if supply is still available, once the pharmacy has 80 doses or less remaining on hand. It should be noted that there may be some variation to these quantities for pharmacies supplied by Shoppers Drug Mart as boxes (100 doses) may be split to accommodate for the limited allocation quantities in certain regions. The Ministry will be monitoring inventory levels using the information available through the COVaxON database therefore it is mandatory and imperative for pharmacies to record inventory received and doses administered on COVaxON as these records are used when determining regional allocations and restock thresholds/limits. Please note that the restock restrictions are a temporary measure that is required due to limited vaccine supply at this time. The restrictions are to promote equity and fairness to all pharmacies participating in the program. The ministry will be monitoring COVaxON inventory records and will re-evaluate the restock thresholds/limitations as vaccine supplies become more stable in the coming months. However, as regional allocations and vaccine supply are dependent on transfer of federal vaccine supply, distributors may not be able to accommodate all restocking requests. For more information on vaccine distribution and allocation, pharmacies can contact their pharmacy distributor.

OPA has also confirmed that second dose allocations will be guaranteed and we will continue to work closely with the Ministry and pharmaceutical distributors to ensure allocations are sufficient for patients to receive their second dose at the same location they received their first dose.

At this time, transferring publicly funded COVID-19 vaccines between stores is not permitted. However, to ensure that all doses are used in a timely fashion and to minimize wastage, we continue to monitor the situation closely with the Ministry to determine the need for such action. Pharmacies with concerns regarding excess inventory should contact the OPA as soon as possible to discuss potential options.

Vaccine Storage and Handling

Each local public health unit (PHU) will decide whether temperature logs for the refrigerator(s) storing publicly funded COVID-19 vaccine doses need to be submitted. Participating pharmacies should check with their local PHU to determine what the specific requirements are.

Scheduling and Patient Eligibility

At this time, pharmacies will be using their own booking systems to schedule vaccine appointments. The online booking system and provincial customer service desk that launched on March 15 will only be used to support appointment bookings at mass immunization clinics. To support pharmacies, OPA has partnered with MedEssist Ltd. to offer a digital health solution that will enable community pharmacies across Ontario to meet the immediate demand for COVID-19 vaccinations. This effective patient-first, digital health solution is a web-based tool that can also be accessed on mobile. As Canada’s first and only inventory-based, patient-triaging platform for pharmacies, MedEssist’s system is designed to enable pharmacies to operate more efficiently and provide exceptional patient care while minimizing vaccine wastage. MedEssist’s innovative system has helped pharmacies across Canada to successfully manage a record-breaking flu vaccination campaign in 2020. More details and additional resources will be shared shortly. In the meantime, for more information, please send your inquiries to [email protected].

Pharmacies will be using their own booking systems to book patient appointments to receive COVID-19 vaccinations. Therefore, appointment times should be scheduled to coincide with the times that vaccine administration would be offered. Additionally, pharmacy staff should be made aware of the hours that COVID-19 vaccine administration would be available in order to communicate the information to patients. Pharmacies are reminded that participating pharmacies are expected to have the capacity and ability to administer, at minimum, an average of 40 injections per day. These considerations must be taken into account when determining vaccine administration times and appointment availabilities to avoid vaccine wastage.

COVID-19 vaccination at pharmacies is currently available by appointment only but there may be situations where walk-ins are possible. Additionally, for second doses, pharmacies are reminded that as part of the documentation requirements listed in the EO notice, a written or electronic record of the COVID-19 immunization administration must be provided to the patient, which includes the pharmacy’s contact information and date and time for the second scheduled dose (if applicable) at the same pharmacy location. Pharmacies should also consider the need to manage the number of doses remaining to ensure no vaccine is wasted when determining the appropriateness to permit walk-ins.

Second doses of COVID-19 vaccines should be scheduled according to manufacturer recommendations and/or based on public health guidance. For AstraZeneca/COVISHIELD COVID-19 vaccine, as per the product monographs, the second dose should be administered between 4 and 12 weeks after the first dose. However, starting March 10, 2021, with limited exceptions, Ontario will be following NACI’s recommendations that in the context of limited supply of COVID-19 vaccines, the dosing interval between the first and second doses will be extended to four months for all Health Canada approved vaccines. As such, pharmacies should be booking second dose appointments for patients four months after their first dose until further guidance is provided. Since this time, the Vaccine Clinical Advisory Group (VCAG) has provided recommendations for exceptions to the extended dose intervals for certain special populations:

  • Transplant recipients (including solid organ transplants and hematopoietic stem cell transplants) should receive the COVID-19 vaccine at the dose interval as indicated in the product monographs for COVID-19 vaccines.
  • Individuals with malignant hematologic disorders and non-hematologic malignant solid tumors receiving active treatment (chemotherapy, targeted therapies, immunotherapy), excluding individuals receiving solely hormonal therapy or radiation therapy, should receive the COVID-19 vaccine at the dose interval as indicated in the product monographs. In keeping with current practice, ideally, vaccination should occur at a time when they are most likely to mount immune responses.

