Boris Trinajstic
Modern Apothecary: Ministry of Health Pharmacists Make Complex Decisions About Medications for the Good of the Province and its Residents
Words by Jessica Natale Woollard Photos by Aaron Lutsch
More than 11,000 medications and products were dispensed in British Columbia in 2023 to improve the health of patients. That’s a lot of medications for health care providers to stay on top of—to understand how to prescribe each of them, under what conditions they are most likely to work, and what the expected outcomes are.
Pharmacists are the medication experts of our healthcare system, providing trusted guidance on prescribing. Patients are most familiar with community pharmacists, who serve the public directly at drugstores and pharmacies where they are accessible and maintain relationships with the public.
But, working behind the scenes in the Ministry of Health are over 36 Public Service pharmacists, all members of the PEA’s Government License Professionals chapter.
These Public Service pharmacists are specialists in a range of pharmaceutical sciences, and their work supports their frontline counterparts. In addition to dispensing, they support the availability, funding, coverage and effective use of drugs in the province. For example, some oversee the list (called a formulary) of medications that are available through PharmaCare, BC’s publicly funded program that helps residents pay for many prescription drugs, dispensing fees and some medical devices and supplies. They ensure the medications are effective, prescribed optimally and available in BC, and they participate in the drug review process for new medications.
Other groups of ministry pharmacists help mitigate province-wide drug shortages; review data and ensure medications are used correctly to provide optimal results for patients; and dispense specialty medications to certain government programs, select patient populations and health authorities. Furthermore, some Public Service pharmacists help people access the drugs they need through both PharmaCare and the Special Authority, the division that grants patients full or partial coverage of a drug or medical device that otherwise may not be covered by PharmaCare.
The work of this team is vital to ensure British Columbians have access to safe treatment options for their conditions. Their work aligns with the mission to be responsible to the residents of BC as a whole and to contribute to responsible and appropriate use of public funds.
Victoria-based Boris Trinajstic, one of the province’s 10 Special Authority pharmacists, explains a key difference between a pharmacist in a community drugstore or hospital and a pharmacist working for the BC Public Service.
“When you’re working in a pharmacy, whether a hospital or community setting, you’re heavily focused on individual patient care,” he begins.
“Working for the Ministry of Health, Special Authority pharmacists must also use a sizeable view; decisions around coverage get made on a case-by-case basis, but also have implications on the entire population level. We’re responsible to the residents of BC, and we have to be mindful of everyone. We need to consider precedent and responsible use of public funds when we make decisions around coverage.”
Special Authority pharmacists work collaboratively and consult with physicians and other medical experts in the field through Drug Benefit Adjudication Advisory Committees (DBAAC). The work of these committees often concerns high-cost medications, addressing case-by-case scenarios in which an individual is seeking access to medication not typically covered by the province. The committee recommends to the Special Authority pharmacist whether the medication should be covered by taking into consideration an array of available information, including clinical patient information, diagnostics and therapeutic expertise.
They also contribute to the drug listing process, working with their counterparts on the Formulary Management team to assist with the addition of new medications being considered for the provincial formulary.
Trinajstic is a third-generation pharmacist but the first to work in the Public Service. He graduated in 2020 from the University of British Columbia with a doctor of pharmacy, and, after working as both a community and hospital pharmacist, he opted to work for the Public Service in 2023, drawn to the broader allure of helping all British Columbians.
Keeping the big picture in mind during decision making is key to the role of the Special Authority pharmacist, Trinajstic says, but it needs to be balanced against the needs of individual patients.
“At the end of the day, we serve all BC residents,” Trinajstic says. “Our day-to-day work often involves the critical thinking, evaluation of information, and collaborative professionalism. Whether we are reviewing a case in our DBAAC committees, assisting with a new medication being listed or adjudicating day-to-day Special Authority requests, we want to make sure any precedent-setting decisions are going to have the best impact on individual patient care, but also the wider system, in an evidence-based manner. For instance, if providing access to a certain medication can result in lower healthcare costs and expenditure down the road, we will always take that into consideration when we look at case-by-case scenarios.”
“But at the same time,” he adds, “we have to be mindful of the broader scale and ensure that we are doing our part to contribute to responsible use of public funds. Our goal is to provide the best outcomes we can for not only our healthcare system or individual patients, but also for British Columbians as a whole.”
See article in the Professional, Spring 2025
