Access to the pill and UTI treatment is changing. Is it a win for women?

From February 2027, eligible women will be able to consult a pharmacist at a participating community pharmacy for treatment of urinary tract infections (UTIs) or hormonal contraception, with no out-of-pocket consultation fee.

If the pharmacist prescribes a medicine, it will cost no more than $25 per prescription.

Health Minister Mark Butler has promoted the initiative, which will be trialled for 12 months, as a win for women's health.

But what's actually changing? And does the evidence support expanded roles for pharmacists?

Queensland introduced pharmacist-initiated treatment of uncomplicated UTIs in 2020. Similar schemes now operate in every Australian state and territory.

But rules around patient eligibility, medicines prescribed and training requirements vary.

Since 2023, some of these schemes have extended to hormonal contraception. Some states only allow repeat prescriptions (resupply). Others allow pharmacists to initiate a prescription.

Currently, pharmacist prescribing consultation fees vary across Australia. Some state governments subsidise this cost. Elsewhere, patients might pay more out of pocket for both the consultation (talking to the pharmacist) and the medication itself.

The new federal initiative aims to address these differences by covering consultation fees at participating pharmacies. It also caps the costs of certain medicines — such as the pill — at rates equivalent to a Pharmaceutical Benefits Scheme (PBS) prescription.

Common UTI symptoms include pain or discomfort when urinating, and needing to urinate more frequently or urgently.

An "uncomplicated" UTI is a bladder infection in an otherwise healthy person, without factors that increase the risk of complications.

Some mild cases may recover without antibiotics. However, treatment can shorten symptoms and reduce the risk of uncommon but serious complications.

Pharmacists can start antibiotics based on symptoms when the patient meets the relevant eligibility criteria.

But people who have symptoms suggesting a more serious infection, or are pregnant, get frequent UTIs, are male, or have other risk factors may need to be assessed by a doctor or nurse practitioner.

Access to contraceptive options allows people to make informed choices about whether and when they have children. In addition to preventing pregnancy, the pill can also help manage conditions such as endometriosis and acne.

For those already taking the pill, a pharmacist-issued repeat prescription can prevent interruptions in treatment, reducing the risk of unintended pregnancy.

Where pharmacists can initiate contraception, they must assess whether the medicine is appropriate, considering factors such as medical history and personal circumstances.

Pharmacists can initiate a limited range of hormonal contraceptives, including the pill, vaginal ring and depot injection.

But for many people, long-acting reversible contraceptives, such as an implant or intrauterine device (IUD), may be a more suitable option. These are more effective at preventing pregnancy but require an appropriately trained health practitioner for insertion.

Contraceptive consultations with a suitably trained health practitioner can also provide opportunities for people to talk about their broader sexual and reproductive health needs, which may otherwise go unnoticed.

It's challenging to evaluate changes to health care delivery. Evaluations often lack a comparison with usual care, making it difficult to determine whether these services lead to better health outcomes.

Evaluations of pharmacist-led UTI treatment in Queensland, New South Wales and the Australian Capital Territory found high rates of symptom resolution and positive patient experiences.

A NSW and ACT trial of contraceptive resupply reported high patient satisfaction and few safety concerns.

These findings are encouraging, but not definitive.

There's a lot of debate about what outcomes to measure when deciding whether a health service is good quality. Patient satisfaction is important, but one concern is that it incentivises a customer service mindset rather than better long-term health outcomes.

It's important that women feel heard and comfortable seeking care, especially with many having experienced dismissal of their pain. But we also need more solid evidence about the quality, effectiveness and appropriateness of these services.

International research supports the feasibility of pharmacists initiating hormonal contraception, but this evidence is also limited.

There is little evidence examining how these services influence informed contraceptive choice, including access to long-acting reversible contraceptives.

A recent report commissioned by the Royal Australian College of General Practitioners highlighted continuing gaps in evidence about safety, effectiveness and broader impacts on the health system.

Improving access to medicines doesn't necessarily improve access to quality health care. While community pharmacies are widely accessible, not every pharmacy offers these services, and not every woman will be eligible.

Pharmacists are registered health practitioners expected to act in their patients' best interests. But community pharmacies are also businesses. Critics argue that prescribing and supplying medicines in the same pharmacy creates potential conflicts of interest. This could favour medicine supply over referral to a GP clinic or other treatment.

Professional codes of ethics are important, but they aren't enough. Pharmacists need appropriate training and support to recognise when prescribing isn't appropriate. This includes evidence-based guidelines, appropriate remuneration and systems that support collaboration and referral.

The government's new policy funds consultations regardless of whether a prescription is issued. This could help. Reassurance, advice or referral can be just as valuable as supplying medicine.

Lauren Cortis is a senior lecturer in pharmacy practice and Hilary Bowman-Smart is a research fellow at the Australian Centre for Precision Health, both at Adelaide University. This piece first appeared on The Conversation.