As such, for these special populations, rather than booking a second dose appointment 4 months after the first dose, pharmacists may use their professional judgement and book an earlier second dose appointment in accordance with the dosing interval indicated in the product monographs. Appropriate documentation should accompany this decision.

Pharmacy professionals are reminded that it is mandatory for pharmacies to have second dose appointments scheduled for patients prior to them leaving after receiving their first dose as per the documentation requirements listed in the EO notice, which state that a written and electronic (if applicable) record of the COVID-19 immunization administration must be provided to the patient, which includes the pharmacy’s contact information and date and time for the second scheduled dose (if applicable) at the same pharmacy location. In addition, patients must be provided with instructions on how they can reach the pharmacy in the event they need to reschedule as well as how the pharmacy will reach them should there be a need to reschedule due to issues such as vaccine supply.

Patients are strongly encouraged to receive their second dose at the same pharmacy location where they received their first dose. To facilitate this, pharmacies should either schedule second dose appointments at the same time as booking for first doses or schedule the second dose appointment before the patient leaves the pharmacy after receipt of their first dose. Patients should also be counselled on the need to receive the same vaccine product for both doses which may not be possible if they go elsewhere (e.g., first dose at a pharmacy and second dose at a mass vaccination clinic may not be with the same vaccine product). In limited cases where the patient cannot return to the same pharmacy for their second dose, pharmacies should ensure the second dose appointment is cancelled in their booking system (if applicable) and they may wish to assist the patient with finding another site that can provide the required second dose.

No. All patients who are aged 55 years of age and older at the time of vaccination or any time in 2021 are eligible for COVID-19 vaccine administration at the pharmacy. Patients who do not have Ontario health cards must bring in an alternate form of valid government-issued identification or one of the following acceptable forms of identification which includes their name and date of birth, such as:

  • Birth Certificate
  • Employee ID
  • First Nations ID
  • Passport
  • MRN (Medical Record Number)
  • Out of Province ID
  • Driver’s License

No. The proxy ID should only be used in cases where a patient does not have an Ontario health card number. Patients with an Ontario health card number are required to provide this to the pharmacy so that a claim for reimbursement through the HNS can be submitted.

As per the Executive Officer notice issued on April 1, 2021, until further notice, the eligible populations for pharmacy COVID-19 vaccine administration are those aged 55 years and older at the time of vaccination or any time in 2021. It is important to note that on March 29, 2021, as a precautionary measure, NACI issued a recommendation that AstraZeneca COVID-19 vaccine should not be used in adults under 55 years of age at this time while the safety signal of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following vaccination with AstraZeneca COVID-19 vaccine is investigated further. As per NACI, adults 55 years of age and older may still be offered the AstraZeneca vaccine with informed consent, given the increased risk of hospitalization and death due to COVID-19 disease in this population and since VIPIT appears to be a rarer event in that age group. Anyone receiving the AstraZeneca COVID-19 vaccine should be informed of this potential adverse event and advised to seek immediate medical attention if they develop symptoms of thromboembolism and/or thrombocytopenia between days 4 and 20 following receipt of the AstraZeneca vaccine. Symptoms to be vigilant for include shortness of breath, chest pain, leg swelling, persistent abdominal pain, neurological symptoms including sudden onset of severe or persistent worsening headaches or blurred vision, skin bruising (other than at the site of vaccination) or petechiae. NACI will continue to reassess this recommendation based on the rapidly evolving evidence. For more information about the rationale behind NACI’s recommendation, please consult the NACI statement. Additional information about this adverse event can be found in Health Canada’s Healthcare Professional Letter on AstraZeneca COVID-19 Vaccine and COVISHIELD: Risk of Thrombosis with Thrombocytopenia as well as the science brief, Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) Following AstraZeneca COVID-19 Vaccination, and Lay Summary from the Ontario COVID-19 Science Advisory Table.

On March 16, 2021, NACI expanded its recommendation for the use of AstraZeneca vaccine (including COVISHIELD) in individuals 18 years of age and older to also include those 65 years of age and older. This change was a result of the review of three recent real-world effectiveness studies. For more information about this updated recommendation, please refer to NACI’s Summary of updated vaccine statement and the Recommendation on the use of COVID-19 vaccines.

In order to ensure alignment with NACI’s recommendation and Ontario’s Ethical Framework, effective April 1, 2021, the patients eligible for publicly funded COVID-19 vaccine administration at the pharmacy are those aged 55 years and older at the time of vaccination or any time in 2021. This eligibility criteria may be updated from time to time. OPA will provide updates to members as new information becomes available.

