Angie Kuek (Health) 0:08
Thank you, everyone. And hi, everyone, and welcome to the webinar for the Oral Contraceptive Pill Initiation. My name is Angie Kuek and I'm the implementation manager for the Community Pharmacist Program and its expansion here in Victoria. And thank you everyone for making the time today to come to this webinar and to hear about the service and the protocol.
Next slide, please.
I'd like to begin this meeting by acknowledging the traditional owners of the lands in which we're meeting on today and paying my respects to the elders past and present and the Aboriginal elders of other communities who may be here today as well. I am joining from the land of the Wurundjeri people here in Melbourne. So that's just where I am located.
Next slide, please, Jackson.
Thank you. So today's webinar will cover 5 agenda items. We'll first talk through the requirements of the Program, which I'm sure many of you are already familiar with, and then we'll provide you with an update on the new services that have been rolled out to date and also the new services that are upcoming.
We will then go through training for the oral contraceptive pill initiation service, so both the modular training pathway for the service and the postgraduate training pathway as well. And finally, we'll spend most of today's time speaking to the protocol for the oral contraceptive pill initiation.
Next slide, please, Jackson.
Thank you. So as I said, I'm sure many of you are already familiar with the requirements for the Program, but we would just like to cover them again so everyone is aware of this.
And all this information can be found on the Resources for Pharmacists page as well, which we will pop into the chat shortly.
So firstly, medication under the Program is not subsidised under the PBS and patients do need to pay full costs for the medications. So please speak to your patients about this before commencing the consultation.
In terms of the consultations costs, pharmacies do receive a $20 payment from the Victorian Government for each consultation, but patients should not be charged a consultation fee, except for travel health, where pharmacies may charge an additional fee when administering a travel health vaccine.
And then finally, it's a requirement to conduct all consultations in a private consulting room with a door that can be shut to prevent unauthorised access. This room should not be used as a dispensary or storeroom or staff room. And this requirement for
private consulting room is especially important for the service, the OCP initiation service. So if a room is not available, this service cannot be conducted.
As I said, more information is available on our web pages and also under Victorian Pharmacy Authority webpage.
Thank you.
So the Program began expanding last December and it will continue to expand over the next 10 months to a total of 23 services that community pharmacists can offer. We recently rolled out the management of acute musculoskeletal pain and this week also launched the oral contraceptive initiation service.
Later in 2026, we've got acne and dermatitis to come, as well as the resupply of menopausal hormone therapy.
So I'd now like to go through the training requirements for the OCP initiation service. We've got two options here, the modular training pathway and the postgraduate training pathway. So firstly, for modular training, the course that the department has recognised for this particular service is the PSA’s prescribing hormonal contraceptives service. And this course is designed to provide pharmacists with an in-depth knowledge and practical skills related to contraceptive counselling and clinical decision making.
I'd also like to note that this course is approved for the hormonal contraception resupply service. So, pharmacists who have undertaken this training course can deliver both the OCP initiation service and the hormonal contraception resupply service.
The second pathway is the postgraduate training pathway. So pharmacists who completed an Australian Pharmacy Council accredited Pharmacist prescriber course in full do not need to complete the PSA's short form training module.
However, pharmacists do need to complete the short form training module if the postgraduate course either doesn't cover the OCP initiation service or you have not completed it in full and you're still awaiting graduation.
And just a reminder that it remains the responsibility of the pharmacy owners to ensure that providing before providing services, pharmacists must have completed the required training.
Thank you, Jackson.
So now I'd like to hand over to my colleague Angelo Pricolo, who is the senior clinical specialist for the Program, and he will talk you through the protocol for the initiation of the oral contraceptive pill.
Angelo Pricolo (Health) 5:56
Thank you, Angie, for that overview and to get the ball rolling, this is a really exciting time for pharmacists as scope is widening. This particular protocol is a is a new initiation. We will look at the wide range of oral contraceptives that are available and we'll look at eligibility in this protocol, things like obviously age group and how we landed on that. So if we go to the next slide, please, Jackson.
As an overview of the protocol, I'm going to give you a bit of a look through these topics, the eligibility criteria, the referral criteria, the treatment options that we have open to us as pharmacists, and then the advice and counselling that Pharmacists are required to give, which is in whole not all that different from what we do as pharmacists anyway, and also the follow up that is important. Next slide, please.
