Yasmin, Juliet, Diane, Brenda. The names are instantly recognisable to many women who take the contraceptive pill.
It has been 55 years since the pill hit the Australian market and it remains the most popular method of contraception, despite a host of other longer-acting options becoming available in that time.
If your brand of pill is a newer variety or happens to carry a woman’s name, it is likely you are funding the cost of your prescription entirely out of your own pocket.
But if these newer and more expensive contraceptives are simply out of your price range, the choice of cheaper pills available to you on the Pharmaceutical Benefits Scheme (PBS) is significantly narrower.
And it is a situation some family planning experts believe needs to change.
In the past 20 years, just one pill has been added to Australia’s PBS, which subsidises prescription drugs. That pill was Femme-Tab ED 20/100 in 2013, a lower dose so-called ‘combination pill’ (containing both estrogen and progestogen classes of hormones), which has existed in higher doses on the PBS for many years.
Before that, the most recent oral contraceptive to receive a PBS listing was Levlen back in 1992.
The difference in price between older PBS-listed pills and some newer varieties on the private market can be significant — as high as $28 or so a month if you are a pensioner or other concession card holder ($21 or so a month for a general consumer).
The newer-generation pills contain different hormones and usually a lower dosage than their predecessors, and can have additional benefits such as reducing acne in some women, or being less likely to cause weight gain as a side effect.
The number of women who receive PBS benefits for oral contraceptives has been steadily falling and decreased by 35 per cent between 2003 and 2011, according to a 2013 Family Planning NSW report.
At the same time, Australia’s health policies trail other markets such as the United Kingdom and the United States, which have enacted policies to make a range of contraceptives available for free.
A question of equity
“While many women find that the PBS-listed pills suit them well, it is inequitable that financially disadvantaged women who do benefit from one of the newer pills, sometimes after trialling several types, may not have that option because of cost,” she said.
Family Planning advises women to start with the PBS-listed pills, which have good safety records and whose efficacy is backed by strong clinical data, or to consider long-acting reversible contraception methods such as the hormonal IUD or implant, which last up to five and three years respectively and cost about $38 on the PBS.
“For many women these newer pills are unaffordable. I’m very conscious of ensuring that we don’t set women up with an expectation that they’re going to have to pay out this amount of money every month unless they’ve tried other cheaper options,” Dr Bateson said.
She said cost barriers also put pressure on women who have been prescribed a hormonal contraceptive to manage conditions such as polycystic ovarian syndrome, endometriosis or heavy menstrual bleeding and, having considered other options, find that one of the newer brands of pill is the best fit for them.
As a community, Australia underestimated the impact such conditions could have on a woman’s quality of life, she said.
While it would not be cost effective to list all pills on the PBS, she said an alternative the Government could explore is allowing doctors to issue an authority script that would supply women with proven medical conditions more expensive pills at a subsidised rate if they have trialled older PBS varieties and found they do not suit.
It’s a suggestion supported by the Consumers Health Forum CEO Leanne Wells.
“While we appreciate the need to balance PBS access and sustainability, we do want to see the most effective contraceptive options available and subsidised,” Ms Wells said.
Why aren’t more pills on the PBS?
For a new medicine to be listed on the PBS, the independent Pharmaceutical Benefits Advisory Committee (PBAC), which comprises doctors, other health professionals and a consumer representative, must make a recommendation in favour of listing.
It must wait for an application, usually from the pharmaceutical company, to do this.
But many of the suppliers of new generation contraceptives have not sought a PBS listing, with one of the key reasons being that it involves presenting evidence that is costly to obtain.
The other factor is profitability, with many companies determining there is more value for them on the private market.
The difference a listing would make to the affordability of the drug for consumers is another sticking point.
“The drug that costs $5,000 a year is more likely to be listed than a drug that costs $500 a year because there’s less people who will be able to afford it,” Dr Ruth Lopert, a former director of policy within the Department of Health’s pharmaceutical division, said.
The more expensive contraceptives on the private market would still be considered affordable for working women; the only reason a company would apply for listing would be to reduce the price for concessional patients, she said.
But contraceptives compete for government subsidies with far more expensive, in some cases life-saving, treatments for other conditions and diseases.
“Twenty-five dollars a month for a general beneficiary is not something that would be considered a strong issue by the PBS because it would generally be considered affordable for someone working,” Dr Lopert said.
She said if Australia wanted to supply free contraception as is done in several other countries, it could do so as a policy but “it would have to be a public health program not a PBS listing. They would have to decide that this is a public health priority”.