Queensland prescribing pilot is actually two pilots

4 minute read

Community pharmacists will be able to prescribe the oral contraceptive pill to women and girls months ahead of schedule, but the details are confusing (to say the least).

Pharmacists across the sunshine state will have the power to prescribe and dispense hormonal contraceptives from July, regardless of whether the state’s controversial pharmacy pilot has begun in their area.  

Queensland Health Minister Shannon Fentiman announced the move at the Australian Pharmacy Professionals Conference on the Gold Coast last week.  

“I’m very excited to share that I have just announced that we will be bringing forward a module as part of our pharmacy scope of practice pilot here in Queensland to enable women to get a prescription for the [oral contraceptive] pill from their pharmacy,” she told Pharmacy Guild’s Australasian Pharmacy.  

“It’s a game changer for women and girls’ health.”  

According to the clinical practice guideline, hormonal contraception covers low- or standard-dose oestrogen formulations of the combined oral contraceptive pill, the progestogen-only contraceptive pill, the combined hormonal vaginal ring and the progestin-only injectable depot.  

Eagle-eyed readers may note that hormonal contraceptives have been a part of the scope of practice pilot’s remit since its inception.  

The even more eagle-eyed may have noted that the pilot, which allows autonomous prescribing for 17 different conditions, was meant to have started at the beginning of this month, long before July.  

On first parse, this makes Ms Fentiman’s announcement somewhat confusing.  

The Medical Republic contacted Queensland Health for clarification. The state health department responded by informing TMR that prescribing for hormonal contraceptives was separate to the Queensland Community Scope of Practice Pilot.  

While it was initially meant to start later in the year, a spokesman said, the decision had been made to bring the commencement date forward to July.  

Both the Pharmaceutical Society of Australia and the Australian Journal of Pharmacy also reported that hormonal contraceptives made up their own pilot.  

Rather than clearing things up, this clarification muddied the water further.  

For a start, it’s always been TMR’s understanding that hormonal contraception would be a facet of the pilot, given that it was included in the original trial proposal documents leaked to Australian Doctor in January 2022. 

TMR could not locate a specific announcement from Queensland Health making it clear that there was more than one trial.  

As recently as September 2023, when Ms Fentiman announced the pilot would expand statewide, the contraceptive pill was listed among features of the main program like asthma medication and treatment for mild skin conditions.  

On the Queensland Health site, the clinical practice guideline for hormonal contraception is uploaded alongside the clinical practice guideline documents for the other conditions covered by the pilot.  

Hormonal contraception is also on the listed conditions under the trial on the pilot’s Queensland Health information page and included in the official extended practice authority covering the pilot

The reason that it’s important to know whether there are one or two trials comes down to evaluation.  

Queensland Health has commissioned an external evaluation of the pilot, to be conducted by Deloitte in partnership with Griffith University.  

If the hormonal contraceptives portion is conducted separately to the main pilot, which is what Deloitte has been specifically contracted to examine, it’s unclear whether the contraceptive data would make it into the evaluation.  

The implications of that could be big.  

Hormonal contraceptives are a particularly contentious inclusion in the trial, considering that the TGA knocked back an application to make the oral contraceptive pill available over the counter in late 2021.  

In its interim decision on the matter, which it ultimately stood by, the regulator specifically addressed the tension between convenience and good medicine in the context of pharmacist-led prescribing.  

“Consumers can identify when they require (oral) contraception, but consultation with a pharmacist is not sufficient to ensure safety, particularly over extended periods of time,” the interim decision read. 

The TGA’s decision not to down-schedule oral contraceptives was somewhat of a moot point, considering that individual states and territories control their own poisons schedules and can elect to down-schedule specific medicines without the regulator’s input.  

TMR sent detailed questions to Queensland Health but did not hear back before deadline.  

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