Contraceptive pill to remain prescription only – at least for now

‘I am a big supporter of the TGA’s decision, and I sincerely hope it continues.’
 
That is Dr Wendy Burton, Chair of RACGP Specific Interests Antenatal/Postnatal Care, speaking to newsGP about the Therapeutic Goods Administration’s (TGA) interim decision to not allow pharmacists to dispense the oral contraceptive pill without the need for a prescription from a GP.
 
The regulator dismissed two private applications to amend the Poisons Standard and downgrade the ingredients in the pill from Schedule 4 to Schedule 3 earlier this month, after it found the risks would ‘outweigh the benefits’.
 
Though the move has been welcomed by GPs, the matter remains open for further consultation until 1 November, after which time the TGA is expected to make its final decision.
 
If the amendment were to pass, doctors are adamant there will be repercussions for patient safety, and continuity of care.
 
Dr Burton says undertaking a clinical assessment of each individual patient is vital as a contraceptive pill prescribed two years prior may no longer be the most suitable option.
 
‘It was like when codeine was over the counter,’ the Queensland GP said.
 
‘It then just becomes the default treatment, even if it’s not the best treatment – and I think we risk that with the pill.
 
‘Don’t get me wrong, it’s a great workhorse; I prescribe it on a daily basis. But there are other options that simply should be discussed.’
 
Dr Amy Moten, Chair of RACGP Specific Interests Sexual Health, agrees.
 
The South Australian GP shares concerns over the potential risks of the contraceptive pill, which she says can change over time with age and the development of comorbidities.
 
‘So someone, for example, who’s had the pill for years might suddenly develop high blood pressure, which will then increase their risk of having a blood clot, and that risk also increases with age,’ Dr Moten told newsGP.
 
‘Also people might have started taking a new medication, which actually makes the pill less effective, and they might not necessarily think to mention that to the pharmacist, for example.
 
‘They may also have turned a certain age, at which point, again, it might be recommended [that they have] a different dose of the combined pill or a different contraception altogether.’
 
She also has concerns that it could reduce the opportunity for sexual health screening, such as for chlamydia, which the RACGP recommends annually for people under 30.  
 
‘I also think it’s good, in general, for people to always have a discussion about the type of contraception they’re on, potentially at least once a year,’ Dr Moten said.
 
‘We know that many people will transition to safer and more effective forms of contraception, such as the long-acting reversible contraceptives, if there’s a proactive discussion at each contraceptive consult.’
 
Meanwhile, the opportunity to check in with patients more generally about their wellbeing and any life changes could also be lost, doctors argue.
 
Dr Burton says the chance to opportunistically check in with female patients has become particularly important since cervical screening changed to every five years, and that an appointment for a script renewal should not be trivialised.
 
‘It’s a really important opportunity … to have preventive healthcare conversations, pre-conception conversations, pre-menopause conversations – there are so many different stages of life that a woman might be taking a contraceptive pill,’ she said.  
 
‘It can also be a doorway through which to explore mental health and domestic violence.
 
‘GPs are really well placed to initiate these conversations.’
 
In support of the proposal, the Pharmaceutical Society of Australia cited easier access to contraception and, in turn, a chance to support continued use.
 
While the TGA acknowledged some prescriber access issues in rural and remote areas, the regulator noted that there are already mechanisms in place to address this, including emergency script provisions and telehealth, with the MBS item for sexual health exempt from the 12-month rule.
 
The interim decision was informed by 27 public submissions to the consultation, including one from the RACGP, which presented concerns about patient health and safety.
 
If the amendment were to go ahead, Dr Burton is also concerned about the pharmacy environment. She says it is not suitable to have personal and nuanced conversations that could come up.
 
‘The pharmacy counter, I don’t think it’s the place for these kinds of conversations,’ she said.
 
‘[Unlike] when you’re in a confidential space with a known and trusted healthcare provider.’
 
Dr Moten reiterated that the arguments against downgrading the Schedule, are in no way about wanting to create barriers to contraception, but rather ensuring patient health and safety.
 
‘People will always be able to access that emergency supply,’ she said.
 
‘It’s just about supporting people to make proactive choices about their contraception, but also making sure that all risk factors are managed appropriately.’
 
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