Could Australia follow the US with a contraceptive pill at supermarkets?

Australia is unlikely to follow a revolutionary healthcare measure introduced in the United States this week which will allow women to buy an oral contraceptive pill from a supermarket without seeing a doctor.

The US Food and Drug Administration has for the first time approved a non-prescription daily contraceptive drug that can be purchased over the counter at pharmacies, convenience stores, grocery stores and online.

Australia is not set to go down the US path with an over-the-counter contraceptive pill.Credit: Fiona-Lee Quimby

The authority said the milestone measure would expand access to contraception for millions of people, help avoid unwanted pregnancies and reduce barriers by removing the need to first see a healthcare provider.

Reproductive healthcare in Australia has come under a microscope this year with a Senate inquiry into the issue and a landmark decision to expand access to the medical abortion pill by cutting red tape for health practitioners to prescribe and dispense it.

But hurdles remain regarding access to contraceptives: the latest and most effective contraceptive pills are largely unavailable for subsidy through the Pharmaceutical Benefits Scheme – meaning they can cost women three times more than older products with worse side effects – and Australia has a low uptake of long-acting options such as intrauterine devices (IUDs).

Greens spokesperson for women, Larissa Waters, who initiated the Senate inquiry, said it had “made loud and clear that the cost of contraceptives is a real barrier and leads to more unplanned pregnancies”.

“With over-the-counter contraceptive pills now available in the US, Australia is again lagging behind when it comes to contraceptive options,” she said.

“We’re in a cost-of-living crisis, we know people are skipping medications and avoiding visits to the doctor. Making contraceptives more accessible and affordable – or better yet, free – would make an enormous difference to people’s lives.”

The Therapeutic Goods Administration is not considering any applications to make contraceptive pills easier to acquire, a spokesperson confirmed on Friday.

They said two separate applications for non-prescription contraceptive pills were considered in June 2021 but knocked back by the medicines advisory committee, which recommended they remain prescription-only based on the need for medical oversight.

Instead, pilot programs in NSW and Victoria will begin later this year allowing pharmacists to trial prescribing the contraceptive pill in certain circumstances, so patients don’t have to visit their GP. Queensland also allows women to buy one packet of their standard pill each year without a prescription.

Waters said she looked forward to the results of those new trials and “exploring all options to increase access”.

Fei Sim, president of the Pharmaceutical Society of Australia, said there were many more options for Australia to consider before following the FDA decision.

“We do have a very different health system and model of care,” she said. “The US is heading in the right direction in terms of improved access, but I think in Australia we have a few steps before we get there.”

She said the pharmacy prescribing trial would strike the right balance between giving people immediate access and ensuring “we still have a health professional at the gate to make sure there’s a check and balance, to provide advice and facilitate a referral to a doctor”.

“The US model also hasn’t been implemented yet, and as with any health policy, we will need to monitor closely and see how it goes,” she said. “In Australia, the trials in Victoria and NSW should be great role models to tell us how we can balance safety with access.”

However, Australian Medical Association vice-president Danielle McMullen said the medical group had reservations about the pharmacy trials. “We do hold concerns that patients may face higher costs because there’s no PBS subsidy and they don’t have their full suite of options presented to them,” she said.

She said there were other levers the government could use to improve access, such as extending pill scripts beyond the current maximum of a year’s worth of repeats, or making it easier for patients to get out-of-session scripts from their regular GP practice.

“Contraception is complex and should be individualised. It’s important women have the opportunity to have that discussion, and that [they] are supported by the PBS to improve affordability,” she said.

While the American Medical Association has strongly supported over-the-counter contraceptives, McMullen said both countries had different health systems and it would be an oversimplification to compare the two groups’ views.

“We do have rigorous structures in place and at this point in the Australian context it’s been decided it’s appropriate to remain [prescription-only] for medical reasons,” she said.

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