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Abortion pill pipeline increases availability in 'red states'

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Thursday, October 19, 2023   

By Carrie Baker for Ms. Magazine.
Broadcast version by Roz Brown for Texas News Service reporting for the Ms. Magazine-Public News Service Collaboration

Earlier this month, the pharmaceutical company GenBioPro announced the names of 18 brick-and-mortar pharmacies that are now dispensing the abortion pill mifepristone. They are the first pharmacies to publicly acknowledge doing so after the FDA in late 2021 finally loosened medically unnecessary restrictions on mifepristone that blocked pharmacy distribution for decades.

"At GenBioPro, we firmly believe everyone has a right to access evidence-based health care and safe and effective medicines, and that includes medical abortion," said Evan Masingill, CEO of GenBioPro, which successfully obtained FDA approval in 2019 for the first generic mifepristone tablet.

The pharmacies listed on their website include independent community drugstores, university-affiliated outlets and compounders located in nine states, including in Arizona, California, Maryland, New York, Pennsylvania, South Carolina, Washington, Wisconsin and Texas. There are no chain pharmacies on the list, although CVS and Walgreens say they plan to dispense the medication soon.

"While it's hopeful to see some brick-and-mortar pharmacies on this list, the large pharmacy chains are notably absent," said Amy Merrill, co-director of Plan C, which provides information on at-home abortion with pills. "Chain pharmacies could play a major part in expanding access, both because of their numerous locations and because they're the only ones with the resources to stand up to bullying by extremist politicians and their supporters."

When the FDA approved mifepristone in 2000, the agency blocked pharmacies from dispensing the medication, instead requiring doctors to give the medication directly to patients. In December of 2021, the FDA announced they would for the first time allow brick-and-mortar pharmacies to dispense mifepristone-if they were certified with the FDA. In the ensuing months, the FDA negotiated with pharmacy representatives, GenBioPro and Danco, maker of the brand name mifepristone, to develop a certification process.

Finally, in January of 2023, the FDA announced the new certification process for pharmacies to dispense mifepristone. CVS and Walgreens immediately announced they would apply for certification to dispense mifepristone.

In response, anti-abortion advocates staged boycotts at CVS and Walgreen pharmacies and 20 conservative state attorneys general threatened legal action against these companies if they dispensed mifepristone in their states. Then 23 attorneys general issued a statement supporting medication abortion at CVS and Walgreens stores.

CVS acknowledged their pharmacies were not currently dispensing mifepristone, but said they were working through the steps required for certification.

"Once certified, we plan to dispense mifepristone in states where legally permissible in the near future," Amy Thibault of CVS Pharmacy told Ms.

Walgreens will also soon dispense the medication. "We are in the last stages of finalizing certification, and once certified, we will dispense this medication consistent with federal and state laws," said Fraser Engerman, senior director of external relations at Walgreens.

In addition to listing pharmacies dispensing mifepristone, GenBioPro has updated their website to help prescribers, pharmacies and patients understand the new FDA rules on mifepristone and learn how to access abortion pills. The website has up-to-date information about how pharmacies can become certified to dispense mifepristone, and how medical professionals can become certified to prescribe mifepristone and dispense the medication directly to patients or through certified pharmacies. They also offer patient education and support resources in English and Spanish, with some resources available in additional languages, including Portuguese, Arabic, Chinese, Vietnamese, French, Haitian and Russian.

"We will continue to do everything in our power to ensure that these ... changes benefit as many people as possible and work toward truly universal access," said GenBioPro, noting that not everyone will have equal access because some states restrict abortion.

In addition to brick-and-mortar pharmacies, there are several mail-order companies dispensing mifepristone, including Honeybee Health and American Mail Order Pharmacy.

While many people prefer to receive abortion pills privately by mail, others may want to pick up the medications in person either because:

  • they do not have a reliable or confidential mailing address,

  • they cannot wait for the medication to arrive by mail because they are experiencing a miscarriage or health-threatening pregnancy, or

  • they live in a state with an early gestational ban.

Advocates expressed frustration at how long it's taken for pharmacies to begin dispensing mifepristone.

"Mifepristone is the only medication that's seemingly regulated in a cultural manner: Can you imagine any other safe, common and essential medication being withheld from people who need it, even when they live right down the street from a pharmacy, and even after it's received long-overdue approval to be there?" said Merrill.

While pharmacy access to abortion pills slowly expands, the anti-abortion movement is trying to remove mifepristone from the market.

In November of 2021, anti-abortion doctors and a dentist filed a lawsuit, Alliance for Hippocratic Medicine v. FDA, asking an anti-abortion federal judge in Amarillo, Texas, to reverse the FDA's approval of mifepristone.

In April, the judge ruled the FDA improperly approved mifepristone in 2000 and stayed the approval-a ruling put on hold by the Supreme Court until it issues a final ruling in the case. On appeal, the Fifth Circuit Court of Appeals reversed in part, but still sharply restricted access to mifepristone nationwide. The Justice Department has appealed the decision to the Supreme Court.

"This is why Plan C is dedicated to researching and listing alternate routes of access on our website, so people know about their full range of options to get safe abortion pills in the US," said Merrill. The Plan C Guide to Pills provides information about how to obtain abortion pills in all 50 states, including through telemedicine, community support networks, and vetted websites selling abortion pills.

Meanwhile, if restrictions are put in place, clinicians are prepared to continue offering telehealth abortion with misoprostol alone.

"We all deserve better. And until our government, policymakers and industries can protect full rights and access, people will continue to need activist providers and community networks, and Plan C will continue to spread the word that these options exist," said Merrill.

Carrie Baker wrote this article for Ms. Magazine.

Disclosure: Ms. Magazine contributes to our fund for reporting. If you would like to help support news in the public interest, click here.

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