Pharmacy-only contraception medications may not have a “long-term future”, Dr Philip Crilly, senior lecturer in pharmacy practice and digital public health at Kingston University, told C+D yesterday (December 4).

Dr Crilly is the lead author of a new study – currently only published in abstract form – based on a survey of community pharmacists around medicine reclassifications. 

Read more: Online pharmacy's erectile dysfunction campaign 'banned' on social media

The research looks at pharmacists’ perceptions of sexual and reproductive health drugs that have been switched from prescription-only medicine (POM) to pharmacy (P) medicine status by the Medicines and Healthcare products Regulatory Agency (MHRA) in recent years. 

The 59-question survey conducted between January and April 2023 gathered responses from 150 community pharmacists based in Greater London. 

Read more: P med erectile dysfunction drug to be sold from Boots pharmacies

Pharmacists were asked about their experiences offering sildenafil citrate erectile dysfunction medication Viagra Connect, desogestrel oral contraceptives Hana and Lovima and estradiol hemihydrate vaginal atrophy medication Gina, among other questions.

The study abstract based on this research was published in the International Journal of Pharmacy Practice last week (November 30), after the work was presented at the 2023 Royal Pharmaceutical Society (RPS) annual conference on November 10. 

 

Why stock P when there’s contraception for free?

 

The study revealed that only half (50%) of community pharmacies visited by the researchers offered desogestrel products like Hana or Lovima and just 28% stocked estradiol.

Pharmacists cited a “lack of public awareness about the availability” and “a lack of public interest in purchasing” both products, it said.

Dr Crilly told C+D that community pharmacists were unwilling to “give up shelf-space” for a product that they thought would be “unlikely to sell”.

Read more: HRT drug Gina 10mcg given green light for POM to P switch

He said that pharmacists believed patients were “more likely” to visit a GP for concerns about menopausal symptoms or to obtain contraception at their GP or family planning clinic where they could access medication for free.

Dr Crilly added that the new pharmacy contraception service may mean trouble for the “long-term future” of P contraceptives because it “looks like” pharmacies could offer patients POM versions of progestogen-only contraceptives for free as part of the service. 

 

“Convenience and flexibility”

 

 

A spokesperson for Lovima manufacturer Maxwellia told C+D that the pharmacy contraceptive service is “a huge opportunity both for women and for pharmacy”. 

They said that the service was “an important step” that would help “underserved” women “take control of their reproductive health”, adding that the service will provide the sector with “a desperately needed new revenue stream”.

A spokesperson for Hana manufacturer Perrigo told C+D that it supports “any scheme that gives women in the UK greater choice” for contraceptive access.

They said that Hana is the UK’s “best-selling” OTC contraceptive pill, adding that it has an “over 95% market share”.

Read more: MHRA approves 2 POM to P progestogen-only contraceptive pill switches

They added that Hana’s success indicates that there are “many women who would rather pay for the pill” over-the-counter or online, because it offers “convenience and flexibility”.

And they said that morning after pill ellaOne, a sister brand to Hana, “continues to be purchased in pharmacies and online in the UK”, even though pharmacies also offer schemes to provide emergency hormonal contraception (EHC) for free. 

A spokesperson for Gina manufacturer Novo Nordisk told C+D that pharmacists are “uniquely placed” to provide women with education on vaginal atrophy.

They said that the company had provided pharmacy teams with “comprehensive” training, including supporting materials and GP referral guidelines. 

 

 

Switch no guarantee of success

 

Dr Crilly also told C+D that the study showed that reclassification from POM to P was no guarantee of a medicine’s success.

While 88% of the pharmacists surveyed felt that POM to P switches “increased their role and provided greater access”, he noted that “if products do not sell, they are likely to be discontinued”.

Read more: MHRA reclassifies erectile dysfunction tablets for OTC pharmacy purchase

In April 2010, C+D reported that menstrual bleeding product tranexamic acid had been switched from POM to P under the brand name Cyklo-F – but this product was subsequently discontinued.

Likewise, tamsulosin capsules for treating prostate enlargement were reclassified from POM to P in December 2009 under the name Flomax Relief only to be discontinued by the manufacturer.

 

Reducing stigma

 

Meanwhile, Dr Crilly told C+D that pharmacists perceived Viagra Connect as a “better marketed” product that was more in-demand than the other products under consideration for the study.

The study found that all respondents offered sildenafil in their community pharmacies. 

He also said that pharmacists had noted that access to P status ED medication in community pharmacies “reduced the stigma of making an appointment to obtain it”.

Read more: Viatris launches 50mg Viagra Connect in two-tablet pack trial size

Pharmacists had also expressed the view that offering ED medication like sildenafil “protected customers who may have otherwise bought it on the black market”, Dr Crilly added.

But while the study found that pharmacists thought that sildenafil offered “safe access” to ED medication, some 86% were nevertheless concerned that the medication had a “high risk of its misuse”.

Dr Crilly said that some respondents reported refusing the sale of sildenafil to customers that wanted the medication but “did not actually have erectile dysfunction”.

Read more: Boots pharmacies to sell own-brand Viagra and vaginal health products

C+D approached Viagra Connect owner Viatris for comment.

Dr Crilly co-authored the study with Iman Al-Saery, Joseph Davey and Shima Abdallah, all of whom are level 7 MPharm students at Kingston University.

He told C+D that he hoped the full paper would be published by April 2024, contingent on the research being accepted for publication and completion of changes recommended during the peer review process.

 

POM to P recently

 

In March, C+D reported that Cialis Together erectile dysfunction tablets had been reclassified by the MHRA from a POM to a P medicine.

In July 2022, the MHRA also decided to permit pharmacists to dispense hormone replacement therapy (HRT) drug Gina 10mcg without a prescription.

Read more: HRT drug Gina 10mcg available OTC in all pharmacies by end of month

In July the previous year, the MHRA authorised the switch of desogestrel contraceptive pills Lovima and Hana from POM to P meds.

And in April 2018, Viagra Connect launched in UK pharmacies, with market analysts reporting months after its launch that the P med had seen “firm growth” in sales, while pharmacists reported that erectile dysfunction conversations were “picking up”.