EXECUTIVE SUMMARY

The easing of the risk evaluation and mitigation strategy (REMS) restriction on mifepristone will make it easier for women to obtain the drug and could allow for pharmacy dispensing of the drug.

  • Pharmacists should have a seat at the table in the conversation on dispensing prescription medication.
  • Allowing pharmacies to dispense the drug might make mifepristone more accessible to adolescents as well as to women in rural areas without physical access to a provider.
  • Pharmacists are medication-use experts, and putting mifepristone in a “widely dispersed network of pharmacies” will allow for more equitable access.

Under the Biden administration, the FDA made it easier for women to obtain mifepristone for medication abortions in the United States.

The FDA’s recent decision that it would not enforce the risk evaluation and mitigation strategy (REMS) until the pandemic ends might pave the way for a permanent relaxation of the restriction.

“In July 2020, a federal court ruled that mifepristone could be mailed out [due to the COVID-19 pandemic],” says Rebecca H. Stone, PharmD, BCPS, BCACP, FCCP, clinical associate professor at the University of Georgia. “Under the Trump administration, in January 2021, the Supreme Court ruled that mifepristone could not be mailed out. Then, the FDA addressed this issue again in April under the Biden administration and stated they would not enforce the in-person dispensing requirement of REMS until the pandemic ended. It can be mailed from a doctor’s office or from a mail-order pharmacy, and that’s a big change from what was previously allowed.”

From a professional perspective, pharmacists are experts in medication, Stone says. “If we’re talking about prescription medication, I believe pharmacists should have a seat at the table to disseminate all types of prescription medication,” she adds.

Women who continue with a pregnancy experience many more baseline health risks than they do from taking mifepristone. “It’s a relatively safe medication. Pharmacies could help make dispensing mifepristone more accessible to women in rural areas, who may not have physical access to a prescriber,” Stone says. “Pharmacy-dispensed mifepristone may also make medication abortion more accessible to adolescents.”

The ability to mail mifepristone makes telehealth care more affordable, Stone says. “In a telehealth care model, a woman could talk with her provider via videoconference, get any required ultrasound or bloodwork completed at her local health center, and then receive the medication in the mail from her provider or mail-order pharmacy,” she explains. “However, it’s important to realize that there are still complications with this model.”

For instance, medical and pharmacy practice is regulated at the state level. Many states enacted specific telehealth abortion bans or further regulations on providing telehealth care across state lines.

“For a mail-order pharmacy, the patient would talk via phone to a pharmacist at the pharmacy, but some people may prefer to ask a pharmacist questions in person,” Stone notes.

Even if mifepristone could be dispensed at pharmacies, that is not to say that every pharmacist will stock the drug and dispense it. Some pharmacists do not want to participate in providing a medication abortion.

“However, I don’t think pharmacies should be excluded from mifepristone dispensing just because not every pharmacist wants to participate,” Stone says. “That’s not a reason to keep it out of all pharmacies.”

Pharmacies already participate in abortion care by providing other medications like misoprostol, and nausea or pain medications. “Instead of getting medications from different sources, they can get everything from one source,” Stone explains. “I think pharmacists are already accustomed to completing continuing education to learn about new drugs. so we’re equipped to provide the education needed to dispense mifepristone.”

It would be acceptable for pharmacists to dispense it just like any other new medication. “Pharmacists are experts in medication use and they help provide equitable access to medications,” Stone says. “Putting medications in a widely dispersed network of pharmacies makes it more equitable for women to get the medication. Pharmacists are medication experts and should be part of the process when prescriptions are involved.”

REFERENCE

  1. Stone R H, Rafie S. Medication abortion: Advocating for mifepristone dispensing by pharmacists. Contraception 2021;104:31-32.