Contraception and endometriosis treatments added to PBS

‘It’s a very positive outcome.’
 
That is how Chair of RACGP Specific Interests Sexual Health Medicine Dr Sara Whitburn describes new Pharmaceutical Benefit Scheme (PBS) listings announced on Sunday, which will expand contraception, endometriosis and IVF treatment options.
 
From 1 May, drospirenone (sold as Slinda) will go on the PBS for the first time, offering a progestogen-only pill for women who cannot take contraceptives with estrogens.
 
At the same time, relugolix with estradiol and with norethisterone (sold as Ryeqo) will also go on to the PBS as an option for treating endometriosis.
 
Meanwhile from 1 April an amended listing of follitropin alfa with lutropin alfa (sold as Pergoveris) will make the combination therapy available earlier in the IVF cycle, as well as doubling the number of pens available per script from two to four.
 
‘It really helps with access, as we know that cost is one of the main barriers to being able to offer options for people to make choices around their contraception, endometriosis and IVF care,’ Dr Whitburn told newsGP.
 
The Federal Government estimates more than 100,000 women annually will benefit from the listing of Slinda. It is viewed as particularly suitable for older women, those at increased risk of blood clots, those who suffer migraines, breastfeeding mothers, smokers, and those who are overweight or have high blood pressure.
 
It also has a 24-hour missed pill window, meaning contraceptive protection is not reduced if the patient is less than 24 hours late in taking the next tablet.
 
In its rationale for the listing, the Pharmaceutical Benefits Advisory Committee (PBAC) said drospirenone ‘can also be useful for women of older reproductive age due to its benefits in relation to bleeding control and not containing estrogen, so it can be used in situations where estrogen-containing contraceptives are contraindicated or not appropriate.’
 
For Dr Whitburn, the increased availability of Slinda is particularly clinically significant.
 
‘In the past, we only had combined oral contraceptive pills, and sometimes it’s not safe to take, or people don’t want to take estrogen, and so that’s actually a game-changer when it comes to being able to offer contraception choices in a cost-effective way,’ she said.
 
‘There are people who, for whatever reason, don’t want to have a long-acting reversible contraception, but because of their health, they couldn’t have the combined contraceptive pill, so it really does provide good, effective contraception for those people.’
 
For women’s health advocate and Melbourne GP Associate Professor Magdalena Simonis, the listings are ‘good news all round’, helping GPs support patients in a previously neglected field.
 
‘It enables GPs to manage women with the presenting complaints that we often see, such as heavy menstrual bleeding, crampy periods that are difficult to control with over-the-counter medication,’ she told newsGP.
 
‘It also represents an acknowledgement that these are severe chronic diseases that really affect the gender health gap.
 
‘There’s a significant cost to women of having heavy menstrual bleeding, endometriosis and infertility.’
 
According to Associate Professor Simonis, the listing of Ryeqo is likely to provide a significant benefit for many endometriosis patients.
 
‘If we have access to it, we can manage the symptoms while also providing contraceptive cover during a really sensitive time in their reproductive life, and maybe even forego the complications of progressive disease spread and even infertility,’ she said.
 
It currently costs $2700 for a year’s supply of the treatment.
 
It follows a $573.3 million Federal Government announcement last month, which includes new PBS listings for oral contraceptive pills Yaz and Yasmin, larger Medicare payments and more bulk billing for intrauterine devices (IUDs) and birth control implants, as well as a new Medicare rebate for menopause health assessments and funding to train health professionals.
 
There were also PBS listings for menopausal hormone therapies, Prometrium, Estrogel, and Estrogel Pro, and funding for 11 new endometriosis and pelvic pain clinics, as well as national trials for pharmacy access for contraceptives and treatment for uncomplicated urinary tract infections (UTIs).

For Associate Professor Simonis, the recent announcements are the culmination of years of campaigning.
 
‘We’ve been talking about this through the National Women’s Health Strategy, we’ve been talking about this at various levels with the PBS, we really came out very strongly,’ she said.
 
‘What has finally happened is you’ve had health professionals partner up with a lot of the advocacy groups, and we’ve been able to drive that push for grants in areas to do with primary care research, and also to support boosting the PBS with impactful drugs.’
 
It is a point also made by Dr Whitburn.
 
‘There’s been advocacy from health groups, colleges like the RACGP, all sorts of people, both consumers and health professionals in the women’s health space,’ she said.
 
‘It can be a struggle to get changes, so it’s been a very positive outcome to see so many positive changes and so much uptake of the advocacy from across the board in women’s health.’
 
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