Pharmacists to take on doctors’ role? Proposed prescribing powers spark concern

ISLAMABAD: Could pharmacists in Pakistan eventually be allowed to prescribe medicines for patients, bringing part of their professional role into an area traditionally associated with doctors? The prospect of expanding pharmacists’ clinical responsibilities has triggered a growing debate among healthcare professionals, with doctors warning that any change must preserve clear boundaries between pharmacy practice and medical diagnosis and treatment.

The controversy centres on proposals for limited prescribing by appropriately trained pharmacists, alongside a wider review of the Pharmacy Act, 1967, and the regulatory framework governing the profession.

The Young Doctors Association (YDA) Pakistan, together with its four provincial chapters, has now appealed to Federal Minister for National Health Services, Regulations and Coordination Syed Mustafa Kamal, urging the government to ensure that proposed changes do not undermine the authority of registered medical practitioners or compromise patient safety.

In its appeal, the association argued that diagnosing diseases and prescribing medicines are not within pharmacists’ established professional scope. While acknowledging the important role pharmacists play in the preparation, dispensing and safe use of medicines, YDA cautioned against changes that could elevate their responsibilities to a level resembling those of medical specialists without the relevant medical qualifications.

The association also urged the federal government to strengthen measures against quackery and unauthorised medical practice rather than create legal provisions that, in its view, could encourage healthcare professionals to work beyond their recognised scope.

The concerns come as pharmacy representatives seek greater recognition of pharmacists’ clinical expertise and a clearly defined role in patient care. The resulting debate is no longer confined to professional recognition; it concerns the limits of prescribing authority, the responsibilities of different healthcare professionals and the safeguards needed to protect patients.

Pharmacists seek limited prescribing authority

A key development in the debate is the proposal to allow pharmacists with additional clinical training and appropriate certification to prescribe selected medicines within a legally defined scope.

During an earlier meeting with Federal Health Minister Syed Mustafa Kamal, a delegation of the Pakistan Pharmacists Association (PPA) had discussed professional and regulatory issues, including a proposal to allow qualified pharmacists to prescribe medicines within a limited scope.

The delegation was led by PPA President Alamgir Rao and included Professor Dr Furqan Hashmi, General Secretary Imran Ahmed Mumtaz, Dr Kaleemullah, Khaqan Babar, Shifa Khan Bangash, Mahesh Kumar and Ms Masiha Noreen.

The discussions also covered uniform standards for pharmacist registration, licensing and pharmacy services across the country. The minister reportedly assured the delegation of cooperation at the relevant forums in addressing professional and policy matters.

The proposal does not envisage granting every registered pharmacist unrestricted prescribing authority. Rather, its advocates have called for a framework under which pharmacists who complete additional clinical training, demonstrate competency and obtain the required certification could be authorised to manage selected conditions and prescribe or supply specifically approved medicines.

This distinction is important because a pharmacist's existing registration does not automatically confer the proposed additional prescribing authority.

What would limited prescribing involve?

Pakistan Drug Lawyer Forum President Noor Muhammad Mahar, a pharmacist and Advocate High Court, has been among those advocating a structured legal framework for expanding pharmacists’ patient-care responsibilities.

In an August 28, 2026, statement, Mahar said any prescribing authority should be linked to approved clinical training, supervised practical experience, competency assessment, certification, standard operating procedures and professional accountability.

He proposed that appropriately trained pharmacists could provide services including blood pressure and blood glucose monitoring, medication reviews, patient counselling, identification of potential drug interactions and adverse reactions, and monitoring of treatment outcomes.

The proposed scope could also include basic first aid, initial care and dressing of minor wounds, and the use of approved screening and patient-monitoring equipment.

For limited prescribing, Mahar suggested that regulators develop a clearly defined positive list or formulary specifying the medicines and conditions that eligible pharmacists could manage. The initial framework could cover selected minor ailments, appropriate non-prescription medicines and continuation or monitoring of treatment already initiated by a physician, where expressly authorised.

He stressed that medicines should not automatically become eligible for pharmacist prescribing simply because they are commonly used. Their legal classification, contraindications, patient-specific risks and approved clinical protocols would need to be considered.

Mahar also proposed mandatory referral arrangements for complicated, undiagnosed and emergency conditions requiring assessment by a qualified medical practitioner.

His stated objective was to recognise pharmacists as medicines experts within a defined healthcare team, rather than turn them into physicians or allow them to replace doctors.

The proposal, however, remains a matter for the competent government and regulatory authorities. Mahar himself has emphasised that limited prescribing should not be treated as an existing legal right until the necessary legislation, rules and professional authorisations are formally approved.

Why doctors are concerned about the proposed changes

For doctors, the central concern is whether an expansion of pharmacists’ responsibilities could create overlapping authority in clinical decision-making, particularly where patients require a diagnosis before a medicine can safely be prescribed.

YDA Pakistan's appeal argues that diagnosing illnesses and determining appropriate treatment require medical qualifications and professional accountability. It maintains that pharmacists' expertise in medicines should complement the work of medical practitioners rather than extend into independent medical practice without a clearly established legal and clinical framework.

