Removing prescriber and pharmacist restrictions has expanded pharmacy access to MS-2 Step, but regional gaps remain.
Lifting Therapeutic Goods Administration (TGA) restrictions on MS-2 Step has led to almost 50% more pharmacies ordering the medicine, new research shows.
But in over half of Australian postcodes, no pharmacies have ordered MS-2 Step, and patients face another hurdle in finding where it’s available.
The findings come as Victoria’s major parties pledge to make abortion care free, with Labor announcing a $30 million commitment this week and the Coalition matching it ahead of the 28 November state election.
The 4-year policy would pay participating providers to deliver medical and surgical abortion up to 16 weeks’ gestation, and also cover blood tests, scans and medication that women often pay for out of pocket.
AP explores what’s behind the remaining gaps in MS-2 Step access, and how pharmacists can help close them.
The impact of the TGA’s changes
Previously, prescribers had to be certified to prescribe MS-2 Step, and pharmacists were required to be registered before dispensing it.
The study found 4,107 pharmacies ordered MS-2 Step in the 2 years after the TGA lifted these restrictions in August 2023, up from 2,228 in the 2 years before.
By July 2025, an estimated 446 more pharmacies ordered MS-2 Step each month than would otherwise have been expected – a 48.6% increase.
More widespread access to MS-2 Step was also identified, with the proportion of Australian postcodes containing at least one ordering pharmacy rising from 34.6% to 48.9%.
However, use of medical abortion had already been rising steadily since MS-2 Step was listed on the Pharmaceutical Benefits Scheme (PBS) in 2013.
‘The pre- and-post numbers don’t take into account the change that was already happening in Australia during that time,’ said lead researcher Professor Kristina Edvardsson from La Trobe University’s School of Nursing and Midwifery.
‘But the impact of this regulatory change really made a difference for individuals needing abortion.’
Before the restrictions were lifted, access was particularly limited outside metropolitan areas, said Professor Danielle Mazza, director of the SPHERE Centre of Research Excellence at Monash University and a co-author of the study.
‘Up to 30% of Australian women didn’t have local access to prescribers or dispensers, and that went up to 50% in women in remote areas,’ she said. ‘These kinds of regulations were very unusual, and we don’t even have them for things like opioids.’
Gaps outside metropolitan areas
While the number of pharmacies ordering MS-2 Step rose most in major cities, climbing from 56.1% to 75.9%, increases were recorded across all remoteness and socioeconomic categories.
The proportion of regional postcodes with an ordering pharmacy rose from 23.3% to 34.5%, while remote postcodes increased from 12.5% to 22.0%.
Associate Professor Luke Grzeskowiak MPS, a pharmacist who leads Flinders University’s perinatal medicines research group and is a SPHERE investigator, said the regional picture is more encouraging than the postcode figures alone suggest.
Following the changes, 98.7% of the regional and remote statistical areas (SA3s) examined in the study had at least one ordering pharmacy.
‘Low socioeconomic status correlates closely with regional and remote areas, so the key issue is likely remoteness,’ A/Prof Grzeskowiak said.
Local prescribing patterns and demand may also help explain why some pharmacies are yet to order the medicine.
‘It may be difficult to find a prescriber in regional and remote areas,’ A/Prof Grzeskowiak said. ‘Unless patients are presenting with prescriptions for MS-2 Step, pharmacies may not think to stock the medicine.’
There is no established benchmark for how many pharmacies need to stock MS-2 Step to adequately meet demand, Prof Edvardsson said. With a 2-year shelf life, keeping the medicine on hand may be difficult to justify in areas where prescriptions are infrequent.
‘There are also privacy considerations for people in small communities who go and pick up the medication at their local pharmacy – where you might know everyone who works there,’ she said.
When the medicine is unavailable locally, patients can face significant barriers to access.
‘It means having to travel, which incurs further costs,’ Prof Edvardsson said. ‘That might be tricky for people to leave work, kids or whatever that might be to go and pick up the medication.’
Preparing for local collection
Before the 2023 changes, most patients using MSI Australia’s telehealth abortion service had MS-2 Step posted to them. Since then, more have chosen to collect it from a local pharmacy, the study authors noted.
‘Having adequate MS-2 Step stock on hand is critical for providing timely access to medicines, particularly during what can be a difficult time for those requesting abortion care services,’ A/Prof Grzeskowiak said.
Although MS-2 Step online training is no longer mandatory, A/Prof Grzeskowiak said it remains a useful way for pharmacists to build their knowledge and confidence in providing safe, evidence-based medical abortion care. The training is available to AHPRA-registered health professionals through MS-2 Step.
Pharmacists’ expanding role
Even where pharmacies are ordering MS-2 Step, patients may struggle to find out who supplies it.
Prof Edvardsson said pharmacists could help address this through abortion care navigation services.
‘One way of improving access is for services to register with navigation services such as the 1800 My Options in Victoria, and equivalents in other states,’ she said.
Pharmacists interested in sexual and reproductive health can also join the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS), A/Prof Grzeskowiak said.
‘AusCAPPS supports [early medical abortion] and [long-acting reversible contraception] providers through expert clinician case studies, questions and discussion with peers and experts, and access to clinical resources, training and local provider information.’
Pharmacists’ role extends beyond providing information and advice on what to expect when taking MS-2 Step to delivering holistic abortion care services.
‘This includes initiating conversations and providing advice regarding the use of supportive care medicines, including pain relief and antinauseants, to address common side effects,’ A/Prof Grzeskowiak said.
‘Where appropriate, pharmacists can also initiate conversations and provide advice regarding ongoing contraceptive use.’
But pharmacists aren’t obliged to supply MS-2 Step if they hold a conscientious objection – a legally recognised right for health professionals. PSA’s 2026 Code of Ethics for Pharmacists makes clear that this right comes with responsibilities.
Pharmacists who wish to exercise conscientious objection must:
- disclose to the patient promptly and respectfully when exercising this right
- notify their employer and colleagues in advance of this objection to put in place strategies to avoid patient impact
- take takes all reasonable steps to facilitate timely access to an alternative provider so that patient care is not delayed, obstructed or otherwise adversely affected.
What’s next for abortion care?
Labor has pledged to extend the window for medical abortion in Victoria from 9 to 10 weeks, which was not matched by the coalition.
But whether this is enacted depends on the TGA, which is considering an application from MS Health to extend MS-2 Step’s gestational limit. If approved, the change would apply nationally.
Prof Mazza said the current 9-week cut-off leaves women with limited options.
‘Once they get past 9 weeks, unfortunately, currently the only option for them is a surgical abortion, and that’s one of the barriers we currently have in Australia,’ she said. ‘There is not enough surgical abortion provision being undertaken in our public hospital system.’
Learn more by completing the online PSA module Pharmacists’ growing impact in early medical abortion care.
