AMA opposes application to down-schedule oral contraceptive pills

Two proposals to make oral contraceptive pills (OCP) available at pharmacies without a prescription will be considered at a meeting of the Therapeutic Goods Administration’s (TGA) Advisory Committee on Medicines Scheduling in late June 2021.

The AMA has stated in its submission to the TGA’s Proposed amendments to the Poisons Standard – June 2021 – oral contraceptives, that it “vehemently opposes both applications to down-schedule oral contraceptive pills from Schedule 4 (prescription only) to Schedule 3 (pharmacist only).

This change will have a detrimental impact on quality and safe care provided to patients being prescribed, or seeking a prescription for an OCP, and will negatively impact public health. Down-scheduling OCPs will allow pharmacists to operate autonomously without acknowledging and examining the effect it will have on fragmentation of care, patient outcomes and quality of prescribing.

The AMA is strongly opposed to allowing OCPs to be dispensed over the counter because pharmacists are not trained to properly assess patients for key risk factors or provide advice on other, potentially more effective forms of contraception.

AMA President Dr Omar Khorshid said, “Taking the oral contraceptive is not without risks and it is best for patients to talk to their GP about which contraceptive option is right for them.”

“It can take time and expertise to determine which contraceptive option is right for an individual patient and this is best done under the advice of a doctor. Pharmacists may not know a patient’s full medical history and are not qualified to assess whether the benefits of taking an OCP outweighs the risks.

“In fact, an OCP might not be the most suitable form of contraception for a patient. For example, intrauterine devices and implants are more effective forms of contraception,” he said

Taking an OCP may increase the risk of blood clots, stroke and heart attacks, all of which can be exacerbated if a patient is overweight or a smoker. Age can also increase the risk of adverse effects.

A 2021 pilot study has found 96 per cent of GPs diagnosed a secondary health issue when an OCP prescription was sought by their patient.

GPs also conduct preventative health checks and discuss wider and more detailed medical and personal circumstances of the patient, including mental health.

Pharmacies operate as retail shops and are not an appropriate setting to discuss intimate details of a patient’s sexual health and their detailed medical history.

“Patients may face additional out-of-pocket costs as Medicare will not cover these services,” Dr Khorshid said.

Any move to make OCPs available over the counter would further fragment health care by excluding the patient’s GP from involvement in their patient’s sexual, reproductive and overall health.

Australia is moving to embrace the concept of the “medical home”, built around the proven model of comprehensive and coordinated GP-led care. This leads to better healthcare outcomes for patients, particularly when pharmacists work in conjunction with general practitioners, focusing on those areas where they are best equipped, including medication adherence, medication management, and providing education about medication safety.

The AMA submission can be viewed here