Women who elect to obtain a medication abortion can now get mifepristone, or “the abortion pill,” as they would any other prescription — from a retail pharmacy. Prior to a regulatory change issued by the Food and Drug Administration last week, the drug could only be dispensed directly from a certified provider or through a few national mail order services.
Since the drugs needed for a medication abortion are now commonly prescribed via telehealth — following a pandemic-era change in FDA policy made permanent about a year ago — the recent decision means patients seeing a local provider can now avoid an in-person visit altogether and instead pick up the medications at their local pharmacy.
Providers and advocates expect the FDA’s change in policy to improve access to medication abortion by lessening the “significant financial and logistical obstacles” faced by some women who must travel long distances to a provider’s office, or who may struggle to take time off work or secure child care, said Lynn McCann-Yeh, co-director of the Baltimore Abortion Fund. She notes that patients living on the Eastern Shore or in Western Maryland often must drive two to three hours to reach the nearest abortion provider.
“For those without reliable access to transportation, getting to a clinic or doctor’s office can be a real challenge,” said McCann-Yeh. The Baltimore Abortion Fund provides logistical support, such as transportation, lodging, childcare, and language interpretation, to women seeking an abortion, as well as financial assistance. While the organization serves both Marylanders and those traveling from out of state, 70% of requests for logistical support came from Maryland residents, McCann says, and transportation was the most common request.
Dr. Jessica Lee, an obstetrician and gynecologist at the University of Maryland Medical Center and medical director of UM Reproductive Health, a hospital-based abortion and miscarriage care clinic, calls the FDA’s modification to mifepristone rules “a great step” in “decreasing health inequities” by removing barriers for those who struggle with access and making the process of obtaining a medication abortion “less burdensome” for women.
Laura Bogley, acting executive director of Maryland Right to Life, condemned the FDA’s removal of “safeguards for women’s health and safety” in the form of an in-person dispensing requirement for mifepristone.
“This is a reckless policy that returns women to the days of back-alley abortions where women self-administer their abortions and hemorrhage without medical supervision or assistance,” Bogley said. (The regulatory change does not affect the setting where medication abortions take place, which is typically in the home, without any required supervision.)
Medication abortion is accessible early in pregnancy, up to 10 weeks gestation, per FDA guidelines, though some providers will prescribe it through the 12th or 13th weeks. The method has become more commonly used by women since it was first authorized in 2000, with pandemic-fueled changes in access contributing to a greater increase in use over the last few years. Medication abortions now account for over half of all abortions performed nationwide, up from less than 40% in 2017.
Mifepristone is the first of two drugs that must be taken to complete a medication abortion, and the only one for which access is restricted. The second drug, misoprostol, has always been easily obtainable at pharmacies, said Lee. This is because it has historically been prescribed for other, non-reproductive uses, such as gastric ulcers, Lee said, and it is therefore “less polarizing or controversial” than mifepristone.
Mifepristone blocks production of progesterone, a hormone needed to maintain pregnancy, and misoprostol causes contractions that expel the contents of the uterus, similar to an early miscarriage.
After the Supreme Court overturned Roe v. Wade, the landmark 1970s decision guaranteeing a federal right to abortion, in June of last year, some reports surfaced of pharmacists in various states refusing to fill prescriptions for misoprostol, usually in cases where it was prescribed for other reasons. This prompted the U.S. Department of Health and Human Services to warn pharmacies that denying patients their prescribed medications risked violating civil rights laws.
Lee said both mifepristone and misoprostol are also used in cases where a woman has miscarried, so a pharmacy’s ability to provide mifepristone is “larger than just abortion; it would help a lot of people who require miscarriage care as well.”
Will pharmacies comply?
While the FDA has enabled retail pharmacies to dispense mifepristone, they are not obligated to do so. Pharmacies must meet certain requirements in order to dispense the drug, but can attest to their compliance by filling out a simple form.
Large pharmacy chains CVS and Walgreens have both stated they intend to seek certification to dispense mifepristone in states where it is legally allowed.
Maryland is also home to 332 independently owned pharmacies, according to a 2022 report from the National Community Pharmacists Association. The willingness of these independent pharmacies to fill mifepristone prescriptions will likely depend on “the local community and their needs as a business owner,” said Ronna Hauser, senior vice president of policy and pharmacy affairs at NCPA.
The decision to certify is ultimately a personal one for independent pharmacy owners, Hauser said, and political views may come into play. She does not anticipate that the need to obtain certification will be “a major impediment” for these pharmacies.
Julie Johnson, manager and former owner of Johnson Family Pharmacy in Aberdeen, said, “We would have to consider if [dispensing mifepristone] is something we would want to be part of.” She said implementing certification requirements — such as designating one staff member to oversee compliance, ensuring provider confidentiality and confirming certification of the prescriber — would “absolutely” prove challenging.
Joy N., pharmacist and manager of Our Liberty Pharmacy in Randallstown who declined to disclose her full last name to The Banner, said, “If I have a patient that wants [mifepristone], I don’t see a problem with providing it,” as long as the patient is medically eligible. She said it should be less difficult for independent pharmacies to meet certification requirements compared to large chain stores because they are localized and tend to dispense a lower volume of prescriptions.
Women living in states where abortion is prohibited will not benefit from the FDA’s decision to expand access to mifepristone, Lee said, but in “abortion-protective” states like Maryland “this will be just another option to expand care” to residents or people traveling from out-of-state.
Baltimore abortion clinic weighs in
Whole Woman’s Health is an abortion provider operating five clinics nationwide, including one in Catonsville. Amy Hagstrom Miller, president and CEO of WWH, called the in-person dispensing requirement for mifepristone “unnecessary and outdated.” She noted that patients have different preferences for how they access an abortion, whether it’s receiving medication by mail, dispensed from a pharmacy, or via surgical procedure (the only option available to women later in pregnancy).
“We believe more options for all people leads to better, more affordable, and more equitable abortion care,” Hagstrom Miller said.
In October through December of 2022, Whole Woman’s Health’s Catonsville clinic provided abortion medication to 70 telehealth patients by mail, according to Moises Serrano, communications manager for the clinic. Patients must either reside in Maryland or travel there to receive telehealth services from the Catonsville clinic. The clinic dispensed abortion medication to 500 patients in person over the same time period, and performed 376 other abortion procedures, Serrano said.
