‘A Donald Trump approach’: GP-politician slams pharmacy prescribing

A New South Wales GP-turned-politician has fiercely criticised governments for allowing pharmacists to initiate prescriptions for the contraceptive pill, likening it to Donald Trump’s America.
 
In Parliament last week, Dr Amanda Cohn, a GP who was elected to the NSW Legislative Council in 2023, told her colleagues the decision in her state will have a detrimental impact.
 
‘What the Minns Labor Government is saying to women is that they should be happy to accept a lesser quality of care than what they deserve,’ the Greens health spokesperson said.
 
‘The TGA considered this change and rejected it because of safety considerations.
 
‘The Minns Labor Government, just like the Victorian Government, has overridden the TGA, which is a frightening creep towards a Donald Trump United States approach to healthcare.
 
‘We have expert bodies in Australia for a reason.’
 
In December 2021, the TGA rejected applications to down-schedule oral contraceptives, saying that assessment by medical practitioners ‘allows routine preventive health screening’ and a regular review of oral contraception suitability.
 
‘I have weighed the severity and frequency of adverse effects, alongside the seriousness of potential drug-drug and drug-condition interactions without medical practitioner intervention and follow-up against the benefits of increased access,’ the TGA delegate stated at the time.
 
‘In doing so, I remain of the firm view that medical practitioner involvement is required and the current scheduling of oral contraceptive substances under Schedule 4 remains appropriate.’
 
Oral contraceptives remain a Schedule 4 medication.
 
Dr Cohn said it is a ‘sorry state of affairs’ the NSW Government’s decision is being celebrated as a win, with the results of a trial allowing pharmacists to resupply the pill for existing prescriptions not yet released.
 
‘But the Government is spending $4.5 million on pharmacist consultations rather than actually supporting people to see the GP and have a holistic consultation about all of their options for contraception to get the best option for them,’ she said.
 
‘The pill is less effective and less safe than other forms of contraception that are harder to access—long‑acting and reversible contraception.
 
‘Things like implantable rods and intrauterine devices are more effective types of contraception and, for many women, much safer.
 
‘Depending on someone’s medical history, the pill can put people at quite high risk of things like blood clots and strokes.’
 
She said she would prefer the Government ‘to support primary care and get people best-quality comprehensive access to contraception rather than this desperate stopgap measure’.
 
Her words struck a chord with RACGP President Dr Michael Wright.
 
‘Dr Cohn is right to call out these major concerns about multiple governments overriding previous recommendations of the TGA, which looks like politicians making health decisions rather than experts in providing safe care for patients,’ he told newsGP.
 
In a Parliamentary response to Dr Cohn, NSW Labor MP Emily Suvaal said she respected the GP’s views and expertise but disagreed with her.
 
‘My understanding, and what I am advised, is that the TGA advised at the time that it did not support it because pharmacists needed additional training,’ she said.
 
‘The Government is filling that gap with the additional training that is needed.’
 
However, Dr Wright says the move is too early, with a Pharmacy Board consultation on national prescribing registration endorsement standards currently underway and a review of the accreditation standards for pharmacist prescribing education programs imminent.  
 
‘Rolling these out before the Pharmacy Board consultation is complete is certainly premature and potentially dangerous,’ he said.
 
Around 60 NSW pharmacists are expected to be able to initiate contraceptive prescription from 1 June, with more to follow once they have completed a graduate certificate through James Cook University along with an induction to reproductive health course.
 
Earlier this year, the Victoria Government also announced a decision to allow pharmacists to initiate the supply of contraceptive pills without patients needing a script.
 
Dr Wright is hosting member consultations about the proposed national pharmacy prescribing standard on 26 May 8.30 – 9.30 pm (AEST) and 3 June 6.30 – 7.30 pm (AEST). For more details, see the RACGP website.
 
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