Retail pharmacies can now sell the “abortion pill” by prescription — but likely not in Florida.
Retail pharmacies can now dispense mifepristone — the drug widely known as “the abortion pill” — following the U.S. Food and Drug Administration’s approval earlier this month. The large pharmacy chains Walgreens and CVS plan to carry mifepristone in states where abortion is legal. But in Florida, where abortion is legal until 15 weeks, people aren’t likely to be able to pick up mifepristone at their local drugstore any time soon.
That’s because state law dictates who can legally perform an abortion and where it can be performed.
On Jan. 11, the state Agency for Health Care Administration issued an “All Provider Alert” reminding providers of two state laws governing abortion, News4Jax reported. One law cited says that “[n]o termination of pregnancy shall be performed at any time except by a [licensed] physician.” The other statute says abortions can only be performed “in a validly licensed hospital or abortion clinic or in a physician’s office” unless it’s an emergency situation.
Florida is one of 17 states that require physicians to provide the medication abortion, according to the Kaiser Family Foundation.
Walgreens has Health Care Clinics and CVS has Minute Clinics. But the clinics are staffed by certified nurse practitioners or physician assistants — not doctors.
“We will not see a change because our state codes require anyone who wants to offer abortion care to a patient to see the patient not once, but twice, and those two visits have to be separated by at least 24 hours,” Amy Weintraub, reproductive rights program director for Progress Florida, said in a phone interview. “The state requires forced ultrasounds and [physicians] also have to be the ones who provide the first pill.”
The FDA initially approved mifepristone, brand name Mifeprex made by Danco Laboratories, in 2000 to terminate pregnancy up to seven weeks. In 2016, that was extended to 10 weeks. In 2019, the federal agency approved generic mifepristone made by GenBioPro.
Medication abortion is a two-pill process that involves first taking mifepristone, which blocks progesterone, a hormone essential for pregnancy to continue. That’s followed 24 to 48 hours later by the second medication, misoprostol, which causes cramping to empty the uterus, similar to an early miscarriage. (Misoprostol has always been less restricted because the medication is used to induce labor and to treat other conditions like stomach ulcers.) Together, the two drugs safely terminate a pregnancy within 24 to 48 hours after use. Medication abortion has a 0.4 percent risk for major complications and a mortality rate of less than 0.001 percent. Comparatively, the U.S. has a maternal mortality rate of 23.8 per 100,000 live births — more than three times higher than other high-income countries, and maternal mortality is three times higher among Black women than white, according to the Commonwealth Fund.
Medication abortion currently accounts for 54 percent of nonhospital abortions in the U.S, according to the Guttmacher Institute. While Medicaid and most insurance typically do not cover mifepristone, it is available on GoodRx with a copay of about $78. Within the U.S., mifepristone prescriptions can only be written by physicians who are certified by either Danco Laboratories or GenBioPro, indicating that they understand how the medication works. Patients must also sign a Patient Agreement Form, and the pharmacies filling the prescriptions must also be certified to fill the prescriptions. Florida does not permit physicians to prescribe abortion pills via telemedicine or write prescriptions to be filled by mail order.
“If an OB-GYN in private practice wanted to provide abortion pills, they would have to have them in stock in their office,” Weintraub said in an email. “Generally, only abortion clinics or hospitals would have abortion pills in stock.”
In April 2021, in response to the pandemic, the FDA relaxed its requirements for in-office visits to receive mifepristone after a review of adverse event reports showed no increase in safety concerns in 2020. The FDA permanently repealed the office-visit requirement in December 2021.
The agency’s Jan. 3 directive extends the ability of pharmacies to dispense the medications directly to patients. The FDA noted this move helps “reduce the burden on the health care delivery system and to ensure the benefits of the product outweigh the risks.”
VoxPopuli asked pharmacists at several West Orange County Walgreens and CVS stores if or when they expected to offer mifepristone. They said they were unsure if their locations would even provide the abortion pill. Independent pharmacies, like Taylor’s Pharmacy in Winter Park, said they will not carry it. Asked if the abortion pill will be available at Winter Garden Pharmacy, a pharmacist curtly said, “We don’t have that” and hung up.
Until Florida pharmacies are permitted to stock the pill, mifepristone can be found at Planned Parenthood and the Orlando Women’s Center. In addition, Plan C provides information about online pharmacies that ship to Florida.
So does AidAccess. The Austrian-based organization has European physicians who can write prescriptions for mifepristone after online consultations and can ship abortion pills to Florida from a pharmacy in India within three weeks for about $105. Accurate pregnancy dating and an uploaded ultrasound image are required to receive pills from AidAccess because the medication is only approved up to 10 weeks, and medication abortion cannot be used if the pregnancy is in the fallopian tube, which is known as an ectopic pregnancy. That requires emergency surgery to remove.
The FDA sent AidAccess a warning letter in 2019, stating the organization had caused “the introduction into interstate commerce of misbranded and unapproved new drugs in violation of sections 301(a), 301(d), and 505(a) of the Federal Food, Drug, and Cosmetic Act (FD&C Act) (21 U.S.C. §§ 331(a), 331(d), and 355(a)].” AidAccess’s website states it has provided abortion medications to more than 30,000 Americans in all 50 states.
The site Women Help Women also provides abortion pill information, including how to keep pregnancy-dating and abortion search information private and secure.
Abortion Pill v. Emergency Contraception. What’s the difference?
Emergency contraception is not the abortion pill. Known as the “morning after pill” or “day after pill,” and available as Plan B One-Step, Julie, and Take Action, over the counter without a prescription, emergency contraception contains levonorgestrel, which prevents or delays the ovary from releasing an egg. It’s 95 percent effective at preventing pregnancy when taken within 24 hours of unprotected sex. It’s 87 percent effective up to 72 hours. Prescription emergency contraception called ella contains ulipristal acetate and is effective for up to five days after unprotected sex.
For years, researchers understood that emergency contraception mainly worked by preventing ovulation. But there was also some thought that it might prevent a fertilized egg from implanting in the uterus. That led to anti-abortion advocates to claim emergency contraception worked as an abortifacient, which is any substance that induces abortion. But the research shows that emergency contraception works only to prevent ovulation. Amid claims that the FDA included the misinformation to get over-the-counter approval for Plan B One Step, the agency revised the package insert in December 2022.
