The pill’s about to get cheaper for some. What are your new options?
Women might want to revisit their choice of contraception as changes are about to be made on price and availability. Here’s an expert’s take on what’s happening.
For the first time in more than 30 years, a commonly prescribed oral contraceptive has been made more affordable by the Pharmaceutical Benefits Scheme.
It’s one of the first outcomes of the government’s welcome pledge to spend $573.3m to deliver “more choice, lower costs and better healthcare for women”. The Coalition has promised to match the spending.
The changes include the oral contraceptive pills Yasmin and Yaz, which were first made available in Australia in 2022 and 2008 respectively and are often prescribed for women who experience premenstrual outbreaks of acne, fluid retention and weight gain. It also includes the hormonal long-acting reversible contraceptives we refer to as LARCs, which will now be more accessible and affordable for women.
The oral contraceptive pill changes are effective from March 1, 2025, and it is hoped that more will be added to this list. This translates to around 50,000 women who would otherwise pay around $380 annually who will now pay $126.40 a year, or just $30.80 a year with a concession card.
Women’s needs change over time according to their reproductive life stage, and although contraceptives are largely used as a form of birth control, they are also selected for their therapeutic properties and used to treat a range of conditions such as polycystic ovarian syndrome, endometriosis, perimenopausal symptoms, heavy menstrual bleeding and pelvic pain, to name a few.
Whichever reason they are prescribed for, it is important to offer a range of options to help women find the most appropriate contraceptive for the various stages in their life.
Yasmin and Yaz, are different to other oral contraceptive pills in that they contain a type of progesterone called drospirenone, which has some anti-androgenic effects. This type of progesterone when combined with ethinylestradiol (the female hormone oestrogen), is particularly helpful for women with moderate acne vulgaris who seek oral contraception. They can also be recommended for women who cannot tolerate the forms of progesterone in the older generation oral contraceptive pills due to headaches, breast soreness and mood changes, and for women who experience anything from mild premenstrual symptoms or even the more severe form of hormone-induced mood disorder, called premenstrual dysphoric disorder. Slinda, much like Yasmin and Yaz, is an even newer oral contraceptive pill formulation which contains only drosperinone and is beneficial in controlling endometriosis and heavy menstrual bleeding. Currently, a three-month script of Slinda costs about $80 compared to the common combined oral contraceptive Levlen, which costs about $15 for 4 months. It is hoped Slinda will also come down in price to match the others.
If you consider that a third of women who take the oral contraceptive pill between the ages of 18 and 39 require these more expensive, newer generation options, this amounts to a large financial outlay over time, starting from their student years through to when they move out of home, spanning the period where they either earn nothing or little, so it is no wonder that many of these young women opt to go “pill free”, even when sexually active.
Inevitably, this increases the risk of unplanned pregnancy. In Australia, around one in four women has had an abortion, commonly due to an unplanned pregnancy, making our abortion rates among the highest in the developed world. A study undertaken in 2019 revealed that of the 18 to 24-year-old women presenting for termination, 39 per cent were using oral contraceptives, 29 per cent were using condoms and 19 per cent were using withdrawal. The oral contraceptives, although effective when taken as prescribed, are sometimes missed or not absorbed well due to interactions with other medications, or due to gastrointestinal upset. Although LARCs are most effective in preventing unplanned pregnancy to the order of 99 per cent, they are also the least popular in Australia, with only one in 10 women opting for them compared to one in three in Sweden. Fortunately, the recent government announcement includes funding towards addressing barriers to increasing uptake of these also.
The LARC group of contraceptives comprises the 4cm etonogestrel implant, which is introduced under the skin (Implanon); the levonorgestrel impregnated intra-uterine contraceptive devices (IUCD), such as MIRENA or Kyleena; and the hormone-free copper IUCD. They are quite literally “set and forget” forms of contraception. The MIRENA emits only progesterone for about five years but can be left in for up to eight years; the Kyleena, much like the Implanon, has active hormone for three years; and the copper IUCD can be left in for 10 years. The hormonal LARCs are not only superior as contraceptive devices, they also markedly reduce heavy menstrual bleeding and help treat pelvic pain and endometriosis. Although the MIRENA and Kyleena are PBS subsidised, costing $31.60 ($7.70 concession), copper IUDs are not; they cost around $100 and can be difficult to access. Copper IUCDs are listed as a device and not as a medication so are treated differently and are not under the PBS, however we hope that their price will also come down.
The uptake of LARCs in Australia has been very low for reasons to do with poor communication around their efficacy, discomfort of the insertion procedure, lack of training and education of the healthcare profession, and poor remuneration for insertions due to low Medicare rebates. The new announcement, however, will change this as these rebates are set to increase by 150 per cent to encourage GPs and nurse practitioners to bulk bill for the insertion and removal procedures, significantly reducing out-of-pocket expenses for around 300,000 women in the order of about $400.
To date, it has also been difficult for women to access GPs who insert IUCDs and implants, as this requires additional professional training. However, opportunities for this training are limited, expensive and overbooked.
About a decade ago, I searched to find a refresher course for IUCD insertion and called the major maternity hospitals to ask if there were such programs. At the time, there were none that I could find, so I called a gynaecologist colleague who agreed to provide a half-day training session for myself and a group of GPs. We each invited a few of our willing patients and he oversaw our technique, after practising on some plastic models. It was effective, safe training and cost each of us $500 back then.
Such courses cost triple that price now and are booked months in advance, so it’s heartening to hear that $25.1m will be used to establish eight Centres of Training Excellence to ensure healthcare professionals are trained, skilled and confident in this. The increased rebates for insertions will roll out on November 1, 2025, so hopefully, by then there will be more community awareness and increased numbers of trained workforce – and a positive uptake of LARCs will flow on from that.
Collectively, these measures represent important progress towards the effort to address the longstanding disparities in women’s health and provide more affordable and accessible options, which hopefully will bridge the divide between the healthcare women need across their life course and the healthcare that has existed to date.
References
More choice, lower costs and better health care for women, 7 February 2025
Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. First published: 10 March 2017 Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: An expert roundtable discussion https://doi.org/10.1111/ajo.12587 https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.12587
Claringbold L, Sanci L, Temple-Smith M. Factors influencing young women’s contraceptive choices. Aust J Gen Pract. 2019 Jun; 48(6): 389-394. doi: 10.31128/AJGP-09-18-4710. PMID: 31220890.
Associate Professor Magdalena Simonis AM is a women’s health expert, member of the RACGP Expert Committee for Quality Care and University of Melbourne Department of General Practice.
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
