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Make oral emergency contraception a GSL med, sexual health leaders urge

Oral emergency contraception should be a general sales list (GSL) medicine, a prominent sexual and reproductive health coalition has demanded.

The Faculty of Sexual and Reproductive Healthcare (FSRH), which represents 14,000 healthcare professionals, has called for oral emergency contraception to be reclassified from a pharmacy (P) medicine to GSL this week (January 30).

This change would permit shops “from supermarkets to petrol stations” to stock and sell oral emergency contraception without a mandatory consultation, the FSRH said, “removing barriers and improving access for all”.

Read more: Quarter of England pharmacies signed up to offer new contraception service

According to the FSRH, the call for reclassification is endorsed by “eight leading organisations” involved in sexual and reproductive health.

These include the Faculty of Pharmaceutical Medicine (FPM), the Faculty of Public Health (FPH), the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of General Practitioners (RCGP), MSI Reproductive Choices, the British Pregnancy Advisory Service (BPAS), the National Unplanned Pregnancy Advisory Service (NUPAS) and sexual health charity Brook.

Previously, pharmacists have argued that putting emergency hormonal contraception on the GSL could put patients “at risk” by encouraging “inappropriate or excessive use”.

 

Pharmacist consultation “a barrier”

 

FSRH president Dr Janet Barter said that the reclassification would be “an enormous step forward”, adding that the “next step” would be to make oral emergency contraception “free for everyone”.

Dr Barter said that the pharmacist consultation currently required under P-med classification “can be very valuable” but that it can “pose a barrier” when pharmacies are shut.

She added that it is a “very safe” medication, which is “more effective” when taken sooner.

Read more: ‘Providing EHC without a consultation would put patients at risk’

BPAS associate director of communications and campaigns Georgina O’Reilly this week (January 30) said that “a revolution in contraceptive innovation” is required and that the reclassification of oral emergency contraception is “vital to this”.

Ms O’Reilly added that pharmacists should “always be available to discuss contraceptive options” but that this should be “on the woman’s terms” and embarrassment-free.

 

“Reasonable safety”

 

A spokesperson for the Medicines and Healthcare products Regulatory Agency (MHRA) told C+D yesterday (February 1) that only companies that hold licences for P-meds can apply to change their classification. 

They said that there are currently two P-med emergency hormonal contraceptives in the UK, levonorgestrel 1.5mg tablet and ulipristal acetate 30mg tablet.

Read more: Why contraceptive pill POM to P switches present pharmacists with a 'massive opportunity'

The MHRA spokesperson could not comment on whether it has received an application for oral emergency contraception GSL reclassification.

They told C+D that GSL classification is limited to medicines that can be supplied without a pharmacist's supervision “with reasonable safety”. 

Read more: Half of pharmacies shun ‘unlikely-to-sell’ P contraceptives, research finds

“Reasonable safety” means that the risk to health of misuse and of mishandling is small and “where wider sale would be a convenience to the purchaser”, according to the Human Medicines Regulations 2012.

The MHRA spokesperson said that while the regulator is “committed to widening access to medicines”, if the regulatory criterion are not met and if supply without “input from a healthcare professional” is deemed unsafe, the medicine will not be reclassified to GSL.

 

Contraception latest

 

Last month, the government revealed that most pharmacies in England have not signed up to deliver the relaunched pharmacy contraception service, with just 3,000 pharmacies on board. 

And in December, C+D reported on research from Kingston University looking at prescription-only to P switches that found community pharmacists were reluctant to offer desogestrel and estradiol.

Read more: Taking levonorgestrel with NSAID more effective, study suggests

In August, a study found that emergency contraceptive levonorgestrel prevents “significantly more” pregnancies when taken with anti-inflammatories.

In March 2022, C+D interviewed the CEO and founder of Lovima manufacturer Maxwellia Anna Maxwell, who said that Lovima's POM to P switch was “one of the biggest revolutions in women's health for the last 60 years”.

But in 2020, pharmacist Laura Buckley argued in C+D that putting emergency hormonal contraception on the GSL would be tantamount to “putting patients at risk” by encouraging “inappropriate or excessive use”.

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