With brick-and-mortar pharmacies beginning to sell abortion pills and increasing access to telemedicine abortion services in all 50 states, more people can find the abortion care they need.
Two developments are significantly increasing access to abortion pills, which have been available for over two decades but highly restricted until recently:
- On March 1, CVS and Walgreens announced they will begin dispensing abortion pills at brick-and-mortar pharmacies in some states, with a promise to expand to more states soon.
- Meanwhile, the Society of Family Planning released its #WeCount report showing that telehealth abortion—where patients consult remotely with a provider, who then mails abortion pills to them—has increased to 16 percent of all abortions.
CVS will begin dispensing the abortion pill mifepristone in all of its pharmacies in Massachusetts and Rhode Island, while Walgreens will offer abortion pills in some of its pharmacies in New York, Pennsylvania, Massachusetts, California and Illinois. Until now, only a handful of independent pharmacies dispensed mifepristone, so patients had to receive the medication directly from their healthcare providers or from mail-order pharmacies. CVS has over 9,000 stores in all 50 states while Walgreens has about 8,500 stores in all states except North Dakota.
“Today’s announcement from CVS and Walgreens shows what we have always known: Medication abortion can and should be treated as any other FDA-approved medication,” said Kirsten Moore, director of the Expanding Medication Abortion Access Project. “People should have the option to walk into their local pharmacy with a prescription and walk out with the medication in hand.”
CVS and Walgreens say they plan to eventually offer abortion pills in about half of states, but will not dispense mifepristone in states that ban abortion or restrict pharmacy distribution of the medication.
GenBioPro, which makes a generic form of mifepristone, has filed a legal challenge to state laws restricting mifepristone distribution, arguing that these laws are not enforceable because federal law allows pharmacies to dispense the medication. Healthcare providers in North Carolina are also currently challenging state-level restrictions on abortion pills in federal court.
People should have the option to walk into their local pharmacy with a prescription and walk out with the medication in hand.
Kirsten Moore, director of the Expanding Medication Abortion Access Project
For years, the only way to access abortion pills was to travel to an abortion clinic and obtain the medication in person. With a dwindling number of abortion clinics, which are concentrated in urban areas, abortion access was increasingly limited, even before the Supreme Court overturned Roe v. Wade in June 2022.
But now, as a result of the efforts of activists, lawyers, medical professionals and public health experts, abortion pills are increasingly available.
Pharmacy dispensing means that more healthcare providers can prescribe abortion pills without having to stock the medications themselves, which can be burdensome, or having pills sent from mail-order pharmacies, which can cause delays. The FDA still requires healthcare providers to be certified to prescribe the medication, a restriction advocates argue is medically unnecessary and creates barriers to access.
“Now that doctors no longer have to stock the medicine themselves and dispense it, it increases the likelihood that a patient can go to their own doctor, the person with whom they already have a relationship, and say, ‘I’m pregnant—I don’t want to be,’” said Moore.
During the COVID-19 pandemic, the FDA expanded access to abortion pills by removing a longstanding and medically unnecessary requirement that only healthcare providers dispense the mifepristone, which they had to hand to their patients in person.
The FDA began allowing telehealth abortion, first in July 2020 by court order, then by FDA order in April 2021 for the duration of the pandemic, and then permanently in December 2021. As a result, healthcare providers could consult with their patients by video, phone, text or online form, and then mail abortion pills to their patients or have the medications sent by two mail-order pharmacies—Honeybee Health and American Mail Order Pharmacy.
On Jan. 3, 2023, the FDA announced a new certification process for brick-and-mortar pharmacies to become eligible to dispense mifepristone, further expanding access.
CVS is certified to dispense generic mifepristone from GenBioPro. Walgreens is certified to dispense the brand-name mifepristone, manufactured by Danco Laboratories. Walgreens has also applied for certification from GenBioPro.
Abortion opponents held protests against CVS and Walgreens when the companies announced last year that they would be dispensing mifepristone. Abortion opponents are also trying to roll back access to mifepristone with a lawsuit, FDA v. Alliance for Hippocratic Medicine, challenging the FDA’s original approval of mifepristone in 2000 as well as recent decisions to allow expanded access, including telehealth and pharmacy dispensing of the medication. The Supreme Court will hear oral arguments for that case on March 26.
“With Republicans and extremist judges continuing their coordinated assault on reproductive freedom, the decision by CVS and Walgreens to dispense mifepristone is a massive step toward ensuring folks can access the essential healthcare they need and deserve,” said Rep. Ayanna Pressley (D-Mass.). “We must continue working to expand access to mifepristone at other pharmacies and by mail in every state.”
‘Seismic Shift’ Toward Telehealth Abortion
Even when some states ban abortions, people continue to need and seek abortion care.
Dr. Alison Norris, #WeCount co-chair
On Feb. 28, the Society for Family Planning released their #WeCount report, showing that the overall number of abortions obtained through the formal healthcare system has remained steady over the last 18 months.
