What guard rails are in place to keep women safe

Women in New South Wales can now get prescriptions for resupply of oral contraceptive pills from their pharmacist, as the second phase of the statewide pharmacy prescribing trial launched on Wednesday.

Women will be eligible for resupply of oral contraceptive pills through their local participating pharmacy if they:

• are aged 18 to 35 years old
• have had a past prescription for certain types of oral contraceptive pill issued in the previous two years, and
• are taking the pill for contraceptive purposes.

There have been some concerns from doctors, such as RACGP NSW chair Dr Charlotte Hespe, who told the Sydney Morning Herald she worried that women going for two years without seeing their GP would miss out on safer alternatives and potentially other health checks.

However sexual health physician Dr Terri Foran helped develop the safety guidelines and parameters for the trial, and describes rigorous protocols to ensure safety.

What safety protocols have been put in place?

“The decision was made very early on to only include those pills that are considered the safest in terms of the clot in the leg and the lung risk. So none of the newer pills are included in the trial,” Dr Foran said.

“Anyone who’s on one of those pills that’s not covered by this trial, or who’s under 18 or over 35, will be referred to their GP for further advice,” Dr Foran explained. The age group was also chosen due to their relatively low risk profile.

When a woman attends a ‘participating pharmacist’ for a resupply of an existing OCP script, they’ll go through a rigorous consultation to identify anything unrecognised that may have cropped up since her last doctor’s visit.

“There are questions around headaches and changes in headaches and all that sort of thing. They have their weight taken and their blood pressure taken to ensure that there are no reasons why it’s not a great idea,” Dr Foran said.

Pharmacists will use the UK Medical Eligibility Criteria developed by the Faculty of Sexual & Reproductive Healthcare to flag issues that might require either an immediate referral to the person’s GP or an emergency month’s supply so they don’t get pregnant while they’re waiting to see their GP.

“Really the thing that will guide safety is the protocol that’s been developed which runs through a checklist of those things that might make ongoing supply of the pill more dangerous,” Dr Foran said.

Another crucial part of the protocol is that GPs are advised of their patient’s prescription.

Additionally, women are informed about recommended screening such as cervical screening, STI testing or breastfeeding—and there’s discussion about other available methods of contraception which may be more convenient or safer for that particular person, she added. “There’s fact sheets they can access and they would be encouraged to go and speak to their GP if that interested them.”

The trial is being led by the University of Newcastle, who are working closely with a multidisciplinary team including GPs, clinicians, pharmacists, rural clinicians and Aboriginal and Torres Strait Islander people to ensure it is safe for women, the NSW government said.

More than 900 pharmacies across are participating in the 12-month trial.

Dr Foran emphasises that it is indeed a trial, which will run for a limited time with a limited number of people—and results will be analysed, stakeholders will be consulted, and the program will be evaluated to ensure it’s safe and useful.

The government has highlighted the potential benefits in rural and regional areas, and the time they expect it will save women.

Under the trial, the only out-of-pocket costs will be for the medication. The NSW government will also provide $20 per consultation to participating pharmacists to cover associated admin.

“This initiative is not only making it easier for people to access medicines, it is also alleviating pressure on our GPs and primary care services,” Minister for Health Minister for Health Ryan Park said at the launch.

For more information: FAQs: The oral contraceptive pill and the NSW Pharmacy Trial