So starting with the eligibility criteria, the first point is the age group, which is 18, females in the age group of 18 to 50 years of age. This has been landed upon after advice and feedback from the clinical experts in Victoria. Secondly, as far as the eligibility goes, obviously there needs to be a request to initiate the contraceptive medication. Pharmacists can initiate or restart. Importantly, in Victoria, we cannot change or switch. And again, in that, that's on, that's from advice from experts in Victoria.
Patient must meet UKMEC. I looked at that the first time and thought it was the minimum effective concentration, but it's not. It's the UK Medical Eligibility Criteria. Now the smart forms that we will be filling out will effectively categorise us into UKMEC one or two where we can continue with the prescribing. If we fall into a UKMEC of three or four, then that is going to require a referral to the GP.
So that becomes much clearer on the smart form. And of course we need to exclude pregnancy with high confidence. Thank you.
If you look at referral criteria, so when we need to refer and a medical history that we take may reveal changes or contraindications that would alert us. So, you know, pretty serious things like stroke or VTE, venous thromboembolism, which can include a DVT or pulmonary embolism, signs of PMOS or PCOS, as it's often called, the two terms are used. It's a common hormonal ovarian syndrome affecting women of a very productive age. It's characterised often by irregular periods. So again, that's a bit of a red flag and a need for us to refer.
With the pharmacist clinical review, we will be investigating blood pressure and BMI. So again, if that falls outside of the ranges that are important for us to stay within for our prescribing,
That's going to require referral. If there are symptoms of a sexually transmitted infection. So again, the obvious things like a vaginal discharge is something that we need to investigate further and refer.
Or if a patient requests a method of contraception that's not available to us on our list of medicines that we can prescribe, then obviously we're going to have to pass those on to a medical practitioner. Thank you.
Now, this is a pretty comprehensive list of the pills that we have open to us to prescribe. There's a bit of a quick reference there too, in that there are some of the, not all, but some of the trade names. It's pretty hard to include all of the all of the generics, but, but they include the low dose estrogen, so the equivalent of 20 micrograms of ethinylestradiol, the standard dose of estrogen, so equivalent to 30 micrograms of ethinylestradiol, the triphasic pills, the quadraphasic pills, again, not seen all that often anymore.
And the POPs or the progestogen only pills, and again, probably the one we see most commonly now is Slender or the Drosperidone 4 milligram variety.
Importantly, there are exclusions in Victoria similar to, not exactly the same, but similar to other jurisdictions. High estrogen pills, so 50 micrograms ethinylestradiol. Combined hormonal vaginal ring, so the NuvaRing. The Depot-Provera or Depot-Ralovera, the generic, Implanon or the subdermal contraceptive implant, and the two IUDs, Mirena and Kylena. So those that I've just run through in that last section are the ones that are excluded from this Program.
Thank you.
And finally, advice and counselling, where, again, as I said at the start, really we as pharmacists are quite aware of, and there aren't really that many differences, although we probably need to be a little bit more comprehensive and clear that we, especially if we're initiating, we do run through all of these quite systematically. So obviously the instructions for the oral contraceptive use, instructions for missed pills in terms of what those windows are and when we just need to take the next one or do we in fact need to use an alternative contraceptive measure.
When the pill has, as it were, become effective, depending on what point of the cycle it started, and attention to possible adverse events like the DVTs that we discussed earlier. And really importantly, when follow up is required, whether that's the mandatory three to four month, which is an essential part of this protocol, but there is a follow-up visit within three to four months. So that the three to four month is landed on, of course, because that's the average pack size. So you can supply that one pack. Or if something unexplained or unexpected, if there's a change, if there's something of concern, then obviously that's another red flag and another reason why we need to encourage women to see their prescriber or their GP.
So that's a bit of a summary of the protocol section that is relevant to our prescribing. And I think I'll leave it there unless there are, I'll cross back to Abbey, but if there are any questions. Otherwise, thank you very much.
Angie Kuek (Health) 14:23
Thank you so much, Angelo. And there is a Q&A, so if people have any questions about the Program or the protocol, please feel free to send it through. Just might wait a minute for the questions to come through and to be published. And I'm also going to put some information in the chat now about where to find further information about the Program, and where you can find a protocol as well for the initiation of the contraceptive pill.
I see we do have a few questions coming in through the chat and Angelo might read this out and get your advice on this. So if there were multiple previous OCPs, are there re-initiation options for these previous ones the most acceptable to the patient? Or really the most recent OCP that has lapsed.
