MS-2 Step (mifepristone + misoprostol) — prescribing, PBS, MBS, conscientious objection, follow-up. Verified against RANZCOG Clinical Guideline for Abortion Care and TGA product information.
| Gestational limit (TGA) | Up to 63 days (9 weeks) from LMP |
| Who can prescribe | Any GP (no certification required since 2023). Nurse practitioners and endorsed midwives — depends on state law. |
| Who can dispense | Any pharmacy — no registered dispenser requirement since 2023 |
| PBS listing | Yes — general copay $25.00, concession $7.70 (March 2026) |
| Ultrasound | Not always required ≤63 days if dates certain. Required if ectopic risk, uncertain dates, or >14 weeks. RANZCOG recommends offering USS — decision based on patient preference and access. |
| Anti-D (Rh factor) | Not routinely required before 10 weeks. EMA ≤10 weeks no longer listed as sensitising event requiring Rh immunoprophylaxis. [NBA 2021, RANZCOG 2023] |
| Follow-up | 14–21 days post-mifepristone. Urine or serum β-hCG to confirm complete. Clinical history alone insufficient. |
If chlamydia or gonorrhoea is detected, treat before or at the time of the procedure where possible. Active untreated cervicitis increases PID risk particularly with surgical abortion and uterine instrumentation.
Source: Australian STI Management Guidelines — Pregnant People (sti.guidelines.org.au, updated 2024–25); RANZCOG Clinical Guideline for Abortion Care.
There is no specific MBS item for the prescribing of MS-2 Step itself. Bill the consultation item appropriate to the time and complexity of the assessment:
| Item | Description | Fee |
|---|---|---|
| 23 | Standard consult <20 min | $45.05 |
| 36 | Long consult 20–40 min | $87.10 |
| 44 | Prolonged consult >40 min | $128.35 |
The initial consultation for MToP typically qualifies as item 36 or 44 given the clinical assessment, counselling, prescribing, safety-netting, and follow-up planning required. Follow-up appointments bill the appropriate attendance item.
In all jurisdictions: A GP with a conscientious objection must disclose this to the patient and must refer the patient to another provider or service that can help, within a clinically reasonable time. You cannot simply decline and end the consultation.
In an emergency: Conscientious objection does not permit withholding care. All practitioners must provide necessary emergency care regardless of personal beliefs.
State variation: Requirements differ by jurisdiction. Some states have specific notification obligations or referral wording requirements. Check your state's legislation and your MDO if uncertain.
Useful resources: MSI Australia — abortion law by state • AMA Position Statement on Conscientious Objection 2019
| State/Territory | On request (approx) | NP/midwife prescribe MS-2? |
|---|---|---|
| QLD | Up to 22 weeks | Yes (with training) |
| VIC | Up to 24 weeks | Yes |
| NSW | Up to 22 weeks | No (doctors only — pending legislation) |
| WA | Up to 23 weeks | No (doctors only — legislation in progress) |
| SA | Up to 22 weeks (1 doctor) | Yes |
| TAS | Up to 16 weeks | No |
| ACT | No gestation limit | Yes |
| NT | Up to 24 weeks | Partial (check local rules) |
Source: Children by Choice — Australian Abortion Law and Practice (2024); MSI Australia; WAPHA. Verify current state legislation before prescribing.
Follow-up at 14–21 days: Urine or serum β-hCG. If using serum, ≥80% decline from baseline (if taken ≥72 hours after mifepristone) to 8–16 days post-mifepristone indicates complete. Clinical history alone is unreliable.
Success rate: Approximately 95–98% effective at ≤63 days. In 2–5% of cases the process is incomplete or fails.
If incomplete: Options include repeat misoprostol dose, surgical evacuation (MVA or D&C), or expectant management depending on clinical picture and patient preference.
Ensure access to 24-hour emergency care: Prescribers must be able to ensure the patient has access to emergency treatment for complications (haemorrhage, incomplete abortion, infection) either directly or through arrangement with another service.
Ovulation can resume as early as 10 days after medical termination. Contraception discussion at the time of prescribing is important.
DMPA (Depo-Provera): Can be given at the time mifepristone is administered per RANZCOG guideline — discuss potential small impact on efficacy. Combined oral contraceptive, POP, and IUDs: commence or insert at follow-up once complete confirmed. Implanon: can be inserted at follow-up visit.