Many pharmacies lacking first-line emergency contraception: Study

Despite being more effective and recommended internationally as a first-line treatment, the emergency contraceptive pill ulipristal was not stocked in almost a third of pharmacies participating in a recent Australian study.
 
Published in Contraception, the survey of 233 randomly selected Australian pharmacies revealed that only 76% of metropolitan locations stocked the medication, whereas almost all (98%) offered the more familiar levonorgestrel emergency contraceptive pill.
 
Supply was even more sparse in regional pharmacies, with only 59% having ulipristal stock, suggesting issues related to geographical health inequity.
 
The study also raises concerns about product cost and availability affecting patients’ ability to make informed decisions about their health, according to Associate Professor Luke Grzeskowiak, lead of the Flinders University and South Australian Health and Medical Research Institute (SAHMRI) Reproductive and Perinatal Pharmacoepidemiology Research Group.
 
‘It highlights that there’s clearly a gap there,’ he told newsGP.
 
‘Ulipristal is well-established to be more effective closer to the time of ovulation compared to levonorgestrel, and is therefore recommended as the first-line oral emergency contraceptive in international guidelines.
 
‘Yet it is less likely to be available in community pharmacies and when it is available, it is likely to be much more expensive.’
 
Associate Professor Grzeskowiak describes the results of the study as unsurprising.
 
Throughout the research, he says the team received multiple anecdotal reports of women having trouble accessing ulipristal, with many claiming they had only ever been offered the single option of levonorgestrel and not the newer medication.
 
He also highlights the extreme price difference between the two medications. According to the survey, the average cost of a dose of levonorgestrel was $13, while ulipristal was in some instances up to six times higher.
 
‘With ulipristal costing anywhere from $26–80, this calls into question whether government subsidies should be available,’ he said. 
 
Alongside proposed medication subsidies, Professor Grzeskowiak is calling for more research into understanding the difference in uptake between the two medications among Australians.
 
‘Some effort needs to go into working out what’s behind this and how to move forward to ensure that everyone is provided equitable access to evidence-based treatments,’ he said.
 
‘We don’t have representative data on the reasons that women are requesting emergency contraception, for example, [is it] contraceptive failure or because it is their regular method of contraceptive?
 
 ‘Without knowing that, it’s a bit tricky to fully understand difference in uptake.’
 
The study’s author, Tahlee Stevenson, from the University of Adelaide, says that differences in uptake between the two contraceptives may be multifactorial.
 
‘Is this because of low consumer awareness and or higher prices impacting demand?’ she questioned.
 
‘Or is it related to a lack of awareness and understanding among pharmacy owners regarding evidence-based recommendations for emergency contraception?
 
‘To truly work towards improving accessibility, we must address these factors and ensure that all consumers can source their preferred emergency contraceptive method in a timely and cost-effective manner.
 
‘By only stocking levonorgestrel, pharmacies are inhibiting their capacity to follow clinical guidelines, and this may mean that some consumers aren’t able to access the contraceptive that is appropriate for their individual needs and circumstances.’
 
Regardless of the reasons, it is important for both health professionals and consumers to be aware of the relative benefits and precautions of each of the multiple different emergency contraception options so that best individualised care can be achieved.
 
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