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Canadian Hospital Pharmacy 2026 — Medication Safety, Formulary & Drug Review Guide
Complete guide to Canadian hospital pharmacy — medication safety, formulary management, CADTH drug review process, provincial drug plans, pharmacy standards, and pharmacy software.
CADTH reviews new drugs for clinical and cost-effectiveness. Provincial drug plans vary by province. Medication reconciliation is a mandatory ROP. This guide covers Canadian hospital pharmacy.
Pharmacy Services
| Service | Description | Standard |
|---|---|---|
| Inpatient pharmacy | Medication supply for inpatients | Global budget |
| Outpatient pharmacy | Discharge and outpatient prescriptions | Provincial drug plan |
| IV admixture | IV admixture and chemotherapy preparation | USP 797/800 |
| Clinical pharmacy | Clinical pharmacy services on wards | CSHP standards |
| Medication reconciliation | Admission, transfer, discharge | ROP (Accreditation Canada) |
| Drug information | Drug information service | CSHP standards |
| Pharmacokinetics | Drug level monitoring and dosing | CSHP standards |
| AMS | Antimicrobial stewardship programme | Accreditation Canada |
Medication Safety Standards
- Medication reconciliation: At admission, transfer, and discharge (ROP)
- High-alert medications: Special handling for insulin, anticoagulants, opioids, chemotherapy
- Independent double check: Independent double check for high-alert medications
- Look-alike/sound-alike: LASA medication management
- Smart pumps: Smart infusion pumps with dose error reduction software
- CPOE: Computerised physician order entry with clinical decision support
- Barcode medication administration: Barcode scanning at administration
- Medication incident reporting: Report all medication incidents (ISMP Canada)
CADTH Drug Review Process
| Step | Description | Timeline |
|---|---|---|
| 1. Submission | Drug manufacturer submits to CADTH | Manufacturer |
| 2. Clinical review | CADTH reviews clinical evidence | 3-4 months |
| 3. Economic review | CADTH reviews cost-effectiveness | Included |
| 4. Patient input | Patient and clinician input | Included |
| 5. Recommendation | CADTH issues reimbursement recommendation | 6 months total |
| 6. Provincial decision | Provinces make funding decision | 3-6 months |
Frequently Asked Questions
- What is CADTH and how does it work?
- CADTH (Canadian Agency for Drugs and Technologies in Health) is the national body that reviews new drugs and technologies. CADTH: 1) Conducts health technology assessments (HTA), 2. Makes reimbursement recommendations to provincial drug plans, 3. Reviews new drugs for clinical and cost-effectiveness, 4. Provides the Common Drug Review (CDR) for non-oncology drugs and pCODR for oncology drugs. Provinces use CADTH recommendations to make funding decisions.
- What are Canadian provincial drug plans?
- Canadian provincial drug plans: 1) Ontario — ODB (Ontario Drug Benefit), 2. BC — PharmaCare, 3. Alberta — ABDI (Alberta Blue Cross Drug Insurance), 4. Quebec — RAMQ drug plan, 5. Other provinces have their own plans. Coverage varies by province. Federal Pharmacare is being developed (national universal pharmacare). Hospitals have separate drug funding (global budget).
- What is medication reconciliation in Canadian hospitals?
- Medication reconciliation is a Required Organizational Practice (ROP) in Canadian hospitals. It must be done at: 1) Admission — compare pre-admission medications with admission orders, 2. Transfer — reconcile at every transfer, 3. Discharge — reconcile discharge medications with pre-admission and in-hospital medications. Medication reconciliation reduces medication errors by 50%.