Angelo Pricolo (Health) 15:22
Look, that's I suppose we start getting into some grey areas. I'm not really going to give you an answer straight away on that. It might be something that we that we follow up those technicalities might. I suppose, as a pharmacist, we'd be making a judgment. I think I think that's the best way I would I would describe it. Paramount is always going to be safety and stability. So, I think if you can tick those boxes, but we'll try and get a more comprehensive and clearer answer for you, I think, Angie.
Angie Kuek (Health) 15:58
Thank you, Angelo. The other question that has come through is, are we permitted to write repeats or will there only be the one supply each time? And I think that Angelo just goes back to the three to four month GP review. Did you want to speak to this?
Angelo Pricolo (Health) 16:14
We can write one pack and then we need to establish that a visit with the GP has occurred. And that's certainly what we need to make really clear to the patient that we can supply the one pack, but then you need a follow up with your GP.
Angie Kuek (Health) 16:34
Yeah. There has been another question about how much the PSA course is going to cost for this Program as well. And I'm just looking at the information. And I believe for non-member, it's about $1,000, but member discounts do apply. So ifyou are a PSA member, just reach out to them to get that information directly from them.
Angelo Pricolo (Health) 17:00
I think that there may also be for Guild members, and I realise not everyone's a Guild member, but if you are, there may also be some, there may be some compensation or money that you can also get from the guild by doing these courses.
Angie Kuek (Health) 17:24
Thank you. Another question has come through for initiation. Can we choose a new OCP, whereas if a patient has used one before, it has to be the same OCP as previously? Angelo, did you want to answer this and also maybe talk to our other protocol, which is resupply of hormonal contraception, which is one thing?
Angelo Pricolo (Health) 17:45
So again, we sort of discussed this and it's a bit of a grey area. So is it following straight on and we're writing a script for a pill that has been used in the immediate past or has it, is it a pill that's lapsed for quite some time and where we're then initiating and effectively you could then call it a new, an initiation, which we are allowed to do. So I think, again, that's a little bit of a grey area where a pharmacist is going to have to use their discretion, always based.
As I said earlier on, on safety.
Angie Kuek (Health) 18:26
Yeah, but just to confirm, for if the patient is commencing the OCP and they are initiating, the pharmacist can choose the OCP after discussions with the patient. Yeah. Thank you.
Angelo Pricolo (Health) 18:36
Yes.
Yes, absolutely.
Angie Kuek (Health) 18:43
Just trying to see if there's any other questions that have come through.
Someone is asking if menopause treatment has been covered yet in this webinar. I am happy to speak to that. So resupply of menopause hormone therapy is something that the Program has planned for implementation later in the year. So once that service is launched, we will be running another webinar to cover that particular protocol.
Someone is asking related to OCP initiation, what can you do if a patient has side effects from other pills and needs one now?
Angelo.
Angelo Pricolo (Health) 19:33
Yeah, and I think, yeah, I think if a patient has side effects, which would mean we would be looking at changing, then that is not covered in this protocol and we would need to refer them to a doctor.
Angie Kuek (Health) 19:49
Thank you.
So there was also a question about the different modules to complete. So just to confirm, so this Program, it depends on what pharmacies want to deliver, and then they are allowed to pick and choose which service they want to deliver. So we are providing pharmacists with two options.
So they can either complete the short form modular training or the Program also recognises ACP accredited postgraduate prescriber courses. So if a person has completed that course in full and that course covers the service that they want to deliver, that will also be recognised.
I'm just making sure that I haven't missed any questions.
Right, I think that was all the questions. So thank you for all the questions that have come through so far. And thank you once again for attending the webinar. The webinar link will be shared as this webinar has been recorded. So the recording will be shared with all pharmacists and pharmacy owners via a newsletter.
And we'll also be sharing more information about the upcoming services and training and how to register for these services in future newsletters as well. So thank you. And there was just a last question that have come through as well. I will answer that. Yes, the remuneration in Victoria is $20 per consultation. And this is something that the department pays pharmacies for.
Patients are not allowed to charge patients are not allowed to be charged a consultation fee, except for travel health, where patients may be charged a consultation fee due to the cost of administrating the travel health vaccine.
Thank you, everyone, and we look forward to seeing you in the next webinar. And if you've got any questions post this webinar, feel free to send them through to the team as well, and we will respond as we can.
Thanks, all.
Updated