THE ANNOUNCEMENT THIS week by Minister Harris to provide greater access to the morning after pill is a step in the right direction for women’s equality.
Up until 2011, anyone who needed emergency contraception had to attend a doctor in order to get a prescription before they could go to a pharmacy to buy it.
Then, following a reclassification by the Irish Medicines Board, it moved from being considered a POM (Prescription Only Medicine) to a P medicine, making it available over the counter, upon request.
It was up to individual pharmacies to decide what they charged and how they chose to provide it. Most places settled on a standard risk-analysis questionnaire, with a brief consultation and an item fee of around €25.
However, real challenges around equality of access arose for patients with a medical card, who would normally pay €2.50 for any prescription item they needed. They could only receive the pill at the €2.50 price if they presented a medical card prescription for it, otherwise pharmacies would charge them the standard fee of around €25, that all their patients were being charged.
Typically, the majority of emergency contraception is dispensed at the weekend or on bank holidays. It is at its most effective the sooner it is taken after unprotected sex, and the more time elapses, the more its efficacy is reduced. Norlevo, the brand licensed by the Irish Medicines Board has to be taken within 72 hours of unprotected sex in order to be effective.
Immediately it became apparent to community pharmacists that people who could not get an appointment at the weekend to see their doctor were faced with a significant financial barrier to accessing the morning after pill. Generally these were people who had been means tested in order to get a medical card, so therefore in many cases a fee of €25 was a huge portion of their weekly or monthly budget.
Some women simply didn’t have the money, others borrowed it off friends, and some, unfortunately, took the risk and went without.
Medical cards
According to a survey by the Irish Pharmacy Union (IPU) last year, 22% of women who bought the pill were medical card holders.
There has been a concerted campaign among community pharmacists to try and have a situation where medical card holders are not expected to pay the private fee.
When I was elected, it was one of the things that I felt I could inform and improve the rules around. The computer systems used by pharmacists are already linked up to the claims and reimbursement processes that the HSE has for all the various schemes.
It would require relatively minor adjustments to the software, so that pharmacists could enter someone’s medical card number on the system and verify their identity. Then, following the usual consultation and chat with the pharmacist, they could have the morning after pill for €2.50 and the HSE would refund the pharmacist as appropriate.
From July, this is going to happen. It’s almost exactly a year today that I started raising this with the Minister – and in fairness to him, he has acted with the HSE, the IPU and the other relevant bodies involved to remove this inequality of access for women.
It was really a case of unforeseen circumstances – the system wasn’t equipped to deal with the unexpected re-classification of a drug like that.
As has so often been the way in Ireland, those who can afford to pay the costs are enabled to make a choice about their reproductive health.
There is nothing to be gained from “punishing” women who haven’t the means to pay for the morning after pill. The same women who, if they become pregnant, might end up in even more financially challenging and possibly marginalised circumstances.
It is a wonderful example of how patient-led approaches to controlling their own bodies can be facilitated in a community setting, with minimal interference, judgement or intrusion by others.
I trust women to make the right decisions for them, I trust pharmacists to make the right call when dispensing and I am glad Minister Harris trusted and listened to the calls for change and then delivered upon them.
Kate O’Connell is a pharmacist and Fine Gael TD for Dublin Bay South
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