At this point in time, only adults 55 years of age and older as of the day of vaccination or any time in 2021 are eligible for COVID-19 vaccine administration at the pharmacy. The eligibility criteria will be updated from time to time and the Executive Officer Notice will be updated accordingly as vaccine supply allows. Patients who do not meet the eligibility criteria can also refer to guidance from their local public health units on when and where they can receive their COVID-19 vaccination.

As per the Executive Officer notice, individuals 55 years of age and older as of the day of vaccination or any time in 2021 are eligible for COVID-19 vaccine administration at the pharmacy. There is no requirement for pharmacies to validate the address of a patient to determine eligibility. However, on March 14, 2021, the Ministry further clarified that it is expected that pharmacies would be focusing on vaccinating their own patients and local community. Pharmacies should use their judgement to support providing vaccinations to those within their region.

Administration of Vaccine

As per the EO notice, vaccine administration must occur at the location of the participating pharmacy premise. For further clarity, this means that for pharmacies insured under OPA’s store insurance program, premises would typically include the parking lot of the pharmacy insured. Pharmacies are encouraged to review the details of their insurance coverage with their individual providers as appropriate. OPA is also advocating for the government to enable pharmacy professionals to administer COVID-19 vaccinations outside of the pharmacy premises in order to reach more patients within the community. OPA will continue to apprise members of any updates when it becomes available.

Yes. Consent may be given directly, either orally or in writing, by an informed patient or their substitute decision maker as long as it is obtained from each vaccine recipient according to the standards, requirements and any associated guidance of the Regulated Health Professions Act, the Pharmacy Act, and the Ontario College of Pharmacists (OCP). Members may refer to the OCP’s Administering a Substance by Injection or Inhalation guideline as well as the Ministry’s Pre-Screening Assessment Tool for Health Care Providers for more information on informed consent to treatment. In addition, for the administration of COVID-19 vaccines, pharmacy professionals are reminded that documentation of the consent must be done not only in the patient record at the pharmacy, but also in COVaxON. Please refer to OPA’s Pharmacy Playbook for COVID-19 Vaccine Administration for a sample workflow on how to integrate the documentation requirements into practice.
Prior to the appointment, pharmacies are encouraged to provide patients with the following, if possible (in situations where this cannot be done, these documents should be provided to the patient upon arrival at the pharmacy for their appointment): Pharmacy professionals are reminded that although this information may be provided beforehand, when the patient arrives for their appointment, it is important to conduct another active screen of the patient for COVID-19, ensure that all screening questions have been answered and inputted into COVaxON and that all patient questions/concerns are addressed in order to obtain informed consent. Please refer to OPA’s Pharmacy Playbook for COVID-19 Vaccine Administration for more information and a sample workflow.

Pharmacies participating in the administration of publicly funded COVID-19 vaccinations must enter all information pertaining to the administration into COVaxON. COVAXON is the database that will capture all COVID-19 vaccine administration for the province. As such, information related to vaccine administration and inventory supply must be entered into this system. The fee paid to pharmacies for administering the COVID-19 vaccine includes pharmacy services related to accessing and using the Provincial COVID-19 Vaccine Solution-COVAXON. For more information about the requirements for accessing and using COVaxON please refer to the COVID-19 Vaccine Agreement.

The “Authorized by” box is meant to capture the name of the supervising pharmacist in situations where the COVID-19 vaccine is administered by a pharmacy intern, student or technician.

Documentation and Billing

No. All users of COVaxON are expected to have and use their own user account. The name of the individual who administered the vaccine (i.e., the vaccinator) must be entered into COVaxON regardless of whether they are a pharmacist, pharmacy student, pharmacy intern or pharmacy technician. However, if the vaccine was administered by a qualified pharmacy professional who is not a pharmacist, the name of the supervising pharmacist should be captured in the “Authorized by” box on the COVID-19 Vaccine Consent Form. In addition, when submitting the claim for payment to the HNS, the Pharmacist ID of the injection-trained supervising pharmacist must be used.

Pharmacy professionals are required to maintain a complete and accurate patient record which would include documentation of the COVID-19 vaccine administration. For more information about expectations for documentation in pharmacy practice, please consult OCP’s Documentation Guidelines. At this time, the information entered into COVaxON is not downloadable and therefore, pharmacies must also keep a record of the vaccine administration in an alternate format within the pharmacy files. Pharmacies may choose to use the Ministry’s COVID-19 Vaccine Consent Form to help capture some of the required information, however, please note that as this form is not specific to the pharmacy sector, there are some documentation requirements specific to the pharmacy program that are not captured by this form, including:
  • Expiry date
  • Signature of the immunizer
  • Documentation that proof of immunization was provided
This information must be documented on the form as per the EO Notice. In addition, pharmacies are reminded that both the name and address of the pharmacy must be included as both are required pieces of information for pharmacy documentation. Please refer to OPA’s Pharmacy Playbook for COVID-19 Vaccine Administration for a sample workflow on how to integrate the documentation requirements into practice.

