The Government is consulting on reclassifying two progestogen-only pills for sale without a prescription from pharmacies – the first time an application has been made for oral contraceptives to be available as a P medicine.
The consultation, launched on 12 February, proposes allowing pharmacists to issue a three-month supply of 75mg Lovima or Hana tablets – both desogestrel (DSG) progestogen-only pills – at initial consultation.
Pharmacies would be able to provide 12 months’ worth at repeat supply, but women under the age of 18 would be limited to three months, the document said.
DSG progestogen-only pills prevent ovulation, can be used by women who are breastfeeding and those unable to tolerate oestrogens, and have a longer ‘missed pill window’ than traditional progestogen-only pills.
The consultation comes after a study published in the Lancet in November 2020 found that enabling pharmacists to supply women with a course of progestogen-only pills along with emergency contraception (EHC) increased overall use of effective contraception.
At the time, the Faculty of Sexual and Reproductive Healthcare (FSRH) said it backed a model where more pharmacies provided contraceptive services, as this could ‘broaden choice for women’.
Current FSRH advice recommends starting regular hormonal contraception straight after taking EHC. But most cannot obtain a supply without visiting a GP or sexual health clinic, which Lancet researchers said could act as a disincentive.
The Government said an engagement exercise carried out prior to the new consultation with patient groups, GPs, pharmacists, and professional bodies had also revealed ‘strong support’ for widening access to oral contraceptives.
The consultation document added that any health risks associated with doing so could be effectively mitigated by providing appropriate information to women both during consultations with pharmacists and via product information leaflets.
Pharmacists would also be provided with additional training materials around the safe use of DSG progestogen-only pills, including a checklist covering customers’ age, medical conditions, medications they are taking and advice around using after EHC and avoiding pregnancy.
‘Enabling an informed choice’
Responding to the announcement of the consultation, Sandra Gidley, president of the Royal Pharmaceutical Society (RPS), said the body welcomed the possibility of a progestogen-only contraceptive pill being provided directly to women by pharmacists without a prescription.
‘Pharmacies already play an important role in provision of contraception and are a convenient, expert source of help and advice,’ Ms Gidley said.
‘This move will increase access to an effective method of contraception and enable women to make an informed choice about their needs after discussion with a pharmacist.’
She added that ultimately the RPS would like to see contraceptive services commissioned by the NHS through pharmacies ‘so many more people can benefit from another point of access to contraception and advice’.
Leyla Hannbeck, the chief executive of the Association of Independent Multiple Pharmacies, also said her organisation supported the reclassification proposals.
‘Pharmacists are very capable at giving appropriate advice on drug interactions for medicines in such a category,’ she said.
She added: ‘We suggest self-medication by pharmacy-only medicines could be enhanced by a pharmacy patient registration scheme, with establishment and retention payments per patient, where the pharmacist would monitor the patients’ use of their medicines and repeat the over-the-counter sale if they considered it appropriate, or refer the patient back to the family planning and sexual planning clinic.’
A spokesperson for HRA Pharma – which manufactures Hana – added the company would be providing pharmacists with comprehensive training to enable them to assess the suitability of women during a consultation and ensure all appropriate guidance was provided.
HRA Pharma’s spokesperson said the company was confident the new consultation would ‘confirm the already strong support demonstrated by many professional organisations for greater availability of oral contraceptives’.
‘Women urgently need broader contraceptive access – now more than ever,’ the spokesperson said.
‘In the current Covid context it has been reported that many are experiencing difficulties in accessing their usual methods of contraception given that medical appointments may be difficult to get, and where sexual health clinics run reduced services.’