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Contraceptive agents

Calls for emergency contraception to be available without a pharmacist consultation

A report from the the Royal College of Obstetricians and Gynaecologists says there is no evidence that emergency hormonal contraception has been misused or overused.

Emergency contraception (EC) should be available over the counter without the need for a consultation with a pharmacist, the Royal College of Obstetricians and Gynaecologists (RCOG) has said.

In a report, ‘Better for women: improving the health and wellbeing of girls and women, published on 2 December 2019, the RCOG said the current mandatory consultation with a pharmacist acts as a barrier to access, warning that the consultation can leave women feeling “uncomfortable, embarrassed or judged”. 

However, the Royal Pharmaceutical Society (RPS) said that a pharmacy consultation before dispensing emergency hormonal contraception (EHC), such as Levonelle (Bayer) or ellaOne (HRA Pharma), can help women to make the choice that is best for them. 

The RCOG report calls for EHC to be moved to the general sales list, meaning it would be available to purchase off-the-shelf, without the need for a consultation.

In Scotland and Wales, EHC is available free of charge and without prescription. 

In England, it is also available without prescription and “should be free for all women attending sexual health clinics and general practices”, the report says.

However, the report adds: “The reality is that many girls and women in England have to pay up to £35 to access EHC, because it is not available free of charge in 50% of services in England. This sum of money is unaffordable for many girls and women, reinforcing the many existing sexual and reproductive healthcare inequalities.” 

And it adds: “EHC has been available over the counter in the UK for almost 20 years with no evidence that it is being misused or overused”.

“Oral EC is available ‘in front of the counter’ in pharmacies in Canada and Scandinavia, where it is recognised that it can safely be used without supervision, and that the ‘behind-the-counter’ framework inhibits access. The UK must follow this example of good practice,” it adds.

Sandra Gidley, president of the RPS, said that pharmacist consultations focus on “helping women who need EC”.

“There are several methods of EC available to women and, as well as supporting the choice that’s best for her situation, pharmacists can advise on future use of contraception and the risk of sexually transmitted infections.”

Gidley added that cost is a barrier to medicines access, and that the RPS “fully supports NHS schemes that allow women to access EC free of charge through community pharmacies”.

“These services already exist in Scotland and Wales and it’s unacceptable that women in England still have to pay.”

The RCOG also recommends that the progestogen-only oral contraceptive pill, such as Micronor (Janssen), which is currently prescription-only, be reclassified as a pharmacy medicine, so that it could be purchased without a prescription.

The recommendation, which includes availability from online pharmacies, is based upon the pill’s “long safety track-record”.

The report also suggests that the Department of Health and Social Care should consider allowing women to take mifepristone — the first of two medicines used in medical abortion — at home. Currently, only the second medicine — misoprostol, which is taken 24–48 hours after mifepristone — is authorised for home use.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20207415

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