Some women will be able to get contraceptive pills directly from pharmacists with only one doctor's prescription required every three years.

Medsafe said today it had accepted the recommendations on this from the Medicines Classification Committee. The changes would come into effect by the end of this month and once pharmacists had been properly trained.

The changes follow years of negotiations at the committee over proposals by Green Cross Health, which has the Life Pharmacy and Unichem brands.

Around 200,000 Kiwi women take oral contraceptives.

Green Cross says: "The cost to customers will be $45 for a three-month supply of oral contraceptives."

But doctors have expressed concern that the changes could undermine the relationship between women and their GPs and might cost women more.

Medsafe says: "The reclassification would mean that pharmacists can sell up to six months' supply of selected oral contraceptives to a woman who has been prescribed the same type of oral contraceptive within the last three years from the date of an original medical practitioner's prescription and has not developed risk factors."

The five types of contraceptives covered by the changes will remain "prescription", with an exemption for pharmacists to sell them under a new set of rules.

Until now, women have needed a doctor's or nurse's prescription, or repeat prescriptions, for each six months' supply - except for emergency contraceptive pills. The Government's pharmaceuticals fee is $5 for each subsidised medication.

Auckland GP Dr John Cameron said he and colleagues expected a woman would typically need two consultations in the first six months of starting on an oral contraceptive, then one every one to two years, plus occasional blood pressure checks at around $10 each. In between consultations, repeat prescriptions could be issued, at a cost around $15 to $20 each.

State-subsidised GP visits cost patients from nothing, to around $60.

At Family Planning clinics, consultations with doctors and prescribing nurses are free for women under 22.

Medsafe Group Manager Chris James said that to be eligible to buy contraceptive pills from a pharmacist, a woman must not have developed risk factors which would preclude continued use without adequate medical supervision.

Risk factors for oral contraceptives include high blood pressure, a personal or family history of blood clots, smoking or being overweight.

James said: "Very young women, under 16, are not eligible nor are first-time users of oral contraceptives. And women will be encouraged to allow pharmacists to notify their GP that they are getting the oral contraceptive across the pharmacy counter."

Committee chairman Dr Stewart Jessamine said the change proposal was extensively reviewed and a wide range of health care practitioners and consumer representatives were consulted.

"The committee was satisfied that pharmacists could supply oral contraceptives to women who meet the specified criteria with the same levels of safety as other healthcare professionals.

"The Pharmacy Council and Pharmaceutical Society will be responsible for ensuring pharmacists are appropriately trained to provide oral contraceptives without a prescription to eligible women.'

Green Cross said the changes meant combined oral contraceptives and progesterone-only pills would soon be available from pharmacists at Life and Unichem pharmacies.

"This is a ground-breaking decision by the Ministry of Health and is in line with its 'Better, Sooner, More Convenient' approach, as well as reflecting our own commitment to provide greater access to healthcare and advice," said the Green Cross group manager for professional services, Alison Van Wyk.

But the Medical Association's chairman, Dr Stephen Child, said it had a number of concerns about the changes.

"This may remove an opportunity for women to have an interaction with their GP, and undermine that therapeutic relationship, both of which are important aspects of prescribing the oral contraceptive pill.

"We are also concerned that the proposal does not actively encourage the uptake of long-acting reversible contraception, which has been shown to be more effective in practice than contraceptive pill use.

"Pharmacists will charge a consultation fee for the time involved in the consultation, and this fee may be considerably higher than that charged for a repeat prescription by a doctor.

"We expect that many motivated women who can afford to pay for their contraceptive pill may use the proposed pharmacist-supplied contraceptive service.

"It is important that market sales are collected and analysed to monitor the success of the scheme in improving access to oral contraceptive pills, particularly for priority groups -young people, Māori and Pasifika."

The new rules:
Pharmacists can sell up to six months' supply of selected oral contraceptives on repeat prescriptions when they have been previously prescribed by a medical practitioner in the last three years.

Customers must be aged 16-39 for the combined oral contraceptive pill, or 16-52 for the progesterone-only pill.

Pharmacists must undertake special training.

The contraceptives:
Combined oral contraceptives:

Ethinylestradiol with norethisterone
Ethinylestradiol with levonorgestrel

Progesterone-only pills:

Desogestrel
Levonorgestrel
Norethisterone

- NZ Herald