As part of its re-election pitch, the Albanese government has slated $573 million in funding over five years for women’s health—and the Coalition has promised to match the funding if they win.
Labor’s package includes new PBS listings for oral contraceptives and menopausal hormone therapy, Medicare rebates for menopause assessments, additional endometriosis/pelvic pain and menopause care clinics, and two national pharmacy-prescribing trials for uncomplicated UTIs and over-the-counter contraceptives.
From 1 March, Yaz® and Yasmin® (drosperinone with ethinylestradiol) will be listed on the PBS. This will help “level the playing field” for women, says sexual health physician Dr Terri Foran, Conjoint Senior Lecturer, School of Women’s and Children’s Health, UNSW.
“Women and their physiology are quite different. The way we all react to various dosages and preparations is quite unique and individual. The nice thing about having a wider range of choices is that you stand a better chance of finding a preparation that suits that woman.”
“And from a medical perspective, there’s nothing more tragic than knowing a certain pill would be the best choice and having someone tell me that they simply cannot afford to pay for it.”
Older pills will still be the first choice in most cases because we have more safety data about them, Dr Foran says. “But my feeling is there’s probably 10% or so of women who really find those pills do not suit them.”
“It’s when those people come back and say, ‘This isn’t working or I’m having this side effect’, and there needs to be some intelligent prescribing of a preparation that best suits that particular person’s needs, that having the option of an alternative preparation that is PBS-listed and therefore not constrained by issues around the ability to pay for it—I think that’s going to make a difference.”
GP and medical educator Dr Sara Whitburn, Medical Director of Sexual Health Victoria and chair of the RACGP’s Sexual Health Specific Interest Group, says it offers more cost-effective options and increases the range of available progestogens.
“And we know that having different progestogens can be useful for people to decrease their side effects. And that Yaz and Yasmin have had studies done into how they might help with acne and fluid retention, but also with premenstrual syndrome. So it means that we’re able to make more decisions based on what might be a clinically appropriate progestogen,” she says.
Dr Foran agrees it provides more opportunities to achieve symptom control, noting Healthed’s Oral Contraceptive Pill Masterclass can help you find suitable choices.
In a press conference launching the package, Health Minister Mark Butler said he was “hopeful” Slinda would be added to the PBS as well, “but there are still negotiations going on about that.”
From 1 March, estradiol (Estrogel®), progesterone (Prometrium®) and estradiol and progesterone (Estrogel® Pro) will be PBS-listed.
Dr Foran says this will increase access for “women who might have been barred in the past from considering them simply for financial considerations.”
“And from a medical point of view, what doctors always want to do is provide the best therapy for a woman. And that hopefully shouldn’t be constrained by costs.”
Professor Rod Baber AM, Clinical Professor of Obstetrics & Gynaecology at The University of Sydney and Past President of the International Menopause Society, agrees.
“For over 20 years it has been clear that the use of government-regulated body identical menopausal hormone therapy is, in most cases, the method of choice and offers an excellent benefit to risk profile,” he says.
“With the addition of these new menopausal hormone options, all Australian women will now be able to receive best practise body identical MHT in an affordable manner.”
The package also includes a new Medicare rebate for menopause health assessments from July 1.
“This will allow family doctors to devote an appropriate amount of time to the very important midlife women’s health consultation,” Professor Baber says.
The package also includes higher Medicare rebates for insertion and removal of IUDs and contraceptive implants. But will they make a tangible difference?
The Government says Medicare rebates will increase by up to 150%, with around 300,000 women each year expected to save up to $400 in out of-pocket costs.
But while the Government claims this will boost bulk billing for insertion and removal of IUDs and implants, Dr Foran says she suspects the incentive is probably inadequate.
“What the government’s offering is not a huge amount of money considering the time and equipment that’s required to insert an IUD,” she says. “I think it probably will pan out that the prices GPs are charging will remain much the same. Thankfully, the patient will get a better Medicare rebate.”
Dr Foran hopes this will prompt conversations, noting “anything that improves women’s access to these long-acting methods has to be a good thing.”
“There’s absolutely no doubt that they are more effective in terms of providing adequate contraception than short-acting methods like the oral contraceptive pill,” she says. “And they also provide huge non-contraceptive benefits in terms of things like control of heavy menstrual bleeding. And they are a wonderful low dose use of hormones in menopausal hormone therapy.”
However, she is not convinced price is the biggest barrier to uptake of hormonal IUDs, but rather persistent misinformation — such as that insertion is inevitably painful, and that they have long-term impacts on hormonal levels.
Funding has also been tabled for:
Dr Foran and Professor Baber both say it’s crucial that the funding reflects a genuine long-term commitment to women’s wellbeing.
“I’m hoping that women’s health stays front and centre in terms of the government’s focus in terms of health outcomes … and it’s not just a temporary measure around election time,” Dr Foran says.
Professor Baber says overall the investment is “a good first step,” but it’s important that the Government sees it as “just the first step in an ongoing process.”
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