KUALA LUMPUR, June 29 — Pharmacists say they can play a larger role in patient care and help ease pressure on the health system, but argue that Malaysia must first establish clear training, credentialing, and oversight standards before expanding prescribing authority.
The debate was reignited after Ministry of Health (MOH) deputy director-general of health (research and technical support) Dr Nor Fariza Ngah suggested expanding micro-credentialing and task-shifting to non-doctors to help address workforce shortages and improve access to care, particularly in underserved areas.
A senior clinical pharmacist working at a government hospital, who requested anonymity, supported the proposal, but said training, credentialing, and governance frameworks must be developed alongside any expansion of pharmacists’ legal scope.
He said pharmacists are already undertaking significant clinical responsibilities within the public health system through services such as Medication Therapy Adherence Clinics (MTAC), therapeutic drug monitoring, and ward-based medication recommendations that physicians routinely rely on.
“I support the direction, with significant caveats. The workforce pressure on MOH is real, and pharmacists already carry out a substantial amount of clinical decision-making informally,” the pharmacist told CodeBlue.
“Formalising some of that through micro-credentialing would simply recognise work that is already happening and bring it under proper governance,” he said.
Chronic Disease Management A Natural Starting Point
The pharmacist argued that the strongest case for expanded pharmacist responsibilities lies in outpatient chronic disease management, rather than across the board.
He pointed to warfarin management and insulin titration as examples where pharmacists already monitor patients regularly and make dose-adjustment recommendations within clearly defined treatment goals.
“Someone on warfarin typically attends monthly INR (international normalised ratio) reviews through MTAC, and a patient on a structured insulin titration schedule is followed at intervals tighter than routine clinic appointments allow.
“Formalising pharmacist authority in these areas recognises monitoring and dose adjustment that is already happening in practice, rather than creating a new function from scratch,” the pharmacist said.
He said such models work because patients are generally stable, therapeutic targets are clearly defined, and any changes in a patient’s condition can be identified and escalated when necessary.
“The precondition is that each area needs a published guideline or protocol in place, setting out the titration steps, the thresholds for escalation, and the point at which the case reverts to the doctor, so the expanded responsibility is bounded and auditable rather than open-ended judgement.”
However, the pharmacist was more cautious about extending similar responsibilities to inpatient settings. “I believe the same logic extends less safely to inpatient care, where greater instability and overlapping specialty input make protocol-driven delegation harder to govern.”
Expanded Roles Need More Than Legal Reform
The pharmacist cautioned against viewing expanded pharmacist roles as a solution to Malaysia’s shortage of specialist doctors.
“Task-shifting can free up specialist time by absorbing routine monitoring and medication-related decisions, which matters, but it does not address a shortage of cardiologists, obstetricians, or anaesthetists performing procedures and making diagnoses that require their specific training,” he said.
He argued that pharmacist role expansion should be viewed as a way to better utilise existing non-doctor capacity alongside broader workforce measures, rather than as a stand-alone solution to specialist shortages.
The pharmacist also urged caution over calls for pharmacist prescribing, arguing that Malaysia lacks the infrastructure underpinning independent prescribing models in countries such as the United Kingdom.
“The legal scope question gets the most attention, but even if the related Acts were amended tomorrow, there is still no open, profession-wide credentialing pathway, no agreed competency framework, and no accredited body running a standardised assessment that any eligible pharmacist, regardless of employer, can sit for,” he said.
The pharmacist described training and credentialing infrastructure, rather than legislation alone, as the biggest barrier to expanding pharmacists’ clinical responsibilities.
While Malaysia already has advanced practice programmes, such as the Malaysia Advanced Clinical Pharmacy Programme (MyACPP), he noted that these pathways are largely limited to MOH personnel and do not function as a national credentialing framework applicable across public and private practice.
Any future prescribing model would require postgraduate training, supervised clinical practice, competency assessments, and recognition by the Pharmacy Board Malaysia (PBM), the pharmacist said.
“At minimum, a postgraduate diploma or certificate-level programme comparable to the UK’s independent prescribing course, structured supervised practice hours under a specialist or experienced clinical pharmacist mentor, and a competency assessment recognised by the PBM.
“MyACPP already demonstrates that MOH can run structured advanced-practice training and assessment, so the institutional groundwork is not starting from zero. What it would need to evolve into is something closer to the board-certification model used in some other health systems, where a pharmacist applies individually and sits a standardised exam or portfolio assessment, regardless of who their employer is,” the pharmacist said.
“That decoupling matters. A credential tied to MOH employment cannot function as the national standard, since it excludes private sector and academic pharmacists by design.
