‘You can’t just give out a pill and expect that that’s actually good medical care.’

packet of contraceptive pills on pink background

A leading doctor has criticised the findings of an Australian study which found a significant cost saving in downscheduling oral contraceptives to Pharmacist Only

The study, conducted by researchers at Macquarie University, used Household, Income and Labour Dynamics in Australia (HILDA) survey data which showed about 55% of Australian women aged between 15 and 49 use some form of contraceptive, with 33% of these using the oral contraceptive pill. The OCP was the most commonly-used method.

From this data, they calculated that “reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only”.

Dr Chris Zappala, Vice President of the Australian Medical Association, appeared on ABC’s News Breakfast with Virginia Trioli and Paul Kennedy and said the organisation is “very much opposed” to such a downschedule taking place.

Ms Trioli highlighted that the study was commissioned by the then Australian Self-Medication Industry (now Consumer Healthcare Products Australia) and asked what medical interest there could be in such a switch.

Dr Zappala pointed out that patients can currently obtain a script for a year’s worth of the OCP, and that in this time medical needs could change.

“So it’s worth having an opportunity to discuss that with a trusted, known, family general practitioner and also look at other contraceptive options,” he said.

“The second thing is that many GPs use what might, in some ways, be a brief consultation as an opportunity for preventive health. So, a skin check, a breast examination, a pap smear, and that opportunity really is very precious in people’s otherwise busy lives, and in busy general practice.

“And the third thing is that you really shouldn’t probably be just handing out a pill and a contraception like that without having some sense of people’s sexual history and understanding, for example, their STD risk.”

He said that “anything that shifts patients away from GP-centred care is not a good idea”.

When asked whether this opposition was due to “protecting their turf,” he said that the study required careful interpretation.

“Iin the same issue of the journal—the PharmacoEconomics journal that published this—it showed that the main reasons, when women were surveyed, that they choose their contraceptive method is based on the risks to them, the side effects and so on and how it might affect them, but also the frequency with which they must take it,” Dr Zappala said.

“And there are some methods of contraception that only need to be renewed or replaced every year or three years, and for many women that is something that is more convenient.

“We agree that there needs to be access to good-quality health care, of course there does.

“But you can’t just give out a pill and expect that that’s actually good medical care.

“It’s the conversation and knowing that individual properly that makes it good medicine, and that’s why the AMA is very much opposed to this.

“We need to keep people having those conversations with their general practitioner.”

Meanwhile Consumer Healthcare Products Australia welcomed the findings.

“Increased access to non-prescription medicines means that more Australians are empowered to practice Self Care with confidence and better self-manage their health,” said Dr Deon Schoombie, CEO of CHP Australia.

“The findings from Macquarie University should serve as a prompt for all key stakeholders to investigate whether it would be appropriate for oral contraceptives to ‘switch’ from prescription to non-prescription.

“Increasing access to non-prescription medicines, where appropriate, will substantially benefit consumers, healthcare professionals, government and industry.”

He said that both sides of politics have recognised the potential benefit of such a switch, with the Queensland Labor Government having instigated the trial for continued dispensing of oral contraceptives in April (a trial which has been repeatedly condemned by doctor groups).

Meanwhile Federal Labor had committed to tasking the TGA to investigate ways to increase access to oral contraceptives during the 2019 Federal Election, and the Liberal Opposition in Victoria committed to making oral contraceptives available over-the-counter during the 2018 State Election, Dr Schoombie said.

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  1. Arvin Mangahas

    I suggest to keep as OCP as S4, but have non-dispensing pharmacists give authorisation to prescribe COC and LARCs.

  2. Michael Ortiz

    The turf war continues!!

    The AMA is clearly concerned about expanded pharmacy practice into areas of autonomous prescribing. Oral contraceptives seem to be the next battle front. The AMA seems to have lost the immunisation battle.

    Common sense says that collaboration and co operation between Pharmacists and GPs would be a much better approach. Pharmacists already have a process to supply emergency contraception. This may be an opportunity to establish Pharmacist Prescribing but being aware that this is not an OTC product that can be picked up off the shelf like a box of aspirin.

    Ultimately it will come down to risks and benefits. A more important issue is whether pharmacist’s OC prescriptions should be autonomous or continuation prescribing. The AMA argues that this brief consultation is an opportunity for preventive health. So, a skin check, a breast examination, a pap smear, and that opportunity really is very precious in people’s otherwise busy lives, and in busy general practice”. He forgot to mention patients having to book in advance and then wait for up to 1 hour in a busy medical practice to see a GP for 6 minutes and pay $70 for the privilege. Th costs savings are obvious and you don’t need a fancy economic model to prove that access to OCs in community pharmacies would save patients time and money. In addition you don’t need to wait to see a pharmacist in most pharmacies.

    The supply of OCs by pharmacists occurs in other countries without any major issues. Maybe it is time to allow Pharmacists to continue of supply of a previous doctor’s prescription up to a maximum of four to six months of treatment. After the single pharmacist prescription, the patient must return to a GP for a new script. This would guarantee the patient is seen at least annually by a GP.

    This prescribing model could be expanded to other chronic use prescription products in patients whose medical condition is stable and controlled . What the AMA is arguing is that patients should not be able to receive their OC indefinitely without seeing a GP for regular checks like PAP smears and breast examinations.

    Lets hope that common sense prevails in this debate and we don’t lose sight of the needs of the patients being treated.

  3. Michael Post

    Prescription of OC is outside the scope of pharmacist practice.
    We have continued dispensing for some contraceptive pills which is a reasonable method of avoiding missed pill days.
    The female reproductive system is complicated and requires knowledge and diagnostic/pathology referral capacity to prescribe proficiently .

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