Pharmacists have begun prescribing abortion pills, not simply dispensing the medication — a development intended to broaden abortion access by taking advantage of rules that give them prescribing ability in most states.
The new effort is small so far — a pilot program in Washington State — but the idea is expected to be tried in other states where abortion remains legal.
“I think it is going to expand, and it is expanding,” said Michael Hogue, chief executive of the American Pharmacists Association, a national professional organization, which is not involved in the new program and does not take a position on abortion.
Nearly 40 states now allow pharmacists to prescribe at least some medications and they are trained to do so, he said. He added that in his organization’s view, it makes sense to have “someone so accessible in a local community be able to provide safe access to therapies that might sometimes be difficult to get.”
Supporters of abortion rights consider pharmacist prescribing part of an effort to open as many avenues as possible at a time when abortion pills are facing growing attacks from abortion opponents.
Pharmacists are regulated by states, so their ability to prescribe specific medications cannot be blocked by the federal government. But if the incoming Trump administration wanted to stop pharmacists from prescribing abortion pills, it could try to reinstate Food and Drug Administration regulations that required that only doctors prescribe mifepristone, the first pill in the two-drug medication abortion regimen.
Anti-abortion activists said they opposed the prescribing of abortion pills by pharmacists, calling the practice reckless and unsafe.
“Pharmacists, who do not receive clinical training, should not be distributing these dangerous drugs,” Dr. Ingrid Skop, vice president and director of medical affairs at the Charlotte Lozier Institute, an anti-abortion organization, said in a statement. “By pushing these medically unsupervised abortions, the F.D.A. and abortion advocates continue down the slippery slope of chipping away at medical standards for women seeking abortion.”
Pills are now the method used in nearly two-thirds of abortions in the United States, and many studies have shown that medication abortion is safe and that serious complications are rare.
Rules governing medication prescribing by pharmacists vary by state. Some allow prescribing for only a specific class or classes of drugs. Some require doctors to sign off on each prescription. Washington State’s is considered the most lenient, requiring only that doctors approve the overall prescribing protocol and training.
Dr. Hogue of the pharmacists’ association said that during the coronavirus pandemic, when access to doctors for nonemergency care was often limited or delayed, patients became accustomed to pharmacists’ writing prescriptions. In many states, he said, pharmacists can prescribe birth control and morning-after pills.
But a lawsuit intended to force the F.D.A. to sharply restrict mifepristone was recently revived after the Supreme Court turned away the case, saying the original plaintiffs lacked the standing to sue.
The Texas attorney general recently sued an abortion provider in New York for sending abortion pills to a patient in Texas. And abortion-rights supporters are concerned that a 151-year-old federal anti-vice law known as the Comstock Act could be invoked by the incoming Trump administration to try to prevent the mailing of abortion medication.
“Attacks on access to abortion care have created an urgent medical, public health and human rights crisis,” said Dr. Beth Rivin, who leads a Seattle-based global health nonprofit, Uplift International, and is the managing director of the new program, called the Pharmacist Abortion Access Project. “Even in Washington State, where abortion is legal, people still face barriers to abortion care, especially people who are struggling to make ends meet, live in rural areas and don’t have easy access to reproductive health care.”
On Tuesday, the Pharmacist Abortion Access Project reported that in a pilot program conducted between Oct. 31 and Nov. 26, 10 pharmacists across Washington State had prescribed abortion pills to 43 patients.
The prescribing was done via telehealth screening, with patients completing forms asking about their pregnancy and medical history. Patients had to be Washington residents and could be up to 10 weeks pregnant. They paid $40, significantly less than many services. Prescriptions were transmitted to Honeybee Health, a California-based mail-order pharmacy that works with many telemedicine abortion services, which shipped the pills to patients.
Don Downing, a co-director of the project and a professor emeritus of pharmacy at the University of Washington, said that in addition to providing a hotline for questions or concerns, pharmacists had contacted patients to see how they were doing, asking questions like: “Have you had excessive bleeding or no bleeding? Do you have fever, pain, whatever?”
He said that during the follow-up, patients had asked typical questions, like whether they were experiencing appropriate levels of bleeding from passing the pregnancy tissue. “We did not have any seriously negative outcomes at all, but we had a full network of other resources available in case that happened, so that we could take care of them,” he said.
Dr. Rivin said the project intends for full-fledged pharmacist prescribing to start sometime this year and to eventually allow in-person prescribing in Washington pharmacies, meaning patients could go to a pharmacy and receive a prescription and pills in one visit.
That would work in tandem with a recent F.D.A. policy allowing pharmacies to become certified to dispense mifepristone, which falls under a special regulatory regimen that previously required that it be dispensed primarily by clinics or other abortion services. The second drug in the abortion regimen, misoprostol, is less restricted and has long been widely available.
Last year, Walgreens and CVS began dispensing mifepristone in some states, as did scores of smaller pharmacies in at least a dozen states.
Brian Noble, chief executive of the Family Policy Institute of Washington and an evangelical pastor, said he was not opposed to pharmacists’ prescribing medications in general or counseling women who are deciding whether to continue a pregnancy. But, he said, “I’m against anything that ends life,” which he believes begins at conception.
“I believe in the aborted babies’ rights,” Mr. Noble said, adding, “I see that women have the great privilege to be entrusted to carry life in their bodies.”
Jessica Nouhavandi, a pharmacist and president of Honeybee Health, who is a co-director of the new project, said she had come up with the idea of pharmacists prescribing abortion pills several years ago because “we need more providers, and we need it to be more accessible and more inexpensive.”
Dr. Nouhavandi said the project’s patient consultation form asked for slightly more information than abortion services where doctors or nurse practitioners issue prescriptions. “We went a little deeper about medical history,” she said. “We wanted our pharmacists to feel more comfortable.”
The protocol was filed with the state’s Health Department and was approved by an obstetrician-gynecologist, Dr. Downing said. He said the pharmacists in the pilot project had day jobs working for various employers, including chain and community pharmacies, hospitals and insurance companies. They prescribed for the pilot in their spare time and did not want to be identified.
Dr. Downing, who has pioneered other prescribing programs that have spread nationally, said other states might need to make changes to their regulations or laws to allow pharmacists to prescribe abortion pills. Still, he said, “if, in fact, abortion is legal in a state, I don’t think there are too many impossible barriers.”