“The UK independent prescribing model runs roughly nine to 12 months part-time alongside practice, including around 90 hours of supervised clinical experience. A Malaysian equivalent would likely need a similar timeframe, though it should be built and piloted locally rather than imported wholesale.”
Authority Must Come With Accountability
Expanding pharmacists’ responsibilities would require more than changes to the law, the pharmacist added. Pharmacists taking on new clinical duties would need legal protection, clearer oversight, and sufficient time to perform those roles safely.
He said amendments to relevant laws would be required to permit defined prescribing or dose-adjustment authority for credentialed pharmacists and to formally define any expanded scope of practice.
“This would require the PBM to formally recognise an open, profession-wide credential, either by expanding MyACPP beyond MOH staff or building a parallel pathway, since a credential limited to one employer cannot easily be written into national legislation as the qualifying standard,” he said.
The pharmacist said indemnity coverage would need to be explicitly addressed in law too so that pharmacists assuming expanded responsibilities receive the same legal protection afforded to doctors making equivalent clinical decisions.
He also stressed the need for stronger clinical governance structures, including clear escalation pathways when cases fall outside a pharmacist’s credentialed scope.
Health care facilities would also need to adjust staffing arrangements rather than simply adding new responsibilities to pharmacists’ existing workloads, while prescribing or dose-adjustment decisions made by credentialed pharmacists should be recorded within the same systems used by doctors to ensure patient records remain integrated.
MPS Sees Untapped Potential In Community Pharmacies
The Malaysian Pharmacists Society (MPS) also backed micro-credentialing and task-shifting initiatives, saying structured competency-based training has already been implemented in various areas of pharmacy practice.
MPS president Prof Amrahi Buang said competency-based credentialing is already embedded in parts of pharmacy practice, citing programmes offered by Malaysian universities as well as credentialing and privileging frameworks implemented by the Pharmaceutical Services Programme in specialised practice areas.
“The key principle is that health care professionals should be enabled to practise to the full extent of their education, training, and demonstrated competencies, with appropriate governance and oversight,” he told CodeBlue.
Amrahi said pharmacists could play a larger role in areas such as vaccination services, medication reviews, chronic disease management, health screening, and medication adherence support, particularly through community pharmacies.
Describing community pharmacies as among the most accessible points of care in Malaysia, he said better integration into the health care system could improve access to preventive and medication-related services while reducing unnecessary visits to overcrowded health facilities.
He pointed to initiatives such as Ubat@Komuniti as examples of how pharmacists can help bring care and medication access closer to patients’ homes.
“In the public sector, pharmacists can continue supporting multidisciplinary care teams through medication management and optimisation, allowing other health care professionals to focus on areas where their expertise is most needed,” Amrahi said.
MPS also supported a gradual and evidence-based approach to expanding pharmacists’ prescribing roles through appropriate training, accreditation, and governance mechanisms.
Amrahi noted that pharmacists already have a limited prescribing role under existing legislation, which allows them to supply and prescribe Group C Poisons without a doctor’s prescription.
Future models could include collaborative prescribing arrangements, supplementary prescribing under agreed clinical protocols, or prescribing within disease management programmes where pharmacists have received additional training and accreditation.
“The objective should not be to replace doctors, but to complement the health care workforce and improve patient access to timely care,” he said.
While legislative limitations remain a barrier, Amrahi said reforms would also require policy alignment, sustainable funding, workforce planning, public awareness, and collaboration across the health sector.
“The health care system should be designed around what benefits patients, not around protecting professional territories,” Amrahi said.
How Independent Prescribing By Pharmacists Works In UK
A Malaysian pharmacist currently practising in the UK’s National Health Service (NHS) offered a glimpse of what an established prescribing model looks like.
Lynn Ng, a primary care pharmacist who qualified as an independent prescriber (IP) last year, said she is authorised to prescribe autonomously for conditions within her area of competence.
“I can write new prescriptions, stop or alter doses and, since I am signing the prescription, I take ownership of the clinical decision,” she told CodeBlue.
“For example, I can manage hypertension and heart failure within my scope of competence. But I also recognise when something falls outside my competency and when I need to escalate it. There are independent prescriber pharmacists in community pharmacies, hospitals, and primary care.”
Ng said IPs are trained to recognise the limits of their competence and escalate patients when necessary.
Her qualification involved a six-month part-time course, objective structured clinical examinations (OSCEs), 90 hours of supervised clinical practice, and supervision by a designated prescribing practitioner, in her case a general practitioner.
She noted that prescribing training is increasingly being embedded into pharmacy degree programmes in the UK, allowing many graduates to qualify as IPs shortly after registration.
