Should more new OCPs be PBS-listed?

codeine shoppers: sad woman examines a white tablet

Family Planning NSW says the current situation is locking out lower-income women from accessing the right medication

Dr Deborah Bateson said last week that choice of oral contraception is limited for women on lower incomes because many new ones are not listed on the PBS.

“While many women find that the PBS-listed pills suit them well, it is inequitable that financially disadvantaged women who do benefit from one of the newer pills, sometimes after trialling several types, may not have that option because of cost,” Dr Bateson told ABC Online.

“For many women these newer pills are unaffordable. I’m very conscious of ensuring that we don’t set women up with an expectation that they’re going to have to pay out this amount of money every month unless they’ve tried other cheaper options.”

In the past 20 years, just one pill has been added to the PBS – Femme-Tab ED 20/100 in 2013, the ABC points out.

Dr Bateson argues that cost barriers also put pressure on women who have been prescribed a contraceptive to manage conditions such as polycystic ovarian syndrome or endometriosis, and find one of the newer brands of pill is the best fit for them.

“We would always want women to trial those PBS-listed pills first. But for those women who have a proven condition that doesn’t respond to those treatments, then it would be good fo them to have access to the newer options,” she told the AJP.

However Samantha Courtis, a pharmacist from Charnwood Capital Chemist in the ACT, says there are other options for women who are financially disadvantaged.

“There’s certainly a lot of contraceptive pills that are not on the PBS. It’s not anything new, it’s been this way for the past 5 years or so. But most women I know have been able to find an alternative,” Courtis says.

“With the newer mixes of hormones, the women I know who have had affordability issues have been able to speak to their doctors and get one that’s similar. Maybe not exactly, but one that’s close enough and also listed on the PBS,” she says.

Courtis says that for OCPs that are not PBS-listed, “you’re looking at $50-$100 for 3-4 months’ supply.

“It’s not really that expensive.”

Courtis admits the price gap is too wide, explaining that “if you’re a concession card owner there’s a big difference between $2 and $70,” but is quick to point out that OCP pricing is very competitive.

“Discount pharmacies all offer competitive pricing which pushes the price down,” she says.

There are already a number of oral contraceptive pills available on the PBS, including in various combinations of hormones, says Professor Lisa Nissen from the Queensland University of Technology.

Professor Nissen says the newer agents are not restricted from applying to list on the PBS in the same category.

“It would be likely that they would be remunerated on the same level or perhaps with a brand price premium,” she says.

“The issue for the companies with this is that the existing agents are low cost and they would be likely to seek a higher return.”

It is up to pharmaceutical companies to make an application to the PBS, and in doing so would need to be prepared to accept the price currently remunerated for existing agents, Professor Nissen explains.

Dr Bateson understands this but offers up an alternative solution

She suggests that the government could explore allowing doctors to issue an authority script to supply women with proven medical conditions with more expensive pills at a subsidised rate, if they have trialled older PBS varieties and found they do not suit.

A list of combined OCPs and their PBS status is available here.

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