As part of the documentation requirements listed in the EO notice, a written and electronic (if applicable) record of the COVID-19 immunization administration must be provided to the patient, which includes the pharmacy’s contact information and date and time for the second scheduled dose (if applicable) at the same pharmacy location. As the record from COVaxON is the official proof of immunization, it must be provided to the patient. Pharmacies should provide patients with the option of receiving either a print-out or electronic version of the COVaxON record. Of note, currently this record from COVaxON does not include the pharmacy’s contact information nor the appointment information for the second dose. For pharmacies who are providing a print-out of this record to the patient, the pharmacy’s contact information and second dose appointment date and time must be added to the print-out. Alternatively, pharmacies may choose to provide a separate written record of immunization (along with the printed or emailed COVaxON proof of immunization record) to the patient that contains all the required information.

To meet this requirement, after providing the written and electronic (if applicable) COVID-19 immunization record to the patient, pharmacy professionals should document that this step has been completed and how it was provided (written and electronic if applicable) with the patient’s administration record for audit purposes.

Pharmacy professionals who have first aid training are permitted to administer epinephrine auto-injectors for emergency treatment after administration of the COVID-19 vaccine and regardless of who administered it, the epinephrine auto-injector will be reimbursed by the Ministry for this purpose. However, it is important to note that when submitting the claim through the HNS, the name of the Part A pharmacist who administered or supervised the administration must be included in the prescriber field.

The date of service for the COVID-19 vaccine administration claim for payment must be the same as the date the vaccine was administered, therefore the claim should, if possible, be submitted on the same day as the administration. However, the HNS can process online transactions for publicly funded services on any of the most recent seven calendar days, including the current date. This means that a claim for the COVID-19 vaccine could be submitted today for a service date in the past (as long as it is within the past 7 days). For example, if the current date is March 24, a claim with a transaction date of March 17 will be rejected (i.e., response code “A1 – Claim too old”); whereas a transaction date of March 18 will be accepted.

For ODB drug claims, if more than seven calendar days have elapsed after the drug was supplied and the pharmacy was unable to verify that the drug was for an eligible person until more than 7 days after the dispensing event, the pharmacy could submit their claim for payment manually with a paper-based submission, in accordance with paragraph 1 of subsection 24(2) of O. Reg. 201/96 under the Ontario Drug Benefit Act. However, no manual paper claims will be accepted for COVID-19 vaccine administration at the pharmacy as per the Executive Officer Notice: Administration of Publicly Funded COVID-19 vaccines in Ontario Pharmacies – Billing. Therefore, the pharmacy can only submit the COVID-19 vaccine administration claim up to 7 days from the service date electronically through the HNS.

Insurance

For pharmacists, pharmacy interns, pharmacy students and pharmacy technicians who have OPA’s Individual Professional Liability Insurance (PLI), coverage will be provided as long as the insured individual is practicing within their scope and in accordance with the COVID-19 Vaccine Agreement with the Ministry. For more information about your coverage, please contact [email protected]. As the terms and conditions of coverage may vary between plans, it is recommended that pharmacy professionals who have individual PLI with other carriers check with their individual plans regarding coverage.

The OPA Store Insurance Program automatically provides entity professional liability coverage for pharmacies that are participating in the administration of publicly funded COVID-19 vaccines. This coverage protects you or other licensed individuals in your employ from negligent acts, errors or omissions as long as the individuals were practicing within their scope and in accordance with the COVID-19 Vaccine Agreement with the Ministry as part of the pharmacy’s business activities. For more information about your coverage, please contact [email protected]. As the terms and conditions of coverage may vary between plans, it is recommended that pharmacy professionals who have store insurance with other carriers check with their individual plans regarding coverage.

Additional Questions

Participating pharmacies who would like to make changes to their pharmacy information on the Ministry’s COVID-19 pharmacy vaccine locations webpage should send their requests directly to the Ministry at [email protected]. Please use the email subject line: “COVID-19 Vaccination Webpage Change Request” and include the following:

  • Change requested (e.g., typo, new phone # or URL, etc.)
  • Pharmacy name, address, ON Provider # (mandatory)

Requests may take at least 24 hours to be processed and reflected on the webpage.

For billing inquiries, pharmacies should contact: ODB Pharmacy Help Desk at 1-800-668-6641.

For inquiries about the program or materials, pharmacies can contact the Ministry at [email protected].

Members of OPA can also access our Practice Support Network at [email protected].

Pharmacies with questions related to COVaxON should contact the Pharmacy IT department of their corporate/chain/banner head office for further assistance. Pharmacies without access to corporate/chain/banner head office support may contact OPA for support.