In May 2022, Pharmacy Forum NI responded to the MHRA consultation on the proposal to make Aquiette 2.5mg Tablets (oxybutynin hydrochloride) available from pharmacies. The Forum opposes the proposal citing safety concerns around the medicine, which are widely evidenced. More generally, the Forum took the consultation response as opportunity to express concern with regard to the growing number of MHRA proposals relating to Prescription Only Medicine (POM) to P (Over the Counter) medicine switches, a move which is shifting the locus of healthcare.

The Aquiette proposal has been the latest in a consistent stream of consultations published recently by the MHRA, which presents a range of potential issues, which the Forum outlined in its response published in February 2022 related to making Estradiol available from pharmacies. Last year, the MHRA also authorised the switch of two brands of desogestrel contraceptive pills, Lovima and Hana, produced by the same manufacturer of Aquiette, Maxwelia which recently revealed plans to switch more products from POM to P.

Pharmacy Forum NI recognises that the pandemic has had a significant impact on people’s behaviour and attitudes towards self-care and access to treatment. However, while this change in legislation is designed to improve access to therapy, the profession is seeing itself challenged with a ‘back wall’ of multiple medicines that require an enhanced and direct patient-pharmacist consultation. Having these higher risk or more complex medicines downgraded to P requires a significant increase in pharmacist time which needs to be reflected in the retail selling price of the product.

Commenting on the increasing number of reclassifications, Pharmacy Forum NI Chair, Eamon O’Donnell said:

“Pharmacists are arguably one of the most accessible healthcare providers to the public, which has been highlighted during the Covid-19 pandemic. They are highly trained clinical experts helping  patients and the public by assessing conditions and making decisions about which medicines or treatments are most suitable, dispensing prescriptions and providing health checks and consultations. All of that work needs to be financed and be commercially viable.”

The Forum supports the move for patients to have access to medicines where cost does not present a significant barrier. We caution however that if the retail price is required by necessity to be high and potentially the expected volume low, then the investment in time for training individuals to a competent standard does not add up for commercial businesses. We have advised the MHRA that this must be taken into consideration. 

Cost of living crisis & ensuring equitable access to healthcare treatment and medicines for all

According to the World Health Organisation (WHO), Universal Health Coverage (UHC) is when all individuals and communities receive the essential health services they need without facing any financial hardship.

It is worth noting that the UK has in excess more P medicines than anywhere else in the world. This continued development is pushing the cost of care back onto the patient, which potentially represents an incremental shift towards a two-tiered healthcare system.

Many of the recent POM to P switches proposed by the MHRA involve issues affecting women in the main. By previously charging a price for the product, which encompasses a consultation cost, pharmacy has come under significant pressure from women’s health advocacy groups and social media campaigns to provide these medicines at a fair price. The Forum does not regard it appropriate to pass on the cost of this to the consumer, in particular with the current cost of living crisis in mind.