Access to abortion care will improve thanks to a nationwide injunction lifting the U.S. Food and Drug Administration (FDA) requirement that medications for abortion may only be dispensed in person. On July 13th, a federal judge ruled that this requirement imposes a heavy burden on patients, their families, and clinic staff when patients are forced to physically go to clinics in the midst of the COVID-19 Public Health Emergency (PHE).
The FDA has placed significant restrictions on the drug combination (mifepristone and misoprostol) that can safely and effectively end early pregnancies and treat early miscarriages. Patients can only receive medication abortions from specific certified providers and only in person, even when counseling can be delivered via telehealth and patients can administer the medications on their own. Neither can a pharmacist prescribe the medication.
Medication abortions are safe and effective, and their delivery or dispensing via pharmacies are allowed in more than sixty countries. The National Academies of Medicine, Engineering and Science and others have concluded that medication abortion is 97 percent safe; it is actually safer than a root canal, Viagra pills, or birth delivery. Medication abortions facilitated via telehealth protect patients’ privacy, do not force them to try to get childcare, and do not involve transportation and lodging arrangements.
Restrictions on medication abortion have remained during the COVID-19 pandemic, despite the current situation; yet, medical facilities are overrun with patients and federal and state governments have asked individuals to socially distance and use telehealth whenever possible.
People who seek abortionーhalf of whom are low-income and many of whom are people of colorーare more likely to work in essential jobs, have less access to health care, face greater health risks, and have limited means of transportation. Under the restrictions, many patients would have to travel using buses or planes to access medication abortionーpotentially endangering their lives and the lives of others.
In addition to involving health risks, the reality of traveling means arranging for child care (sixty percent of abortion patients are already parents) and missing workーharming the economic wellbeing of patients in the midst of a worsening recession.
Thanks to this nationwide injunction, in thirty-three states medication abortion can be mailed and delivered to the patient’s location during the Public Health Emergency and 30 days after its conclusion. The ruling marks a victory for all abortion patients and providers but is particularly important for communities of color and low-income communities who make up the majority of patients and are heavily impacted by the COVID-19 pandemic.
Other REMS requirements stay in place; for instance, medication abortion must still remain under the certified provider’s control and cannot be prescribed through a retail pharmacy. The status of the injunction may change, and the injunction does not apply to the seventeen states that prohibit telemedicine delivery of abortion, where patients will still have to see their abortion providers in person. The injunction only applies to the use of mifepristone for abortion, but not for miscarriage care.
This national victory offers states and private health insurers alike a profound opportunity to strengthen access to safe, effective, and legal abortion care during the pandemic. Medicaid programs and insurance plans should immediately adjust their payment systems to make sure they are covering medication abortion that is mailed or delivered.
The National Health Law Program believes that these FDA restrictions should be lifted not only during the pandemic, but permanently, so that individuals can acquire the health care they need under the circumstances that are best for them.