In the past year, there’s been a significant surge in interest in medication abortion via telehealth, after the Supreme Court overturned Roe v. Wade and the Food and Drug Administration made it possible for patients to get a prescription online and have the drug delivered to their front doors.
Now, telemedicine patients will have more pathways to care. A finalized rule from the FDA makes permanent the ability to distribute the medication by mail, while newly allowing retail pharmacies to distribute mifepristone, one of two drugs used to safely end an early pregnancy.
Several telemedicine companies that provide medication abortion expressed enthusiasm for opening up local pickup for patients — an option that could increase access for those who live in states where abortion is not currently legal.
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Just the Pill medical director Julie Amaon imagined a patient in South Dakota, where abortion is illegal, traveling to Colorado for a telehealth call and staying until their prescription could be filled at a certified retail pharmacy. Assuming that patient would previously have had to wait for a mail-order pharmacy to deliver to an address in Colorado, “this would reduce their travel from two days to one,” Amaon wrote to STAT.
Other telemedicine providers of medication abortion, including Tia, Choix, and Wisp, told STAT they would explore partnerships with retail pharmacies. On top of convenience, Choix CEO Cindy Adam suggested that local pickups might allow for decreased costs. But they could also introduce new challenges for a medical model that prides itself on discreet and stigma-free care.
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“As pharmacies expand access, Tia will continue to monitor which pharmacies are able to offer the best service to our patients — including things like non-judgemental care, timely access to medication, and insurance coverage,” Stephanie Long, reproductive health specialist for Tia, told STAT in an email.
Those new points of access will still take time to establish. Even as big box pharmacies like Walgreens and CVS publicly plan to distribute the drugs where abortion is legal, the certification process established by the FDA will require work to register and train pharmacists. In addition, “insurance will need to expand coverage for the medication as a pharmacy benefit and not just a medical benefit,” Long explained.
In the meantime, telemedicine patients will continue to be able to access mifepristone — which is approved for use in combination with misoprostol to end a pregnancy through 10 weeks — through mail-order pharmacies such as Honeybee Health and American Mail Order Pharmacy. Jamie Phifer, medical director of Abortion on Demand, said she believes most patients will still prefer the privacy benefits of home delivery. Patients can also seek medication abortion pills online with services like Aid Access that operate outside the U.S. health care system.
Honeybee Health, which partners with many telehealth companies that prescribe medication abortion, also doesn’t expect many of those businesses to make much use of brick-and-mortar pharmacy distribution yet. Co-founder Jessica Nouhavandi said that’s because burdens on providers and patients — such as identifying local certified pharmacies, verifying that certification, and coordinating pickup — will leave mail-order as a preferred option.
The important part, telemedicine providers emphasized, is that the FDA’s rule gives patients more choice. “For some patients, a mail order pharmacy with delivery to their home is still the best option for a medication abortion,” wrote Long. “For others, walking into a retail pharmacy without waiting for shipping may be the best option.”
But they also stressed that adding access points at retail pharmacies won’t be a silver bullet. Just because pharmacies can carry mifepristone doesn’t mean that they will choose to stock it. And the new rule doesn’t change which states have prohibited abortion or telehealth abortion.
“While we applaud this significant step towards improving access to medication abortion care,” wrote Choix’s Adam, “we cannot forget that this update comes at a time when millions of people are still left without options for care because they live in states that ban telehealth for medication abortion or have outright banned abortion.”
