OCP pharmacy pilot announced for WA

The Pharmacist Resupply of Oral Contraceptive Pills (OCPs) pilot has today been announced in Western Australia, with the RACGP cautioning that caveats remain in place.
 
The pilot’s scope authorises registered pharmacists working in community pharmacy to supply approved OCPs in ‘defined circumstances’, according to the State Department of Health. It stipulates re-supply of the oral contraceptive pill be initiated by a GP or nurse practitioner and the patient has been stabilised for at least the previous two years continuously.
 
RACGP WA, along with key peak medical bodies in the state, sits on the working party to ensure the safe implementation of a pilot for pharmacy re-prescribing of the pill.
 
While the college does not support pharmacy prescribing, it has previously said involvement in project working parties enables advocacy for change to reduce risk of harm for patients.
 
Dr Damien Zilm is Deputy Chair of RACGP WA. He told newsGP the college’s presence is not a sign of endorsement of the OCP pilot program.
 
‘Being an active member has allowed RACGP WA to strongly advocate for patient safety and reinforce the immense experience and central role that GPs have in assessing risk and determining the most appropriate contraceptive option for our patients,’ he said.
 
‘The RACGP is concerned that the role of diagnosis, screening and comprehensive and holistic care in prescribing is being minimised in these pharmacist prescribing programs. There are several clinical concerns with such pilots.
 
‘While the RACGP appreciates member concerns about these pilots, and acknowledges these do not align with our position, we feel that being at the table allows an opportunity to minimise the risk for patients and general practice.’
 
In a recommendation for the WA OCP pharmacy prescribing pilot, the college advocates for a narrow age bracket, ideally 18–25 years. However, the program’s scope landed on 16–39 years, with 16–18 years for a four-month resupply only.
 
The RACGP’s preferred position for rationale in relation to age range is 35 years as a cut-off, which is supported by medical eligibility criteria (MEC) for contraceptive use, noting that a number of risk factors increase at age 35 and need reassessment, such as smoking and migraine without aura.
 
It also lists contraindications, using UK MEC criteria, and recommends excluding high-dose estrogen (50 microgram ethinylestradiol).
 
Dr Zilm said RACGP WA has ‘strongly advocated for patient safety’ in this pilot, and that GPs and nurse practitioners should remain as the decision makers when it comes to contraception advice with their patients.
 
‘Our role on the working group and what we’ve been able to influence and advocate for includes the fact this is a “pilot”,’ he said.
 
‘We also advocated for combined oral contraception and progestogen-only contraception and for dosage forms other than oral formulations to be excluded. Different OCP or OCPs not on the protocol medicines list are not permitted.’
 
The RACGP also recommends a maximum pill break of two weeks, with the OCP initiated by a GP or nurse practitioner that has been stabilised for a minimum of two years continuously. A thorough review of the OCP with a medical practitioner or nurse practitioner should be conducted at a minimum every two years.
 
While being able to collect an OCP from a local pharmacy has benefits for patients, GPs remain at the foundation of the process, according to Dr Zilm.
 
‘There is obviously a convenience factor for our patients and which patient advocates have strongly pushed for,’ he said.
 
‘This pilot will easily allow our patients the time needed to book in and see their GP for comprehensive reassessment as part of our holistic care.
 
‘There is no substitute for the extensive and holistic care GPs provide for our patients. There is no such thing as “just a script” for our patients – the OCP is no exception.
 
‘There is a risk that our patients may come to see a script for the OCP as “just a script”, however it will be obvious from the comprehensive care provided by their GP that it is not just a script.’
 
The WA pilot should be subject to an evaluation, according to the RACGP, and it is hoped the college’s role on the working group will continue to enable best outcomes.
 
‘Ongoing monitoring and feedback mechanisms should be permanently in place to ensure patient safety is always at the forefront,’ Dr Zilm said.
 
‘It is our hope that any future pilots will always be pilots, and should have an evaluation process built in from the very outset.’
 
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OCP oral contraceptive pill pharmacy pilot pharmacy prescribing Western Australia