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C+D readers split on proposed contraceptive pills switch from POM to P

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Hana 75mcg film-coated tablets could be switched from POM to P Credit: MHRA P mock-up labelling
Hana 75mcg film-coated tablets could be switched from POM to P Credit: MHRA P mock-up labelling

C+D readers are split as to whether two desogestrel contraceptive pills – Hana and Lovima – should switch from POM to P, a snapshot poll has suggested.

Fifty two (49%) of the 107 respondents to the poll – which ran on the C+D website from March 1-8 – said they thought Hana 75 microgram film-coated tablets and Lovima 75 microgram film-coated tablets should switch from prescription-only medicines (POM) to pharmacy (P) medicines.

Forty eight (45%) respondents said the tablets should not switch classification, while seven (7%) said they were “undecided”.

Result

Should desogestrel contraceptive pills Hana and Lovima switch from POM to P?
Yes
49%
No
45%
I am undecided
7%
Total votes: 107

The poll comes after the Medicines and Healthcare products Regulatory Agency (MHRA) requested views on whether the contraceptive pills should be made available to women directly from pharmacists, without a prescription.

The results of these consultations are due imminently.

Suggestions to reclassify the pills were made in the hope of improving sexual health availability and services.

“Patient choice has to be factored in”

Paul Arnett, superintendent pharmacist for Intrahealth Pharmacy Limited, said reclassifying the pills will make contraception much more accessible to women who have less time to attend standard appointments in the day.

“I feel for that cohort of patients,” he said. “If they can access this more easily through pharmacy, it's less likely to lead to unwanted pregnancies because people will be able to get the contraceptive they need.”

Although making the pills available through pharmacy may result in increased consultation times, he maintained that the workload would be manageable, because demand is unlikely to be high at the beginning.

And while the potential reclassification may result in there being a cost attached to the contraceptives, Mr Arnett believes the ease of accessing the medication will outweigh the cost for patients.

“I think it's important to say that as long as it’s safe, patient choice has to be factored into all of this,” he said.

Cathryn Brown, a locum pharmacist based in the north west of England, agreed that Hana and Lovima should be switched from POM to P, stating that “easier access to contraceptives is always positive”.

“This drug has been used safely for years, and pharmacists definitely have the expertise to make the supply,” she said.

In the lead up to the consultations' launch, the MHRA said there was “strong support” from stakeholders, including the Company Chemists’ Association Professional Practice Group – which responded to the consultations on behalf the large multiples and supermarket pharmacies – and the Royal Pharmaceutical Society.

“Missed opportunity to discuss alternatives”

Toni Hazell, a GP based in London, said that while it would be useful for some women to access these contraceptives without having to see a GP, “I worry about the missed opportunity to discuss longer acting methods such as the IUCD or implant”, she said.

“I always offer them at every contraception consultation.”

Naimah Callachand, C+D’s clinical and custom content editor and locum pharmacist, also raised concerns about the strain this move might put on pharmacists.

“The switch from POM to P means a more in-depth consultation will be necessary – discussing contraindications, side effects and monitoring for any issues. This extra service will be putting extra pressure on teams that are already stretched having to provide pharmacy services,” she said.

Alia Husain, senior clinical pharmacist at University College London Hospital, acknowledged the benefits and drawbacks on both sides of the debate.

“Offering desogestrel contraception as a P can only be a good thing, I think there is such a need for easy access. However, I also agree that you do not want [patients] to miss out on other forms of contraception that is available to them, so it would have to be in conjunction with appropriate counselling of other options,” Ms Husain said.

“A few things make me nervous”

Mikin Patel, lead pharmacist at Imperial College NHS Trust, said that while the potential switch is “a great step forward to give women the choice”, there are “a few things that make me nervous”, he said.

This includes the potential of sales becoming “tick box exercises”, without the proper consultation or conversation on alternatives, Mr Patel said.

He also flagged the need for appropriate governance: “There has to be a mechanism to capture basic patient details and entering them on to the system, eg NHS number, patient consultation/checklist, patient signature and that they are aware of the risks, etc.

“At the moment, there is nothing of this sort for sildenafil and it is risky, as we have patients just coming in asking for the medications. We have the consultation and go through the checklist, but I don't know if patients are telling the truth about their cardiovascular risk or not.

“There's nothing to protect the pharmacist to prove the patient was well informed, as none of this information is captured and stored,” he stressed.

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