Pharmacists Should Not Be Allowed to Prescribe Abortion Pills

At the end of 2024, Washington State implemented a month-long pilot program that allowed some pharmacists to prescribe mifepristone to patients via telehealth screening. Mifepristone is one component of the two-part drug regimen needed to end pregnancies up to ten weeks of gestation. (The second part, misoprostol, is widely available.) The program, Pharmacist Abortion Access Project, is spearheaded by Uplift International and aims to serve as a model for other interested states where abortion is legal. The medication was provided by the online pharmacy Honeybee Health. According to the New York Times, the “project intends for full-fledged pharmacist prescribing to start sometime this year and to eventually allow in-person prescribing in Washington pharmacies, meaning patients could go to a pharmacy and receive a prescription and pills in one visit.”

The problem is that mifepristone is not equivalent to a flu vaccine or even birth control, both of which can be prescribed by pharmacists in some states. An induced abortion is a medically generated event that results in fetal death. One in five women who take abortion pills experience complications, such as hemorrhaging or infection. Incomplete abortions may require surgery. A pharmacist is unable to provide ultrasound imaging to confirm intrauterine pregnancies, accurately assess a pregnancy’s gestational age, evaluate whether a mother has Rh incompatibility, or assess the risk of sepsis if an infection develops over the course of an abortion. Programs like these threaten pregnant women’s lives. 

This program disrupts the physician-patient relationship by design, a relationship that is integral to the health and well-being of a pregnant woman and her baby. My own physician recently treated a woman for a suspected ectopic pregnancy after she received mail-order abortion pills online and failed to experience any bleeding. He monitored this patient to ensure that her HCG (a hormone produced during pregnancy) levels dropped appropriately. (Hormones continuing to rise would indicate a pregnancy developing outside of the uterus, which can be fatal if not treated in a timely manner.) This patient required expert follow-up care in order to ensure her safety. A pharmacist is unable to triage an obstetric emergency like an ectopic pregnancy, which requires labs, careful monitoring, medications, and, in some cases, surgery. 

Mifeprex, the name brand version of mifepristone, was approved by the FDA in 2000. The pharmaceutical has been the center of a legal battle that culminated in a widely anticipated Supreme Court hearing in May 2023. The physicians at the center of FDA v. Alliance for Hippocratic Medicine alleged that the systemic relaxation of safety protocols surrounding the use and prescription of mifepristone has resulted in an unfair burden on physicians who do not prescribe the drug but nonetheless treat patients suffering complications from medical abortions. However, the plaintiffs were unable to establish sufficient standing, and the case was dismissed.

Mifepristone is regulated by a set of safety protocols called REMS (Risk Evaluation and Mitigation Strategies). These protocols have been relaxed several times, most notably in 2021 when the FDA, in response to Covid, eliminated the requirement for the drug to be obtained in person. Instead, patients could be prescribed the drug via telehealth screening and receive it in the mail. The prescriber pool was widened to include non-physician providers. These safety protocols were permanently adopted in January 2023 under the Biden administration and remain in place today.  

The current REMS protocols for prescribing mifepristone stipulate that certified prescribers must have the “ability to assess the duration of pregnancy accurately” and “diagnose ectopic pregnancies.” Prescribers must also be able to “provide surgical intervention” if an abortion is incomplete and products of conception remain, which pose an infection risk. If unable to personally provide that care, prescribers must have plans to “provide such care through others” and “assure patient access to medical facilities.” 

Yet the REMS protocols for mifepristone use do not specify how to accurately assess the duration of a pregnancy or diagnose ectopic pregnancies. Contrary to common belief, there is no requirement, for any prescriber, to conduct a physical examination or an ultrasound procedure in order to evaluate a pregnant woman for these risk factors. Previous REMS protocols had stipulated that mifepristone was not to be dispensed outside of medical facilities, hospitals, or clinics. Specifically, mifepristone could not be “dispensed through retail pharmacies.” 

A Washington State-based pharmacist familiar with the program told me that pharmacists can prescribe medications that are listed within collaborative practice agreements, where pharmacists or groups of pharmacists prescribe under the oversight of a physician licensed in the state. These agreements vary state by state, and drug by drug. She argued that because the pharmacists are required to ask about medical history, they have the same ability to assess patients for ectopic pregnancy risk, Rh factor risk, and gestational age of the pregnancy as a physician. 

But a verbal medical history provided by a patient, without medical records, lab work, or imaging, isn’t sufficient to ensure patient safety. 

The pharmacist assured me that the pharmacy group that prescribed the abortion pill regimen in Washington State had a list of healthcare providers that they could refer patients to, when indicated, and provided patients with two follow-up phone calls during the abortion process. Lastly, she impressed to me that the goal of the program is to expand access to early medical abortions, so that later-term abortions can be avoided. 

But, as Charlotte Lozier Institute medical director and OBGYN Ingrid Skop reminded me, “pharmacists are unable to perform a physical exam, order pre-abortion testing, or intervene surgically when complications occur.” “Women are injured by these abortions,” Dr. Skop explained. “These women, who I see and care for in the ER on a regular basis, are being regarded as no more than collateral damage in an effort to push abortion at all costs.”

If the abortion lobby continues to degrade prenatal standards of care nationwide, millions of women will pay the price. The Trump administration must restrict access to the abortion pill regimen by reinstating safety regulations surrounding mifepristone use to ensure that pregnant women nationwide receive high standards of prenatal care. 

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