money Dozens of Providers in Red States Move to Prescribe Abortion Pills
In the wake of the Supreme Court decision to overturn Roe v. Wade, which has triggered abortion bans in more than 13 states, the abortion-rights advocacy group Plan C says it has seen a surge in the number of primary care providers asking how they can begin offering medication abortion to patients in their respective states. Some may choose to do so over state lines.
“There’s been an overwhelming amount of interest,” said Christie Pitney, a certified nurse midwife who coordinates Plan C’s efforts to increase the number of clinicians offering telehealth abortions by guiding them through the various steps required to do so. According to Pitney, who herself began providing telehealth abortions in 2021 through her private practice Forward Midwifery, Plan C has gotten 20 requests for help since May, when a leaked draft of the Supreme Court opinion was published by Politico. Since Friday, more than 100 more clinicians have come forward, she said, including dozens from states that have already banned abortion or are poised to do so over the next several weeks.
A medication abortion is performed using a two-drug regimen consisting of mifepristone and misoprostol, access to which is tightly restricted by the Food and Drug Administration. When it was approved in 2000, mifepristone was regulated under what’s called a “risk evaluation and mitigation strategy,” or R.E.M.S., which is typically reserved for drugs associated with a serious risk of adverse events. Though mifepristone is safer than Tylenol, the FDA requires it be dispensed only in clinics, medical offices and hospitals; only to patients who have signed an FDA-approved patient agreement; and only by, or under the supervision of, a provider certified to prescribe the drug.
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Abortion rights advocates have long argued that there is no medical justification for applying the R.E.M.S. to mifepristone, the safety of which has been well established, and that the decision to do so was politically motivated. In April of last year, the FDA suspended enforcement of the requirement that mifepristone be dispensed in a medical clinic for the duration of the COVID-19 pandemic. In December, FDA lifted the in-person requirement entirely.
But it maintained the provision that providers must register with either Danco Laboratories or GenBioPro, the only FDA-approved manufacturers of mifepristone, and that requirement remains in place today.
Doctors, midwives, advance practice nurses and physician assistants are all able to order and prescribe mifepristone. When a request comes in, Pitney connects the provider with one of several telemedicine start-ups—groups like Hey Jane, Choix, Just the Pill, or Abortion on Demand—that mail abortion drugs to patients after a consultation via telemedicine. For those interested in setting up their own telemedicine practice, Pitney provides information about registering with GenBioPro, and points providers to an online “toolkit” published by a physician-led team at the University of Washington Department of Family Medicine. A step-by-step guide to registering and prescribing mifepristone and misoprostol, the document gets regularly updated with new clinic protocols and regulations.
“The separation of abortion from general primary care has made it an easy target for those who wish to ban abortions,” said Dr. Emily Godfrey, an associate professor in the department of family medicine at UW, who leads the Access, Delivered initiative, a partnership between Plan C and UW aimed at creating new channels of abortion access in the U.S.
“As primary care providers and other clinicians step up to protect the health and wellness of patients, the U.S. public may come to realize that first trimester abortion care belongs in primary care along with other reproductive health services and not just in stand-alone, independent abortion clinics.”
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