Pharmacists have begun prescribing abortion pills, not just dispensing them — a development aimed at expanding access to abortion.
The new effort is small so far — a pilot program in Washington State — but the idea is expected to be tested in other states where abortion remains legal.
“I think it’s going to expand and expand,” said Michael Hogue, executive director of the American Pharmacists Association, a national professional organization that is not involved in the new program and does not take a position on abortion.
Many states now allow pharmacists to prescribe a variety of medications, he said, adding that in his organization’s view, it makes sense to have “someone so accessible in a local community can provide safe access to treatments that can sometimes be difficult to get.” be taken.”
Abortion rights advocates see the pharmacist prescribing as part of an effort to open as many avenues as possible at a time when abortion pills are facing increasing attacks from abortion opponents.
The pill is now the method used in nearly two-thirds of abortions in the United States. But a lawsuit aimed at forcing the Food and Drug Administration to drastically limit mifepristone, the first pill in the two-drug abortion regimen, was recently revived after the Supreme Court threw out the case, saying the original plaintiffs lacked standing to sue . The Texas attorney general recently sued a New York abortion provider for sending abortion pills to a patient in Texas. And abortion rights advocates worry that a 151-year-old federal anti-abortion law known as the Comstock Act could be invoked by the incoming Trump administration to try to prevent the shipment of abortion drugs.
“Attacks on access to abortion care have created a medical emergency, public health and human rights crisis,” said Dr. Beth Rivin, who leads a Seattle-based global health nonprofit, Uplift International, and is the new program’s executive director. called the Pharmacist Abortion Access Project. “Even in Washington state, where abortion is legal, people still face barriers to abortion care, especially people who are struggling to make ends meet, live in rural areas, and don’t have easy access to reproductive health care.”
Anti-abortion campaigners said they opposed pharmacists prescribing abortion pills, calling the practice reckless and unsafe.
“Pharmacists, who do not receive clinical training, should not be dispensing these dangerous drugs,” said Dr. Ingrid Skop, vice president and director of medical affairs at the Charlotte Lozier Institute, an anti-abortion organization. “By pushing for these medically unsupervised abortions, the FDA and abortion advocates continue down the slippery slope of dismantling medical standards for women seeking abortions.”
On Tuesday, the Pharmacist Abortion Access Project reported that in a pilot program conducted between Oct. 31 and Nov. 26, 10 pharmacists across Washington State had prescribed abortion pills to 43 patients.
Prescribing was done via telemedicine, with patients filling out forms asking about their pregnancy and medical history. Patients had to be Washington residents and could be up to 10 weeks pregnant. They were paying $40, significantly less than many services. The prescriptions were forwarded to Honeybee Health, a mail-order pharmacy based in California that works with several telemedicine abortion services, which shipped the pills to the patients.
Many studies have shown that medical abortion is safe and that serious complications are rare. Don Downing, co-director of the project and emeritus professor of pharmacy at the University of Washington, said that in addition to providing a hotline for questions or concerns, pharmacists had been reaching out to patients to see how they were doing, asking questions such as : “Did you bleed excessively or did you not bleed at all? Do you have a fever, pain, anything?’
She said that during the follow-up, patients were asked standard questions, such as whether they were experiencing appropriate levels of bleeding from the passage of pregnancy tissue. “We didn’t have any serious negative outcomes at all, but we had a whole network of other resources available in case that happened so we could take care of them,” he said.
Dr. Rivin said the project plans to begin full pharmacist prescribing sometime this year and eventually allow in-person prescribing at Washington pharmacies, meaning patients can go to a pharmacy and get a prescription and pills in one visit. .
This would work alongside a recent FDA policy allowing pharmacies to be certified to dispense mifepristone, which falls under a special regulatory scheme that previously required it to be dispensed primarily by clinics or other abortion services. The second drug in the abortion regimen, misoprostol, is less restricted and has long been widely available.
Last year, Walgreens and CVS began dispensing mifepristone in some states, as did dozens of smaller pharmacies in at least a dozen states.
Jessica Nouhavandi, a pharmacist and president of Honeybee Health who is co-director of the new project, said she had the idea several years ago. Washington State became the first location, he said, because it has a decades-old system that allows pharmacists to prescribe drugs, requiring only a collaborative agreement with a physician or nurse practitioner who approves the prescribing plan.
He said other states require more steps, such as a doctor’s approval on prescriptions that pharmacists fill every day. But said Dr. Downing, who has pioneered other prescription programs that have spread nationally, “if, in fact, abortion is legal in a state, I don’t think there are too many insurmountable obstacles.”
The pharmacists’ association’s Dr Hogg said nearly 40 states allow pharmacists to prescribe at least one drug and that during the coronavirus pandemic, patients had become accustomed to having pharmacists write prescriptions. In many states, pharmacists can prescribe birth control pills and morning-after pills.
Brian Noble, executive director of the Washington Family Policy Institute and an evangelical pastor, said he is not opposed to pharmacists prescribing drugs in general or counseling women deciding whether to continue a pregnancy. But, he said, “I’m against anything that ends life,” which he believes starts at conception.
“I believe in the rights of aborted babies,” said Mr. Noble, adding, “I see women as having the great privilege of being entrusted with bringing life into their bodies.”
Dr. Nouhavandi said the project’s patient counseling form asked for slightly more information from abortion services where doctors or nurses issue prescriptions. “We went a little deeper into the medical history,” he said. “We wanted our pharmacists to feel more comfortable.”
The protocol was filed with the state Department of Health and approved by an obstetrician-gynecologist, Dr. Downing said. He said pharmacists in the pilot program had day jobs for a variety of employers, including chain and community pharmacies, hospitals and insurance companies. They were writing for the pilot in their spare time and did not want to be identified.
Dr. Nouhavandi said she hoped the project could give patients more options in the face of increasing restrictions on abortion. “It’s really just about expanding access,” he said, adding, “We need more providers and we need it to be more accessible and cheaper.”
