Peak advocacy bodies are urging the next Victorian government to independently review pharmacy prescribing models, including its own community pharmacist program.
With the state’s elections just over two months away, practitioners are instead calling for sustained investment in the women’s health workforce.
The RACGP, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Rural Doctors Association of Victoria (RDAV) penned an open letter on Tuesday urging that access to contraception not come at the expense of safety, quality of care, or informed choice.
“Contraceptive care extends beyond the supply of a medicine. It requires clinical assessment, discussion of available options, consideration of individual risk factors and ongoing review,” the letter read.
Consultations provide opportunities to identify and manage the gamut of sexual and reproductive health concerns – from STIs and cervical screening to management of abnormal menstrual patterns, endometriosis, PMOS, pregnancy planning, menopause-related concerns, family violence, and reproductive coercion, RANZCOG president Dr Nisha Khot said.
“All of those opportunities to provide healthcare are lost when someone just gets the pill from the pharmacy,” she told The Medical Republic.
“I don’t think pharmacists would be able to have those nuanced discussions about which hormonal preparation or combination could work best for an individual woman.”
From July, participating pharmacists who completed an accredited postgraduate pharmacist prescriber course could initiate the oral contraceptive pill for women aged 16 to 65.
But independent analyses by the Sax Institute and the Grattan Institute, the peak bodies said, underscored the lack of robust trials, evidence, transparent monitoring and comprehensive assessment of their enduring impacts prior to the rollout of pharmacy prescribing models.
While contraception can be prescribed safely in individual encounters, the open letter questioned whether broader regulatory frameworks were in place to manage clinical risk and patient safety downstream.
Dr Khot said detailed program monitoring was needed, including which contraceptive pills were prescribed, what follow-up information would be provided if the patient developed complications, and whether the patient had received detailed information about STI screening and alternative contraception options.
“In Australia, we have some of the lowest uptake of long-acting reversible contraception (LARCs), which we know is much more reliable in terms of contraception,” she said.
“There are many more nurse practitioners and endorsed midwives who can now insert IUDs or [an] Implanon. But where is the opportunity to tell women that these are better contraceptives and to provide them?”
Moreover, pharmacists would be able to elect to charge an additional consultation fee – a decision that defeated the initiative’s purpose of making contraceptive access more equitable and accessible, Dr Khot told TMR.
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According to the statewide community pharmacist report released last year, 84% of the 23,000 pilot services delivered to patients in the first 12 months were provided to women, with 27% of services comprising oral contraceptive resupply.
Among the 25 LGAs with higher participation in the pharmacy pilot, the number of GPs per 1000 residents was below the state average. Of these, 21 were in regional or rural Victoria.
RDAV president Dr Louise Manning told TMR she was unsure why the government was “cutting itself off at the knees” by establishing services that compete with existing funded comprehensive women’s and sexual health services,
She also pointed to the 20 multidisciplinary women’s health clinics and 20 sexual and reproductive health hubs – funded under the $153.9 million women’s health package – due to be fully operational by late 2026 across the state.
“It doesn’t seem to make sense to then undercut that with pharmacy prescribing,” she said.
Dr Manning also expressed concern for participating pharmacists, including potentially insufficient guidance and understanding of the associated risks.
While the likelihood of adverse events in healthy individuals is relatively small, they could be “disastrous”, she said.
For instance, fewer than 40 in every 100,000 women taking a combined hormonal contraceptive pill will experience a stroke; however, these events can be life-altering, she said.
“There are quite a lot of safeguards that have been written into the current protocol, which is pleasing, and I think they’ve been trying to make it as safe as possible.
“[But] we just don’t have the evidence to suggest that overall, the whole process is safe,” she told TMR.
Moreover, pharmacists would be unable to provide long-acting reversible contraception, which she said was often safer and more effective.
“For time-poor people in rural areas, it’s just another barrier to good, comprehensive, holistic care,” she said.
Dr Manning said it might also push more rural women toward the oral contraceptive pill for convenience, rather than seeking more comprehensive care.
Another concern was the potential increase in unplanned pregnancies, for which women living in rural and remote areas are already 1.4 times more likely to experience than those in metropolitan areas.
“We call on the next Victorian government to commit to an independent review of patient outcomes and adverse events, and broader system impacts associated with these new models of care, including Chemist Care Now,” the letter read.
There are more than 900 chemists across Victoria participating in the government’s initiative.
The open letter followed the Pharmacy Guild of Australia championing the cost benefits of pharmacist prescribing, ahead of the government finalising details of the NSW women’s health trial.
Set to commence in January 2027, the trial will provide subsidised access to affordable contraceptives and treatments for uncomplicated UTIs at $7.70.
Read the open letter here.
