If your first question to this is, Wait, it was illegal to fill your script for medical abortion at your local retail pharmacy? The answer is yes. However, since Tuesday, Jan 3, 2023, the U.S. Food and Drug Administration (FDA) announced that they would allow certified retail pharmacies, from corner drug stores to Walgreens and CVS, to fill prescriptions for mifepristone.
Though confusing, this is good news regarding medication abortion says Mary T. Jacobson, MD, chief medical officer of Alpha, an online health care provider, and former Stanford faculty abortion provider.
Unfortunately, good news has been in short supply on the heels of 2022, when we saw the fall of Roe vs. Wade. Currently, state legislatures decide on abortion access, and 13 states have officially banned abortion. This expansion of medication abortion access is a very valuable step in the right direction.
"This doesn't mean that a provider could send in a script for medication abortion today, and CVS will fill it by the evening."—Mary T. Jacobson, MD, chief medical officer of Alpha
How does this change medication abortion access
Previously, before the COVID-19 pandemic, medication abortion was required by the FDA to be administered in person in a clinic. This was because mifepristone was overseen by the REMS program, meaning that providers were required to supervise the administration of the pill for patient safety and risk mitigation, Dr. Jacobson explains.
However, the US government lifted this requirement during the pandemic to meet citizens' need for telehealth abortion access. Now, the manufacturers of mifepristone successfully appealed this requirement, and the FDA has agreed to allow retail pharmacies to become certified providers of this important medication, Dr. Jacobson explains.
"This doesn't mean that a provider could send in a script for medication abortion today, and CVS will fill it by the evening," says Dr. Jacobson. Instead of a green light, this is more of a yellow light: The option to become certified is now on the table for pharmacies.
Currently, Walgreens and CVS have expressed their intent to begin the certification process for pharmacies located in states that are legally allowed to dispense these pills. It’s unclear exactly how long this process will take, and when you’d actually be able to pick up your script for a medication abortion at your local pharmacy.
What is a medication abortion?
In case you’re curious about how a medication abortion actually works, Dr. Jacobson lays out that mifepristone is one-half of medication abortion. It is the medicine that halts the development of a pregnancy and terminates it—essentially by blocking progesterone. The second pill one takes during a medication abortion is misoprostol; this drug initiates cramps and contractions in order to induce a miscarriage and expel the terminated pregnancy from the body, she adds.
As mentioned, misoprostol is and has been FDA-approved for other medical uses like inducing labor and was previously used for treating stomach ulcers. So, the red tape and complicated regulations don't apply to this medicine—just mifepristone because it is the abortifacient portion of medication abortion.
However, until this recent FDA announcement, the two pills together as medication abortion have previously only been available to patients via specific pharmacies, a few certified mail-order pharmacies, or directly from an abortion provider, doctor, or clinic.
What does this mean for states that have banned abortion?
Though this medication abortion access announcement will not take effect in states where abortion is illegal, this does mean that people from banned states could potentially fill their medication abortion prescriptions in neighboring, legal states. However, there are still numerous potential hoops people seeking abortions and their providers may have to jump through.
For example, some providers in states where abortion is banned may not be able to prescribe across state lines even if they are licensed in both places, Dr. Jacobson explains. It also really depends on the shifting sands of legislation as we head into 2023.
Additionally, we don't know where corporations will land on this news, larger pharmacy chains may choose not to pursue this certification, or it will vary by state, city, and county. Dr. Jacobson says that there is also a "conscience clause" that pharmacists have a right to invoke. This clause means that pharmacists can refuse to fill prescriptions if it disagrees with their religious beliefs. This is something people seeking medication abortion should keep in mind if they are on a time crunch and traveling to another state to get their script.
What questions do experts still have?
This is, admittedly, the epitome of a grey area, and the fog is expansive— the legal risk of filling a script in another state is unknown. The specifics of legality will likely come down to each individual state, so your local abortion fund will likely have resources about exactly how you can legally access an abortion.
"The laws around getting prescriptions for medical abortion filled are currently focused on where you are when you get a prescription for mifepristone, not where you are when you take the medication," says Ahmad Bani, CEO of Wisp, a telemedicine company that offers primary care and telehealth abortion care in select states. "That being said, we are concerned about retail pharmacists refusing to offer patients access to medication abortion, as we've seen with emergency contraception and birth control."
Ultimately, staying in touch with educated abortion providers, abortion funds, and networks can help citizens to stay informed about their state and city's unique rules and risks when it comes to seeking abortion care.
In the meantime, retail pharmacies will need to apply for certification to fill medication abortion scripts and agree to follow certain criteria. For medication abortion support, there is always your local abortion fund, Planned Parenthood, Plan C, Wisp, and Hey Jane.
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