MS-2 Step access set to expand

Michelle Wisbey

11/07/2023 4:32:24 PM

Medical abortions will become easier to access under landmark regulation changes due to come into effect on 1 August.

A patient prepares to take mifepristone
A patient prepares to take mifepristone. (Image: AAP)

The Therapeutic Goods Administration (TGA) has announced that several restrictions around prescribing mifepristone and misoprostol (MS-2 Step) for medical terminations will soon be lifted.
Currently, only certified doctors can prescribe the medication, which is then dispensed by a registered pharmacist.
But, under a raft of changes coming 1 August: 

  • GPs will no longer be required to undertake mandatory training and registration every three years to prescribe MS-2 Step
  • pharmacies will be able to stock and dispense the medication
  • any healthcare professional with appropriate qualifications, including nurse practitioners, will be able to prescribe MS-2 Step.
Monash University General Practice Chair, Professor Danielle Mazza told newsGP the announcement is a long-awaited change to decade-old rules.
‘This is the first time that the regulations have changed since it was first introduced over 10 years ago,’ she said.
‘At that time, medical abortion was new to Australia and the political environment and the newness of it meant that the TGA took a very cautious approach, which, in retrospect has caused a lot of barriers.’
Professor Mazza said the changes are a step forward in healthcare accessibility for women, especially those living in rural and regional areas of Australia.
‘Say you’re a community pharmacist in a rural town, and you’re the only pharmacy there, if that particular pharmacist was sick that day, or went on maternity leave, or was on holiday, that pharmacy wouldn’t be able to dispense the medication,’ she said.
‘This move will really normalise the process and lead to its better integration into routine care and that’s what our patients want.
‘There shouldn’t be any requirements that set abortion apart from any other form of healthcare.’
RACGP President Dr Nicole Higgins labelled the changes a ‘huge step forward’.

‘As a GP in a regional centre, I know all too well that there are significant barriers to reproductive care in rural and remote areas,’ she said.

‘The TGA’s changes will enable greater access to medical abortion for women throughout Australia and will reduce unnecessary red tape for the GPs who provide these essential services.

‘Access to safe medical or surgical abortion services for women is part of a holistic approach to reproductive health. This is essential, regardless of a woman’s income or where she lives.’
The RACGP previously made a submission to the Senate Community Affairs Committee inquiry into universal access to reproductive healthcare, with Dr Higgins and Professor Mazza appearing at a public hearing.
The new announcement is in line with the inquiry’s, and the college’s, recommendations.
In following those recommendations, the TGA said its changes are about improving access issues reported by patients.
‘The decision to approve these amendments was informed by expert advice from the Advisory Committee on Medicines, an independent committee with expertise in scientific, medical and clinical fields and including consumer representation,’ it said in a statement.
‘Noting these revised restrictions, a new warning/instruction has been included in the Product Information, which provides information about circumstances where a person should be referred to a medical practitioner.’
Professor Mazza said GPs are well placed to provide the additional support needed for patients accessing a medical abortion, and are often a first port of call in both metropolitan and rural communities.
‘It’ll just be like prescribing any other medication in practice and that’s really why medical abortion has been such an innovation for women because there’s nothing mysterious, or strange, or difficult about being a provider of medical abortion,’ she said.
‘[Patients] want GPs to be delivering this kind of care, and they turn to GPs for this advice and this care, and GPs are well placed to deliver it.’
But Professor Mazza said there’s still a long way to go in ensuring women’s healthcare is accessible to all.
‘The next challenge is really to make sure that all GPs who are undertaking the general practice training program receive excellent training in healthcare so that they can deliver the services that our patients require of us,’ she said.
‘There are six million women of reproductive age in Australia, so GPs have to get it right because we are the workforce to deliver this kind of care.’
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Dr Peter James Strickland   12/07/2023 11:46:10 AM

I note that this article states that abortion is a "health" issue. Almost all abortions I have known carried out have nothing to do with a health issue, but rather as a convenience issue. The exceptions are those with serious life-threatening consequences for the woman or the conceptus. However, I have seen serious damage done to the endometrium after a woman has had several terminations. Surely, in this age of very safe contraception and/or medical abortion very early, there should not be a need to have as many surgical abortions that are being carried out now. Doing an abortion at 24 weeks will produce a living & formed foetus in most cases, which has to be left to die ---is that what we want to see as being ethical? Not a genuine health issue to me, as it is rare for the woman's health to be the issue apart from seeing some women crying because they are unable to really conceive later because of uterine scarring after terminations?

Dr Cameron Thomas Hoare   12/07/2023 3:02:19 PM

Whilst this may improve access to care, my concern is that the training was currently free, and is high quality and only takes a little bit of time.
its easily done online.

presciption of mtop is not something that should be done in 5 minutes or less.
Doctors that are so time poor that they cannot find the time to do the training, may not be the right doctors to prescribe the MTOP

Dr Kyria Laird   13/07/2023 11:47:12 PM

This change needs to be considered in context of state dependent abortion legislation. The WA legislation states an abortion can only be performed by a medical practitioner. Unless the legislation changes, this to me excludes nurse practitioners and other healthcare providers. I think we need to be cautious with advertising these blanket changes as state legislation may still mean some of the changes are not able to be implemented.

Dr B Florance   18/07/2023 4:28:40 PM

I wonder if this change mean that GP registrars are now able to prescribe MS2 as previously only Fellowed GPs specialists could prescribe??