Pharmacists prescribing abortion pills, as opposed to only dispensing them with a doctor’s prescription, could be the next frontier in the fight over abortion policy at the state level.
A test program in Washington state, the Pharmacy Abortion Access Project, reported Tuesday that 10 participating pharmacists prescribed abortion pills to 43 patients in the state between Oct. 31 and Nov. 26 in a first-in-the-nation effort that abortion advocates hope will expand across the country.
Access to the abortion pills mifepristone and misoprostol have become the epicenter of the abortion debate since the overturning of Roe v. Wade nearly three years ago. Nearly two-thirds of all abortions in the United States use the two-medication regimen.
Abortion rights supporters see pharmacists prescribing as a critical part of the effort to meet patients where they are instead of navigating the often complex process of obtaining a physician’s prescription.
The Pharmacy Abortion Access Project has been training pharmacists in Washington state since spring 2023, following a rule change from the Food and Drug Administration that relaxed regulations on mifepristone and misoprostol to allow certified pharmacists to prescribe the medications directly to patients.
The vast majority of Americans, nearly 90%, live within five miles of a community pharmacy, and most visit their pharmacy more frequently than they see a physician. According to a 2024 Gallup poll, 55% of Americans have a high or very high trust in the integrity of pharmacists, a ranking only one percentage point lower than medical doctors.
In the Washington state pilot program, the prescribing was completed via telehealth screenings involving patients reporting the duration of their pregnancy and other medical history. The prescriptions were then dispensed and shipped to patients by Honeybee Health, a mail-order pharmacy in California that works with telemedicine abortion services.
Don Downing, professor emeritus of clinical pharmacy at the University of Washington and PAAP member, told NPR that he believes this type of program “could have a huge impact in our state.”
“This is about meeting women where they are,” Downing said.
Anti-abortion advocates have challenged the FDA’s 2021 decision to deregulate mifepristone to remove requirements for a patient to see a physician in person before obtaining a prescription, a move from the FDA that allowed for abortion pills to be sent by mail to patients.
Those who oppose abortion in general are also strongly opposed to pharmacists being able to prescribe medication abortifacients.
“Pharmacists, who do not receive clinical training, should not be distributing these dangerous drugs,” Dr. Ingrid Skop, OBGYN and director of medical affairs at the anti-abortion Charlotte Lozier Institute, told the New York Times.
Anti-abortion advocates argue that, without examination from a physician, it is difficult for women to know the exact gestational age before taking abortion pills, which are only approved for up to 10 weeks of pregnancy.
Medication abortion patients who did not receive their prescription from a physician are also more likely to seek emergency care in the event of complications or be lost to follow-up, anti-abortion advocates say.
Skop, who was a named party in the recent Supreme Court case challenging the FDA’s deregulation of mifepristone, said allowing pharmacists to prescribe the medication continues “the slippery slope of chipping away at medical standards for women seeking abortions.”
A study published by the British Medical Journal last month found that nearly half of all medication abortion patients experienced more pain during the process than they were told to expect by their healthcare providers.
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Four in 10 patients involved in that study rated their pain as severe, between eight and 10 on the pain scale.
The FDA’s warning label for mifepristone indicates that as many as 4.6% of medication abortion patients will experience significant complications, including sustained severe bleeding or life-threatening infections.