Emergency hormonal contraception free through pharmacies for medical card holders

Kurtosis

As things stand currently, medical card holders requiring emergency hormonal contraception (the "morning after pill") must attend their GP for a prescription in order to obtain EHC on the medical card (paying the €2.50 co-payment). Alternatively they can attend a pharmacy to obtain EHC however in such cases are required to pay for it.

Pharmacists have called for the EHC to be made available on the medical card through pharmacies without patients having to attend their GP:
http://www.breakingnews.ie/ireland/pharmacy-union-calls-for-free-morning-after-pill-for-medical-card-holders-674372.html

I think anything that reduces potential barriers to obtaining EHC, particularly for women who may not have the means to pay for it privately, is a good move. It should also allow more timely access to a treatment which has a substantial decrease in effectiveness with time. Such a change has the potential for increased supplier-driven demand, so any reimbursement to pharmacists for this would require sufficient checks and balances to guard against this.

Any opinions on this?

Xeyn

Personally thInk it's a good move. For the emotional and financial health of the country. Everything is open to abuse but overall this is a good one.

RobFowl

Xeyn wrote: »

Personally thInk it's a good move. For the emotional and financial health of the country. Everything is open to abuse but overall this is a good one.

+1 from me

Mrs OBumble

Is there evidence that female medical card holders are having difficulty getting GP appointments at short notice in order to get the morning after pill?

Poverty (indicated by having a medical card) is pretty strongly linked with poor education. I would think that poor women are more likely than most to need to education about how to avoid the need for emergency contraception in future, and that would be better delivered in the privacy of their GP's office (where issues like the risk of the situation having arisen due to sexual violence) can also be addressed.

Kurtosis

Mrs OBumble wrote: »

Is there evidence that female medical card holders are having difficulty getting GP appointments at short notice in order to get the morning after pill?

Poverty (indicated by having a medical card) is pretty strongly linked with poor education. I would think that poor women are more likely than most to need to education about how to avoid the need for emergency contraception in future, and that would be better delivered in the privacy of their GP's office (where issues like the risk of the situation having arisen due to sexual violence) can also be addressed.

Just to disclose, my perspective is going to be biased by the fact I am a pharmacist (though with no commercial interest in community pharmacy).

I'm not aware of any evidence of this occurring and have no insight to offer regarding typical waiting times in a GP surgery, however in my experience the most common time that patients will present in the pharmacy for EHC is at the weekend. Generally surgeries will have restricted/no opening hours at these times and the only option may be doctor on call.

I would contest your second point however. Community pharmacies are required to have a private consultation area where I imagine any conversation regarding contraception/EHC is going to happen so privacy should not be an issue. It's not a case that the morning after pill is just handed out in pharmacies, the Pharmaceutical Society has issued guidance on this which includes advising on regular contraceptive methods and the need for STI/STD screening. Such a discussion can also occur again between the patient and their GP at their next visit. I do not think patients should be penalised with restricted access to a time-sensitive treatment purely to allow facilitate a discussion with their GP.

RobFowl

Mrs OBumble wrote: »

Is there evidence that female medical card holders are having difficulty getting GP appointments at short notice in order to get the morning after pill?

Poverty (indicated by having a medical card) is pretty strongly linked with poor education. I would think that poor women are more likely than most to need to education about how to avoid the need for emergency contraception in future, and that would be better delivered in the privacy of their GP's office (where issues like the risk of the situation having arisen due to sexual violence) can also be addressed.

I have seen women with medical cards wait 24 hours for appointments for the MAP because they cannot afford the cost.

Xeyn

I agree with penguin. Education is not being denied neither is the right to attend a GP. Both can still occur. They are being afforded the same options as those not on medical cards by removing a financial barrier and now what some would describe as a beaurocratic obstacle. I won't speak for GP as I am not one, but they are an extremely scarce resource currently with time subsequently being equally scarce so I would imagine freeing up a medical card patient slot from someone who might not even want to be there might be welcomed by some GPs. EC is not exclusively for the careless, things happen; condoms break.

echo beach

Declaration of interest. I am a pharmacist and have supplied emergency contraception on prescription for many years and OTC since it became available.

Mrs OBumble wrote: »

Is there evidence that female medical card holders are having difficulty getting GP appointments at short notice in order to get the morning after pill?

GPs are under pressure. Medical card holders and private patients often find it difficult to get an appointment for any reason at short notice. Even with an appointment, waits of 30 or even 60 minutes are common as surgeries run late. Emergency appointments should be for patients who NEED to see a doctor urgently, not those who could be easily and quickly dealt with by another health professional.

I would think that poor women are more likely than most to need to education about how to avoid the need for emergency contraception in future,

I think you are mistaken. ALL women buying emergency contraception get advice on regular contraception. Because most women in this country get little or no education on contraception, I find many have little knowledge of the subject, regardless of how long they spent in school or what their income level is.

and that would be better delivered in the privacy of their GP's office (where issues like the risk of the situation having arisen due to sexual violence) can also be addressed.

Privacy isn't an issue as all pharmacies have private consultation areas. Sensitive issues, like violence or possible abuse, are equally difficult for GPs and pharmacists. If there are issues a pharmacist can't deal with, like a need for STI testing, the women will be referred to her doctor or a clinic.
If women prefer to see a doctor they still have that choice but if they are happy with the convenience and professionalism in their pharmacy they should also have that choice. Giving the choice only to those who can pay is unfortunately the norm in our health system but this would allow medical card holders one extra choice, and a choice that could benefit both them and society.