In a state first, participating Victorian pharmacists can now dispense a one-month resupply of menopausal hormone therapy (MHT), but the RACGP says there are conflicts of interest and missed opportunities for care.
The expansion forms part of the Victorian government’s Chemist Care Now expansion, announced on Wednesday.
Eligible women must be aged 45 to 59, or aged 30 or older with confirmed surgical menopause. They must have seen their GP within the past 12 months and have been using the same MHT for at least 6 months.
Consultations for eligible patients would be free, an initiative the Victorian Minister for Health said would save both time and out-of-pocket costs, particularly for women in regional areas.
Initially developed as a pilot in October 2023, Chemist Care Now has delivered more than 100,000 services across more than 900 pharmacies, with almost 70% of services accessed by women and 26% of participating pharmacies in rural and regional areas.
Associate Professor Magdalena Simonis, a GP, women’s health expert and longstanding member of the RACGP’s Expert Committee for Quality Care, told The Medical Republic the expansion was important for patients who cannot regularly access their GP, helping prevent breakthrough symptoms.
“When a patient runs out [of MHT], it can have significant impacts for them,” she said.
“I think this is a sensible move.”
Current menopause guidelines suggest prescribers regularly assess efficacy, symptom relief, side effects, and risks.
Before dispensing medication, pharmacists would be required to conduct a thorough consultation in a private room and outline potential risks, with those requiring further care referred to a medical practitioner.
But Professor Simonis affirmed the importance of GPs remaining the “overall care custodian”, responsible for conducting regular reviews of patients’ medications and making adjustments as needed.
“If there are any new symptoms, patients should present to the GP and not the pharmacist, ideally, because the pharmacist does not have access to the [patient’s] background history,” she said.
This included abnormal bleeding, postcoital bleeding, and liver enzyme changes, as well as ensuring that cholesterol and cardiovascular disease risk factors are assessed and monitored, Professor Simonis told TMR.
Ongoing shortages and supply disruptions of MHT, particularly patches containing estradiol, led to the Serious Scarcity Substitution Instrument for MHT products being extended to 28 February 2027.
Where existing MHT supplies were not being met, patients could discuss alternative options with their pharmacist, but changing the medication type required discussion and approval with their GP, Professor Simonis said.
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Dr Aadhil Aziz, RACGP Vic deputy co-chair, told TMR it was not a matter of “us versus them” but about ensuring sufficient follow-up, which could also create opportunities to check immunisation status, cancer screenings, mammograms, and blood pressure.
“These are nuances, and we do this over decades of study and experience. You cannot do this with just a script,” he said.
Before commencing MHT, prescribers must also carefully consider contraindications and comorbidities, and rule out other conditions with similar symptomatology, such as thyroid disease, Dr Aziz said.
While the government has announced plans to develop a National Medicines Record – an overarching database to monitor all patients’ current prescriptions – interoperability between pharmacist and GP systems remains limited, which could lead to duplication and adverse events.
Pharmacies’ ability to prescribe and dispense generic MHT products also posed a conflict of interest, Dr Aziz told TMR.
“GPs, when we prescribe a medication, we cannot legally make any money off that medication, whereas a pharmacist directly can. So, there is a massive conflict of interest here that I don’t think is getting enough attention,” he said.
RACGP Victoria chair Dr Anita Muñoz said pharmacy medicine management and the provision of repeat prescriptions played an important role but could not replace the value of a patient’s ongoing relationship with a GP familiar with their medical history.
“We need to make sure any care they provide is connected to the patient’s usual GP, so important health information isn’t missed,” she said.
Medicines supplied through Chemist Care Now are not PBS-subsidised, which Dr Muñoz warned could potentially cost patients more than GP-prescribed medicines.
“If the Government wants to make healthcare more accessible, it should start by removing the payroll tax burden on GP billing,” the RACGP Vic chair said.
Between March 2025 and September 2026, approximately 520,000 women accessed PBS-listed MHTs, filling roughly three million prescriptions.
With Victoria’s state election just over seven weeks away, the college urged the next Victorian government to pause any further expansion of Chemist Care Now until a “comprehensive, independent review” had assessed its impact on patient safety, health outcomes and continuity of care.
It also called for funding medicines for children in foster and kinship care, boosting GP incentives and mentorship for opioid dependence treatment, and reinstating the chief general practice advisor.
Under the most recent expansion, Victorian community pharmacists with additional accredited training can also initiate treatment for gastro-oesophageal reflux disease.
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