12 March 2020

Pushing the Pill OTC ‘only benefits pharmacies’

General Practice Pharmacy Women

Down-scheduling the contraceptive pill would be “fraught with danger” and would sacrifice women’s long-term health for the sake of short-term convenience, the AMA says.

The Queensland branch of the AMA has written to that state’s health department urging it to reverse its position on making the contraceptive pill available over the counter, so that women would never need to see a doctor to renew their initial prescription.

Premier Annastacia Palaszczuk announced on International Women’s Day that she would write to Prime Minister Scott Morrison to ask the federal government to support the down-scheduling.

In the meantime, she said, her government would make changes to allow women to buy an interim supply between prescriptions by the end of the year.

“It will mean when a woman can’t get her usual repeat pill prescription, pharmacists will be allowed to provide one full pack of her usual pill,” the Premier said.

“Most women who take the pill have done so since they were teenagers and are used to managing their reproductive health.

“But there are situations where a woman can’t get an appointment with their doctor or can’t make one. The changes we’re making by the end of the year will make women’s lives easier.”

She said it would also benefit those in regional areas where it was easier to see a pharmacist than a GP, and would “free up GP waiting rooms”.

The announcements were made at the launch of the trial of pharmacist prescribing for urinary tract infections in Queensland, which is set to begin in a few weeks, and which has also been vocally opposed by doctor groups.

Queensland GP and AMAQ representative Dr Nick Yim said down-scheduling contraceptive pill prescriptions was “fraught with danger”.

“Under the guise of convenience it would put the safety of women at risk around the country,” he told TMR.

“AMA Queensland has communicated with the Minister for Health Steven Miles expressing our concerns and actually advising him quite strongly to reverse that decision.”

He said women were generally prescribed a year’s worth of the pill and that in that time a lot could change.

Contraceptive pills were serious medications associated with various cancers, deep-vein thrombosis and pulmonary embolism, so renewals required full health checks.

“Will they get that opportunity within the pharmacy?” Dr Yim asked.

“When a woman comes in annually to get their renewal, I ask them how they’re going or if they’re getting side-effects, and whether that pill is actually the best pill – and are they remembering to take the pill? Because at the moment there’s actually a lot of other products that’s available that are long-acting such as Implanon.”

He said it would be in pharmacists’ interest to suggest options that generate more foot traffic through their shops.

“So it’s unlikely that I pharmacists would recommend the Mirena, for example, that only needs to be changed once every five years. That gives very, very good long-term contraceptive coverage.”

National AMA president Dr Tony Bartone said GPs treated women’s contraceptive needs holistically in the context of their whole medical history.

“Convenience is not always a blessing when it comes to your health,” he told TMR. “Prescribing the contraceptive pill is not merely giving a piece of paper. It’s about ensuring that the person is on the right pill, the person is having no side-effects, the person is up to date with their preventative health screening options, including cervical cytology and breast examination. That the person is aware of all the other health-related issues regarding the pill and is having the appropriate checks.

“And it’s having a conversation about other non-oral medications that may be a more appropriate option. And in fact in Australia, we lag the world when it comes to the use of LARCs [long-acting reversible contraception]. Then there’s the issue of barrier protection against STDs.

“Making it easier to replenish supply means we run the risk of preventative health measures running as a poor second and having adverse outcomes in the long run.”

Dr Yim said community pharmacies were the only parties likely to benefit overall.

“Women may benefit in the short term, but they are sacrificing long-term safety,” he said.

The same went for the UTI trial, which he said was designed by a pharmacist with no input from the medical profession.

The Pharmacy Guild of Australia’ Queensland president Trent Twomey welcomed the idea of down-scheduling, but according to Pharmacy Daily said the PBS subsidy on contraceptives “needs to be maintained”.

“The better solution involves minor changes to the current Drug Therapy Protocols, and I would urge the government to move now, as down scheduling could take years.”

Dr Yim pointed out that the guild only preached convenience when it came to removing the need for GP visits. It was absolutely opposed to extending prescriptions to two or three months’ supply to allow fewer pharmacy visits.

He said the guild, while a famously generous political donor across states and parties, appeared to hold particular sway in Queensland, possibly because it was easier to get legislation through the state’s unicameral parliament.

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