The demonstrations aim to bring the same chants, signs and tense confrontations to drug store parking lots that groups have long used to try to deter visits to abortion clinics.
Jose Luis Magana/AP Photo
“The safety of pharmacy teams is really important, and that’s something they’re going to take into consideration when they decide whether or not to become certified,” said Ilisa Bernstein, the interim CEO for the American Pharmacists Association. “In some communities, that may be more of a concern than others, but it is a concern.”
Rachel Rebouch?, a reproductive health law expert and dean of Temple University’s Beasley School of Law, said she doesn’t think the certification process FDA has outlined for pharmacies is “super onerous,” but the tracking and records requirements may deter pharmacies that aren’t accustomed to handling these sorts of restrictions from seeking certification, especially small independent operations.
“It’s kind of focused on diversions — how you would police a controlled substance to make sure it’s not being overprescribed, that people aren’t stockpiling, for instance, medication abortion,” Rebouch? said.
Everyone involved in the manufacturing, distribution and regulation of mifepristone is trying to “avoid a single database” of records of prescribers and patients, said Ronna Hauser, the senior vice president of policy and pharmacy affairs for the National Community Pharmacists Association.
The prospect that some pharmacies might be dissuaded from dispensing the pills even in states where they remain legal has some medical groups and progressive advocates arguing the FDA should have dropped all of its restrictions.
“The FDA could have taken the opportunity to greatly simplify the process,” said Ushma Upadhyay, a professor at the University of California at San Francisco’s school of medicine and researcher with the group Advancing New Standards in Reproductive Health. “Medication abortion is extremely safe. Many studies have found severe complication rates of less than half of one percent. And we know pharmacies dispense other drugs with much greater risks without all these restrictions and certification requirements.”
Cost could prove another barrier to patients accessing the pills.
The average retail price of one mifepristone tablet — the amount needed to begin a medication abortion — is about $75, according to prescription drug price tracker GoodRx.
The biggest reason the pills won’t be available at all pharmacies, however, will likely be the growing number of state laws dictating how patients can obtain them or banning them outright.
Pharmacies in 18 states are barred from dispensing the drugs either because abortion is illegal in most circumstances or because patients can only get the pills directly from a physician. More GOP-controlled states are expected to enact pill-specific restrictions this year — including states where abortion is already banned.
“They’re trying to deter people from going online and getting pills and, in their minds, close gaps in their current law,” explained Elizabeth Nash, who tracks state policy for the pro-abortion rights think tank Guttmacher Institute. The new FDA policy around pharmacy dispensing of the pills, she added, “put a spotlight on medication abortion right as these state legislatures were coming back into session.”
Some of these laws under consideration, in Texas and other states, are focused on expanding federal laws that allow health care providers, including pharmacists, to opt out of providing services to which they have a moral or religious objection.
Rep. Buddy Carter (R-Ga.) plans to reintroduce a federal version on Wednesday that bars employers or the government from penalizing any health worker who refuses to fill a prescription for any medication that he or she “in good faith believes may be used to cause an abortion.”
Though it’s not expected to pass the Democratic-controlled Senate, medical groups have raised concerns that such a policy could exacerbate the already acute problem of patients being denied drugs prescribed for other purposes — from lupus to arthritis to miscarriage management — because they also can be used to end a pregnancy.
Even if they can’t enact new laws or block the new pharmacy distribution policy in court, anti-abortion forces say they will continue working to chip away at its impact, employing the “death by 1,000 cuts” strategy they relied on for decades that eventually brought about the elimination of abortion access in a quarter of the country.
“The idea that we’re going to stand by while there’s a reckless distribution of abortion pills is very short-sighted,” Hamrick said. “We have a much savvier operation now than when Roe became Roe.”