The association has also pointed to the regulatory obligations already placed on registered medical practitioners under the Pakistan Medical and Dental Council (PMDC) framework, arguing that professional responsibilities and limitations must be respected across the healthcare system.

The concern is not simply about who can issue a prescription. A prescription may require consideration of a patient's symptoms, medical history, existing conditions, allergies, potential complications and the possibility of an underlying disease requiring further investigation.

Doctors therefore argue that any limited prescribing arrangement must clearly identify which conditions can be managed, which medicines may be prescribed, when referral is mandatory and who bears responsibility if a patient's condition is misdiagnosed or treatment causes harm.

The distinction between screening and diagnosis is equally important. Measuring blood pressure or blood glucose, for example, can provide useful clinical information, but interpreting those findings in the context of a patient's overall health and diagnosing an underlying condition involve broader clinical responsibilities.

These concerns do not diminish the contribution pharmacists can make to patient care. Their expertise in pharmacology, medicine interactions, dosage, dispensing and medication safety is essential to healthcare. The policy question is how those capabilities can be used more effectively without creating uncertainty over clinical responsibility.

Doctors challenge reported proposal concerning Section 31(4)

A separate but closely related dispute concerns Section 31(4) of the Pharmacy Act, 1967, particularly subsection 4(a).

The provision creates an exception to the general prohibition on practising as a pharmacist without registration. Under Section 31(4)(a), a registered medical practitioner may dispense medicines to their own patients or serve their own prescriptions.

Doctors have raised objections to a reported proposal to abolish or amend Section 31(4), arguing that doing so could affect their ability to prescribe and dispense medicines to patients at their clinics and hospitals.

Commenting on the matter, Dr Mohammad Rizwan Rajpot, vice-chairman of the Khyber Pakhtunkhwa Professional Doctors Association said that doctors would oppose amendments that curtailed registered medical practitioners' authority to prescribe and dispense medicines.

Dr Rizwan said a delegation of senior doctors from Khyber Pakhtunkhwa, including Dr Zulfiqar Ali, Dr Hakeem Khan Marwat and Dr Khawaj Abid, had met members of the National Assembly's Standing Committee on National Health Services, Regulations and Coordination in Islamabad to convey their reservations about proposed changes concerning independent prescribing.

He described the reported proposal to abolish Section 31(4) as unacceptable to doctors, arguing that it could affect their professional authority to supply medicines to their own patients.

The legal distinction surrounding this provision is significant. Section 31(4)(a) does not grant pharmacists independent prescribing powers. It provides a specific exception for registered medical practitioners in relation to dispensing medicines to their own patients or serving their own prescriptions.

The Federal Constitutional Court addressed the provision in an October 3, 2026, judgment, holding that a registered medical practitioner may dispense medicines to their own patients within the scope of Section 31(4)(a), but cannot operate a medical store or retail drug outlet without a separate licence under the Drugs Act, 1976.

The court distinguished between a doctor's limited dispensing activity for their own patients and the commercial sale of medicines through a retail outlet, which is subject to separate licensing requirements.

Consequently, the reported proposal concerning Section 31(4) and the wider demand for limited pharmacist prescribing should not be treated as the same legal issue. The former concerns an exception available to registered medical practitioners, while the latter concerns a proposed expansion of pharmacists' professional scope.

The exact wording of the draft amendment is needed to determine how the two issues may be affected by any eventual legislative changes.

How the Pharmacy Act is being reviewed

The Pharmacy Act, 1967, is the principal federal law governing pharmacy practice and the regulatory framework for pharmacy education and pharmacist registration.

The current debate involves both parliamentary proceedings and a separate government-led technical review. Neither process should be confused with an amendment already enacted by Parliament.

One legislative initiative was the Pharmacy (Amendment) Bill, 2023, introduced in the Senate by Senator Mushtaq Ahmed. The Senate passed the bill on February 19, 2024.

A separate Pharmacy (Amendment) Bill, 2024, was moved in the National Assembly by Abdul Qadir Patel, MNA, on December 17, 2024. The proposal was referred to the National Assembly's Standing Committee on National Health Services, Regulations and Coordination for consideration.

The committee subsequently sought a comparative analysis of the Senate-approved bill and the National Assembly proposal, with a view to examining and harmonising their provisions. Its proceedings also recorded the deferral of the National Assembly bill at meetings where the mover was absent.

These legislative initiatives form part of the wider effort to update pharmacy regulation and education. Their consideration does not, by itself, establish that pharmacists have been granted independent prescribing or diagnostic powers.

A separate development came on January 11, 2026, when Federal Minister for National Health Services, Regulations and Coordination Syed Mustafa Kamal directed the formation of a high-level technical committee to review the existing legal framework and propose amendments to the Pharmacy Act.

According to an official announcement issued by the Press Information Department, the minister was briefed by the Director General (Health) and the Director of Pharmacy Services at the Drug Regulatory Authority of Pakistan (DRAP).

The minister called for the Pharmacy Act and pharmacy curriculum to be restructured in line with international standards, with particular emphasis on medicine quality, patient safety and professional competence. He also directed the digitalisation of the Pharmacy Council of Pakistan's functions to improve transparency and institutional effectiveness.

