Regional abortion providers are celebrating the removal of red tape that has reduced and limited medical terminations.
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The drugs regulator has agreed to reduce burdens on doctors prescribing medical termination of pregnancy (MTOP), effectively removing the need for prior authorisation to prescribe the the two drugs used in medical terminations - mifepristone, and misoprostol.
The two drugs, distributed in Australia under the name MS-2 Step, induce an abortion by cutting off the supply of progesterone needed to keep an embryo viable, then making the uterus contract to remove the pregnancy.
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Under current regulations, a doctor is required to specially register for the MS-2 Step program, then request authority to prescribe each time they want to offer a medical abortion.
Nova Health general practitioner Carla Flynn said special authority to prescribe a drug is usually only required in cases where there alternatives. The purpose is to make prescribers consider alternatives - usually for cost reasons.
"When they changed the combination puffers for asthma to be authority, that was to try to push GPs towards prescribing the single agent rather than the combination because it's cheaper," Dr Flynn said.
"I don't see why that applies to MS-2 Step - it's our only product registered for this use.
"I don't see it [authority to prescribe] adding anything to the process, because they're only going off what we tell them anyway."
Streamlining the process for bush doctors
The changes shift MS-2 Step from "Authority Required" - the same level of authorisation as amphetamines and opioids - to "Authority Required (Streamlined)". In practice, this means abortion providers will have to notify the authority, but not seek approval prior to prescribing.
Nova Health obstetrician and general practitioner Trudi Beck said the changes were a big win for regional abortion providers.
"The current authority process is really onerous. Certain times of the day you can call and get straight through to them, but other times you might sit on the hotline for 15 minutes waiting for an answer," Dr Beck said.
"It just feels like red tape from a clinical perspective."
MS Health, a not for profit entity set up by MS-2 Step provider MSI is pushing the drugs regulator loosen regulations further, allowing other qualified health providers, like nurse practitioners, to prescribe medical abortions.
In an email sent to registered doctors, MS Health's new managing director Greg Johnson said they expected the changes to be implemented in July.
"We await further announcements from the TGA for our additional applications to simplify access to medical abortion," he said.
"We will continue to focus on strengthening our partnerships with healthcare professionals like you, enhancing our product offerings, and supporting the implementation of streamlined prescribing for mifepristone and misoprostol."
The next steps towards universal abortion access
MS Health currently have three additional proposals before the drugs regulator.
The first would remove the requirement to register and undergo special training to prescribe MS-2 Step.
The second would expand the base of authorised prescribers to include other health professionals like nurse practitioners, midwives, and aboriginal health practitioners.
The third would removing the requirement for pharmacies to register to prescribe the drugs, allowing them to more easily keep a stock of MS-2 Step on hand.
Doctor Beck was supportive of the plan to extend prescription rights to other health workers, but said that she had reservations the removal of special training and registration.
"Carla and I have both spent significant time and resources training to safely, carefully, and compassionately provide this service," she said.
"I think it would be a real shame if this process is handed over in a way the people providing the care are not passionate about providing good quality care.
In an Senate Committee hearing on universal access to reproductive healthcare, Health Products Regulation Group's (HPRG) Chief Medical Adviser Dr Robyn Langham said the drugs regulator would work quickly on MS Health's proposals.
"At the moment we're talking a couple of weeks," she said.
"It really has to do with the calendar for the meetings to which they sit. I'm not sure of when their [The Medicines Advisory Committee] next sitting is. They generally happen every couple of months.
"If it's too far away, then we could certainly have an out-of-session consideration for something like this."
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