The number of abortions during this time period ranged from a low of 74,390 in November 2022, to a high of 92,370 in March 2023.
These numbers do not include people who obtained abortions outside of the medical system, including for free from community networks and online for as little as $42 with two-day delivery.
“#WeCount shows that even when some states ban abortions, people continue to need and seek abortion care. In fact, the national numbers that we report have not declined despite the fact that clinicians in 14 states cannot provide abortions to people who live there,” said Dr. Alison Norris, #WeCount co-chair and professor at The Ohio State University’s College of Public Health.
The #WeCount report found that telehealth was an increasingly common way for people to access abortion care in the United States.
- The percentage of telehealth abortions has increased rapidly over the last year and a half, from 3,650 in April 2022 to 13,770 in September 2023.
- Telehealth abortion now makes up 16 percent of all abortions in the formal healthcare system—described as a “seismic shift in service delivery” by Dr. Jenny O’Donnell, senior director of research and evaluation at the Society of Family Planning.
- In the October 2023 #WeCount report, telehealth was only 8 percent of all abortions in the 12 months following Dobbs.
“The process of seeking abortion care in the U.S. can feel frustrating and needlessly complex. We aim to change this by simplifying care and empowering people throughout the process,” said Melissa Grant, chief operations officer of carafem, which provides online and in-office abortion services.
“Through telemedicine, we have successfully reduced costs and improved healthcare accessibility, particularly in rural areas, offering round-the-clock access to care.”
Before July 2023, the Society for Family Planning only counted telehealth abortions provided by fully virtual clinics to patients in states without abortion bans.
Beginning in July 2023, they began including telehealth abortions provided by brick-and-mortar clinics as well as telehealth abortion services provided to patients located in states restricting abortion.
As of September 2023, five states had abortion provider shield laws that protected clinicians in those states providing telehealth abortion services to patients located in states banning abortion.
At the time, two organizations provided telehealth abortion services to people in states banning abortion:
- Aid Access, which provided services to people in all states, and
- Abuzz, which provided services to people in about half of ban states.
Later, a third provider, Cambridge Reproductive Health Consultants, also began providing telehealth abortion services to people in all 50 states.
Today, these three providers provide telehealth abortion services to approximately 12,000 people living in states that ban abortion each month.
Whereas before COVID-19, patients had to travel hundreds of miles to brick-and-mortar clinics, walk a gauntlet of protesters and pay on average $560 for medication abortion, now they can obtain these pills by telehealth from the privacy of their own homes and have them mailed directly to them in all 50 states with prompt delivery for a sliding scale fee of up to $150.
The sliding scale fee structure for telehealth abortion for people living in states with abortion bans is supported by two new abortion funds: the Abortion Pill Sustainability Fund and the Abortion Coalition for Telemedicine Fund.
“In the post-Dobbs era, healthcare providers in some states are forging innovative new solutions to provide abortion access,” said Dr. Ushma Upadhyay, #WeCount co-chair and professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health (ANSIRH). “Telehealth abortion is now a central pillar in the abortion care landscape—and the continued availability of abortion care demands that we must ensure equitable access to this essential health care service.”
There’s been an exponential increase in demand for telehealth abortion in the last five months. … They can meet their needs safely and much more conveniently with telemedicine.
Francine Coeytaux, co-founder of Plan C
Increasing access to telehealth abortion has been especially important for:
- people living in rural areas who don’t have transportation to abortion clinics;
- people living in the 14 states banning abortion entirely (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia);
- people living in the two states that ban abortion at six weeks (Georgia and South Carolina); and
- those living in the five states that allow some abortions but prohibit telehealth abortion (Arizona, Nebraska, North Carolina, South Carolina and Wisconsin).
On Jan. 1, 2024, California became the sixth state to pass a telehealth abortion provider shield law, and more clinicians are now offering these services.
“There’s been an exponential increase in demand for telehealth abortion in the last five months,” said public health expert Francine Coeytaux, co-founder of Plan C, which maintains on their website an updated list of options for obtaining abortion pills in each state. “The magnitude of the switch is really being driven by the user experience … the realization that they can meet their needs safely and much more conveniently with telemedicine.”
But can everyone find these services? According to the #WeCount report, in the 14 states banning abortion, there are 120,000 fewer people obtaining abortion healthcare from providers in their states since July 2022. Many of these people have been able to travel out of state for care or obtain care via telehealth from providers located outside of their states. Others have obtained abortion pills from outside of the medical system through community networks and websites selling pills, but likely, many cannot find these services.
“We can’t lose sight of the incredible unmet need and the disastrous impact of abortion bans on people who already have the least access to care,” said Norris. “We don’t know from our #WeCount data what happens to the people who can’t get out of their states and don’t get pills by mail. How many of them are forced to stay pregnant?”
With expanding access to abortion pills through brick-and-mortar pharmacies such as CVS and Walgreens, as well as increasing access to telemedicine abortion services in all 50 states, more and more people will find the abortion care they need.
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