The publicly available announcement did not disclose the technical committee's individual membership, detailed terms of reference or final recommendations.

The committee's role is to review the existing framework and propose changes. Any amendment to the Act must still follow the constitutional legislative process and obtain the required parliamentary approval and presidential assent.

Pharmacy Council's role in defining professional responsibilities

The Pharmacy Council of Pakistan is a statutory regulatory body established under the Pharmacy Act, 1967, and operates under the Ministry of National Health Services, Regulations and Coordination.

Its responsibilities include regulating pharmacy practice, maintaining the register of pharmacists, approving pharmacy examinations and courses of study, recognising qualifications, setting educational standards and inspecting institutions providing pharmacy education.

The Act also provides for provincial pharmacy councils, which have responsibilities relating to registration and other aspects of pharmacy regulation.

The Pharmacy Council is therefore an important institution in determining educational and professional standards. It can provide technical input, develop regulations within the authority granted by the Act and contribute to proposals for a clearer scope of practice.

However, its regulatory role does not give it the authority to independently amend the Pharmacy Act or create statutory prescribing powers beyond those permitted by law.

The National Assembly's Standing Committee on National Health Services, Regulations and Coordination has also examined the need to update the Pharmacy Council Rules, 1967.

At a meeting on July 10, 2026, chaired by Dr Mahesh Kumar Mallani, MNA, the committee expressed dissatisfaction with a briefing by the Pharmacy Council and directed it to revise the rules to address contemporary challenges facing the profession.

The committee was informed that a draft of the revised rules was expected to be presented in October 2026 for consideration.

The meeting was attended by MNAs Ch. Muhammad Shahbaz Babar, Ms Farah Naz Akbar, Dr Shaista Khan, Dr Darshan, Dr Shazia Sobia Aslam Soomro, Ms Sabeen Ghoury, Dr Nikhat Shakeel Khan, Mr Gul Asghar Khan, Ms Farukh Khan and Ms Aliya Kamran, along with Federal Health Minister Syed Mustafa Kamal and senior ministry officials.

Any revision of the Pharmacy Council Rules must remain within the powers conferred by the parent Act. Changes to rules and regulations are distinct from amendments to primary legislation.

The question of professional boundaries, patient safety

The debate reflects a broader challenge for Pakistan's healthcare system: how to make better use of pharmacists' specialised knowledge while ensuring that patients receive appropriate clinical assessment and treatment.

Pharmacists are integral to medicine safety. Their role in identifying drug interactions, reviewing prescriptions, advising patients on dosage and administration, supporting treatment adherence and ensuring the appropriate dispensing of medicines can help prevent medication errors and improve healthcare outcomes.

A properly regulated clinical pharmacy framework could strengthen these services, particularly in hospitals and multidisciplinary healthcare settings.

However, extending pharmacists' responsibilities into limited prescribing would require more than a change in professional recognition. It would need a clearly defined legal scope, additional clinical training, competency assessment, certification, approved medicine lists, referral protocols, professional indemnity and accountability arrangements.

It would also need to distinguish between providing medicine-related advice, screening for health risks, recommending non-prescription products and making a clinical diagnosis that requires medical assessment.

For doctors, the concern is that poorly defined responsibilities could leave patients uncertain about who is qualified to diagnose an illness, determine the need for investigations and take responsibility for treatment decisions.

For pharmacists, the concern is that their clinical training and contribution to patient care should be recognised through a coherent regulatory framework rather than remain limited by unclear or outdated professional rules.

The two positions need not be mutually exclusive. A system in which doctors and pharmacists work collaboratively, with clearly defined responsibilities and appropriate referral arrangements, could make better use of both professions. The challenge is ensuring that any expansion of services is supported by evidence, training and enforceable safeguards.

YDA asks health minister to facilitate consideration of doctors' concerns

Against this backdrop, YDA Pakistan and its four provincial chapters have urged Federal Health Minister Syed Mustafa Kamal to ensure that doctors' concerns are considered as the government and Parliament examine changes to pharmacy legislation.

The association has called for the protection of recognised professional boundaries, stronger action against quackery and safeguards against any legal provisions that could encourage medical practice beyond an individual's qualifications.

Its appeal places the minister in the position of an important government interlocutor who can facilitate consultation between the ministry, the Pharmacy Council of Pakistan, DRAP, parliamentary representatives and relevant professional organisations.

The association's concerns also underline the need for the government to make the proposed changes transparent by publishing the relevant draft clauses, explaining their intended impact and inviting feedback from doctors, pharmacists and other healthcare stakeholders before any decision is finalised.

At present, the debate involves proposals for limited prescribing, objections to changes affecting doctors' dispensing rights and a broader review of pharmacy regulation. The available public record does not establish that pharmacists are about to receive unrestricted authority to diagnose diseases or practise as medical specialists.

What Parliament and the relevant regulatory authorities ultimately decide will determine whether pharmacists receive an expanded, clearly defined clinical role and how that role will interact with the responsibilities of registered medical practitioners.

For patients, the essential consideration must remain the same: access to safe medicines and appropriate healthcare, with clear accountability for every clinical decision.

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