OCP resupply

Question 1

What is the age range for OCP resupply under the WA protocol?

Answer 1

16–39 years inclusive.

Question 2

What forms of contraception are eligible for resupply?

Answer 2

Combined oral contraception (COC) and progestogen-only contraception (POP) in oral form only.

Question 3

Who must have initiated the OCP for a patient to be eligible for resupply?

Answer 3

A GP or Nurse Practitioner.

Question 4

What is the minimum duration of continuous OCP use required for eligibility?
OCP Hx

Answer 4

At least 2 years.
Undergoing >1 medical review since starting
Well tolerated (have you noticed any side effects from this?)
Good adherence (how do you take it?)

Question 5

What is the maximum allowed pill break duration?

Answer 5

2 weeks continuously.

Question 6

What is the maximum resupply quantity?

Answer 6

One manufacturer’s pack or up to 12 months
16-17yo only up to 4 months as an extension to original prescription (should have more frequent reviews req: health and social risk factors)
18-39yo up to 12 months at once acc to preference (but e.g. turning 40 in a month, only 1 month/manu-pack supply)

Question 7

Are transgender and gender diverse people presumed female at birth eligible?

Answer 7

Yes, if all protocol conditions are met.

Question 8

Which estrogens and progestogens are not permitted to be resupplied?

Answer 8

Estetrol, mestranol, cyproterone and 50mcg ethinylestradiol or more

Question 9

What are some of the common exclusion criteria for BOTH COC and progesterone only pills?

Answer 9

• Current or previous history of breast cancer (including carrier of known gene mutations, e.g. BRCA)
• Hepatocellular adenoma, or malignant liver tumour
• Severe (decompensated) cirrhosis
• Potentially pregnant
• Unexplained and un-investigated vaginal bleeding or acute, severe menstrual bleeding
• Drug Interactions

Question 10

What may be an exclusion criteria but is up to pharmacist’s discression?

Answer 10

• STI screening is indicated

Question 11

What would some of the drug interactions that could proclude OCP resupply (COC and POP)?

Answer 11

CYP 3A4/5 inducers such as carbamazepine, corticosteroids, modafinil, phenobarbital, phenytoin, rifampicin, St John’s wort

Question 12

What is the exclusion criteria solely for POP?

Answer 12

Ischaemic heart disease, stroke or transient ischaemic attack (TIA) that develops during use of POP.

Question 13

What is the exclusion criteria solely for COC?

Answer 13

• Migraine with/without aura
• Gallbladder disease (treated or current)
• Hx of COC related cholestasis
  VTE risk:
• prolonged immobilisation,
• 35+yo current smoker/vaper or quit w/in 12 mo, - Hx of ischaemic heart disease, stroke or trantient ischaemic attack
• Systolic ≥140, Diastolic ≥90 OR adequately controlled HTN
• complicated valvular or congenital heart disease
• Cardiomyopathy w impaired cardiac function
• AF
• Hx of VTE or 1st degree relative w VTE aged <45yo
• thrombogenic mutation
• Diabetes with nephropathy, retinopathy, neuropathy, or other vascular disease
• BMI ≥35

Question 14

What clinical measurements must be taken to resupply?

Answer 14

BMI (<35)
BP (Sys <140 and Diast <90 - cannot supply for controlled HTN either)

Question 15

Pregnant or BF?

Answer 15

No. If BF, would have had greater than 2 week period break within the 2 years

Question 16

What history must you obtain regarding the OCP?

Answer 16

• Adequate stable history of using for last 2 years (dispensing software or MyHealth record)
• Medical review of it within last 2 years (not continuous resupply by pharmacists)
• Well tolerated and good adherence

Question 17

From the consultation, what must be documented? How long should this be kept?

Answer 17

1. Identifiers and consent given
2. Date, pharmacist
3. Clinical information relevant (ans to qs: med and OCP Hx, BMI, BP, preg status and STI risks)
4. Clinical opinion reached: actions and management plan
5. Details of OCP supplied
6. Counselling advice
7. Referral made with patient consent (if app)

Kept for 2 years according to MPR 2016

Question 18

What should be given to the patient?

Answer 18

If supply:
The medicine, copy of the documentation of consultation as well as a copy to their regular practitioner with their consent
If unsupplied:
Copy of the documentation of the consultation as well as a copy to regular practitioner with consent

Question 19

With regards to dispensing, what must be included?

Answer 19

1. Medicine and regular directions etc
2. Pharmacist’s name as prescriber (not regular practitioner)
3. Pharmacist’s Healthcare Provider Identidiet- Individual (HPI-I) in record (connected to the ‘pharm prescriber’ number)
4. Regular patient information (IHI etc)
5. Uploaded to MyHealth Record w consent (pxt may request it isn’t but this must be documented and serve a justifiable reason acc to SASA)

Question 20

What are some non-pharm and self-care advice?

Answer 20

1. Instructions on how to take
2. Side-effects incl VTE signs and what to do if suspected
3. Missed pill and what to do
4. BP monitoring: should be checked 12-monthly
5. GP-review: remind that they should see a GP every 2 years for the pill
6. Cervical screening from age of 25 then 5 yearly
7. Breast checks: If personal or familial Hx of breast cancer - speak to GP regarding advice on freq and type
8. STI screening: anyone who is sexually active and engaging in unprotected sex