“As a pharmacy, we believe everyone has the right to choose whether or not an abortion is right for them,” said Dr. Jessica Nouhavandi, co-founder, co-CEO and lead pharmacist of Honeybee Health.
For years, pharmacies outside the U.S. have been shipping abortion pills to American women wanting to end their pregnancies. But now, for the first time, a U.S.-based pharmacy—Honeybee Health—is distributing abortion pills directly to patients within the country by mail, now legal because of a recent federal court ruling.
“This is a momentous achievement for Americans, particularly for women of color and others who historically faced barriers to reproductive healthcare that are made even worse by COVID-19,” said Dr. Jessica Nouhavandi, co-founder, co-CEO and lead pharmacist of Honeybee Health.
Honeybee is a California-based, accredited, online pharmacy that sells generic medications at steep discounts, without the need for insurance.
“As a pharmacy, we believe everyone has the right to choose whether or not an abortion is right for them. We’re deeply honored to be part of the pioneering group of medical professionals who are bringing increased access to safe abortion pills across the country.”
The pandemic has led to a rapid, revolutionary change in treatment protocols for medication abortion. A new no-test protocol has made ultrasounds and blood tests unnecessary for many women seeking medication abortion. This protocol allows doctors to provide the service via telemedicine so that patients do not have to make an in-person visit to a health care clinic and risk exposure to COVID-19.
But a long-standing, politically motivated FDA restriction on the abortion pill mifepristone has meant that patients still had to go to their doctor’s office to pick up the medication in person. Despite the fact that the abortion pill is an extremely safe way to end a pregnancy, the FDA prohibited pharmacies from distributing mifepristone to patients, instead requiring physicians to register with the drug maker, and then stock and distribute the pills to their patients directly.
So medical providers and reproductive justice activists challenged the restriction in court and won.
In July, U.S. District Court Judge Theodore Chuang ruled that the FDA requirement of in-person visits to obtain the abortion pill during the COVID-19 pandemic imposes a “substantial obstacle” to abortion health care that is likely unconstitutional. He ruled that patients may receive the abortion pill mifepristone through the mail.
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While some physicians are mailing the pill directly to their patients, the option to use Honeybee Health to distribute the drug makes it easier for health care providers to offer medication abortion services because they do not have to stock the drugs themselves.
Paired with the no-test protocol, which opens up the possibility that general practice doctors who do not own expensive ultrasound machines can now provide medication abortion services, access is likely to increase, says Elisa Wells, co-founder and co-CEO of Plan C, which advocates for increased access to medication abortion.
“The exciting thing is that we’re moving towards this 21st century model of abortion care where abortion pills can be obtained through a pharmacy like almost every other medication that people get from a doctor and it can be done without an in-person visit,” Wells told Ms. “This type of access is inevitable. It is the future of abortion here in the United States.”
Plan C and the University of Washington Department of Family Medicine have developed a Provider Toolkit for primary care physicians with step-by-step instructions on how to offer medication abortion services without a clinic visit.
Patients who wish to terminate an early pregnancy must consult with a certified clinician to ensure they qualify for treatment. Many clinicians offer this consultation entirely through telemedicine, either synchronously or asynchronously.
From there, the prescriber can send the prescription directly to Honeybee Health. A trained pharmacist will then process and ship the medication to the patient and provide further guidance during the process if the patient desires it.
Telemedicine health care combined with pill delivery by mail order pharmacies is the pathway for increasing access to abortion in the U.S., says Wells.
“That would enable a very private, confidential, convenient solution to people that would avoid the picketers and protesters in front of the clinic and avoid the need for childcare, taking time off from work, and traveling long distances. We at Plan C have had this as a vision for years that the pills could be provided in this way and that in fact in many places in the world they are provided in this way.”
“Convenience confidentiality and control. That’s what this model brings to abortion care,” Wells told Ms.
Honeybee is now offering their services to patients who receive prescriptions from certified clinicians in Washington, New York and New Jersey, and will be expanding to more states soon.
Honeybee offers low prices because they buy medications directly from FDA-approved, U.S. wholesale distributors and cut out the middlemen—like insurance companies and pharmacy benefit managers. As a result, they can sell generic medications for up to 80 percent less than what traditional pharmacies charge—often less than copays or coinsurance.
While Judge Chuang’s ruling only extends to patients seeking care during the COVID-19 health crisis plus 30 days, and the Trump administration is appealing the injunction to the U.S. Supreme Court, this window of opportunity is proving the viability of a new model of abortion health care.
“It’s critical that women be able to access abortion pills via mail during COVID-19, but we also believe that receiving the medication through mail is the way forward,” continued Dr. Nouhavandi. “Abortion pills are extremely safe, effective and widely used in other countries without the kind of political scrutiny we see in America. We hope that by shipping abortion pills now during COVID-19, we increase access for the years to come.”